Bwimana Aembe

Title: Networked Health Sector Governance and State-building Legitimacy in Conflict-affected Fragile States. The Variable Impact of Non-state Provision of Public Health Services in Eastern Democratic Republic of Congo

State fragility in the Democratic Republic of Congo (DRC) has impacted the state’s ability to provide public services, as well as and the population’s experiences and perceptions of the state. For public health and for social welfare more broadly, the contributions of the state are weak and contingent on the involvement of non-state service providers (NSPs). The population has become dependent on non-state actors for the provision of basic social services, and NSPs are especially important in public health, where their engagement accounts for the survival of the sector. The state and NSPs interact through networked governance, where relevant actors are involved in a network through resource interdependency, cooperation, collaboration and even competition to achieve social goals (Klijn, 2004). Networked governance processes in the DRC public health sector take place at three structural levels: national, provincial and operational. Networked governance serves as an institutionalised public model for health sector management through these three levels.

A great deal of previous work has studied the link between legitimacy and state service delivery, but there has been little investigation of the link between basic service provision by NSPs and state legitimacy in fragile states. This study explored how the networked governance of the health sector contributes to state-building processes and to state legitimacy in the DRC, also examining how the image of the state is shaped by NSP service provision. The study focused on state-building outcomes related to effective public health governance, the strengthening of system management and health service provision through state–non-state interactions. The study also explored state legitimacy and the population’s experiences and perceptions of the state, in a context where the delivery of public health services is mediated by non-state actors.

The research was guided by the following key question:

How does the networked governance of health services, involving state and non-state actors through multi-stakeholder interactions, affect state-building and legitimacy in the fragile setting of eastern Democratic Republic of Congo?

Supervisors: D.J.M Hilhorst, D.T.G. Dijkzeul, Mashanda Job

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