RESEARCH ARTICLE t o m

manner. One approach to improving access to1London School of Hygiene and Tropical Medicine, London, UK Full list of author information is available at the end of the articleHealth service contracting Health service provision is particularly challenging in countries affected by or emerging from armed conflict, due to interrelated constraints including destruction of health infrastructure, death and migration of health workers, insufficient domestic resources, and weak gov-ernance [1-3]. Non-state providers, particularly inter-national non-governmental organisations (INGOs), often play an important role in addressing health needs during services are not designed for long-term sustainability, potentially weakening national health systems and con-sequently undermining the state-building process [6-8]. Linkages between effective service delivery, health system strengthening, and state-building are becoming clearer [2,3,7,9,10], including the role of non-state providers in this process [4,5,11,12]. However, empirical data remains lim-ited on how the international community can best support the transition from a fragile post-conflict country, often largely dependent on international support, to a sovereign state capable of serving its citizens in an effective and sus- * Correspondence