Improving Palestinian Health and Health Care
 Achieving successful Palestinian development will involve confronting a wide range of political, economic, social, and environmental challenges. One of those challenges is improving the Palestinian health system. A RAND Corporation report focused on assessing the health system's current status in the West Bank and Gaza and described specific programs and policies to strengthen the system and improve health.
The assessment shows that the Palestinian health system starts with many strengths, including a relatively healthy population, a high societal value placed on health, many highly qualified health professionals, and a strong base of governmental and nongovernmental institutions. However, overall, the health system is poorly positioned to address the health needs of the population, particularly with respect to the rising burden of chronic illness and physical and psychosocial trauma. Moreover, even some of the historic strengths of the Palestinian health system, such as public health and maternal and child care, have weakened during the second intifada and especially since the 2006 legislative elections.
The RAND study describes a number of ways to strengthen the Palestinian health system, focusing on two in particular as priorities: improving system-wide coordination and implementation, and improving public and primary health care programs. Given the ongoing economic crisis, there is a particularly acute need for interventions to improve nutritional status, both on humanitarian grounds and because malnutrition creates lasting impediments to future economic and social development. The study concludes that successful health sector development will require considerable outside resources for the foreseeable future—between $130 million and $165 million per year in external (international) support over the next decade, three to four times the average annual level of international donations to the Palestinian health sector from 1994 to 2000.
Successful development of the Palestinian health system is worthwhile in its own right, and it may be a relatively cost-effective way to help demonstrate the tangible benefits of independence and peaceful relations with neighboring countries. Moreover, health system development is an area where Israel, other neighboring countries, and the larger international community could play a constructive role, especially in areas such as health system planning, licensing and accreditation, development of information systems, and research.
Rebuilding Health During Nation-Building Missions
 Rebuilding public health and health care delivery systems has been an important component of nation-building efforts conducted after major conflicts. However, few studies have attempted to examine a comprehensive set of cases, compare the quantitative and qualitative results, and outline best practices. A RAND Corporation study assesses seven cases of nation-building following major conflicts: Germany and Japan immediately after World War II; Somalia, Haiti, and Kosovo in the 1990s; and Afghanistan and Iraq since 2001.
Looking across the case studies, the study concludes that nation-building efforts cannot be successful unless adequate attention is paid to health. This is because health is strongly interrelated with other areas of nation-building—economic stabilization, security, basic infrastructure, governance, and education. The study also concludes that successful health reconstruction depends on two factors. First, it depends on coordination and planning, including the degree of coordination among the host government, nongovernmental organizations, international organizations, and donor states, as well as the establishment of a plan for health. Second, it depends on infrastructure and resources. This includes the existence of functioning hospitals, other infrastructure (such as water and power systems), and donor support.
Finally, the study stresses the importance of focusing on health outcomes—such as life expectancy, birth, death, infant mortality, and infectious disease rates, and malnutrition—in measuring success, as opposed to health outputs—such as number of hospitals built or the percentage of trained doctors and nurses. Since these outcome measures may not always be readily available, more-tactical and short-term measures—such as vaccination rates and percentage of births with skilled attendance—may also be appropriate to give policymakers some indication of performance. Building such assessments into current and future assistance programs, and encouraging host nations to undertake such assessments, will make foreign actors better placed to optimize assistance programs.
Forthcoming: Securing Tyrants or Fostering Reform?
The United States has historically provided assistance to a number of countries that have not shared its political ideals. This practice of providing assistance to repressive states, as well as to states seeking to transition away from repression, raises a number of questions. Has U.S. assistance improved the effectiveness of internal security agencies in countering security threats? Has U.S. assistance improved the accountability and human rights records of these agencies? What is the relationship between improving security and improving accountability and human rights? A forthcoming RAND study will help answer these questions.
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RESEARCHER PROFILE
Seth G. Jones
Seth Jones is a Political Scientist at the RAND Corporation where his current focus of research includes examining best practices in past nation-building missions and evaluating the United States' success in conducting counterterrorism and counterinsurgency operations.
Publications by Seth Jones »
Commentary by Seth Jones »
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