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Politiques publiques de santé dans les pays en sortie de crise et influence de la communauté internationale: la reconstruction du système de santé primaire dans l’Afghanistan post-conflit

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Abstract

Rebuilding health systems in post-conflict countries has the financial and technical support of key actors in international development, such as the World Bank or the World Health Organization. This support helps to influence the process of formulating and implementing public health policies. In Afghanistan, two factors contributed to increase the influence of major stakeholders: first, the institutional legacy of the war years, and second, the positioning of actors on the national and international scene. The absence of modern institutions, the ‘institutional vacuum’, that characterizes the country in 2001, the predominance of the World Bank on the international stage and the lack of any real counterbalance on a national level have contributed to the development of a primary health-care system based on contracting out services.

Abstract

La reconstruction des systèmes de santé dans les pays en sortie de crise bénéficie du soutien financier et technique des principaux acteurs internationaux du développement, tels que la Banque Mondiale ou l’Organisation Mondiale de la Santé. Ce soutien contribue à influencer le processus d’élaboration des politiques publiques de santé. En Afghanistan, le degré de cette influence a été le produit de deux facteurs: d’une part, l’héritage institutionnel des années de guerre, et d’autre part, le positionnement des acteurs sur la scène nationale et internationale. L’absence d’institutions modernes, le « vide institutionnel », qui caractérise le pays en 2001, la prédominance de la Banque Mondiale sur la scène internationale, et l’insuffisance de contrepoids ont ainsi contribué à la mise en place d’un système de santé primaire basé sur la contractualisation des services.

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Acknowledgements

L'auteure est candidate au Ph.D. Santé publique de l'Université de Montréal et est financée par le Programme stratégique de formation en recherche en santé mondiale, un partenariat des Instituts de recherche en santé du Canada et du Réseau de recherche en santé des populations du Québec. L'auteure remercie Nicole Bernier et Valéry Ridde de l'Université de Montréal, ainsi que les réviseurs anonymes, pour leurs précieux commentaires.

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  1. Centre de recherche du Centre hospitalier de l’Université de Montréal (CR-CHUM), Unité de santé internationale – Edifice St Urbain, 3875, rue St Urbain, 5e étage, Montréal, H2W 1V1, (Québec), Canada

    Emilie Robert

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Robert, E. Politiques publiques de santé dans les pays en sortie de crise et influence de la communauté internationale: la reconstruction du système de santé primaire dans l’Afghanistan post-conflit. Eur J Dev Res 24, 169–185 (2012). https://doi.org/10.1057/ejdr.2011.27

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