Measurements of pH drift were used to assess the ability of 38 red algal seaweeds to use bicarbonate and to deplete the dissolved inorganic carbon pool (DIC) from seawater medium. Subtidal algae were typically restricted to the use of DIC in the form of dissolved CO 2 , reducing the initial DIC by only 9%. Intertidal species used both dissolved CO 2 and bicarbonate and reduced initial DIC by as much as 70%. DIC reductions and pH compensation points for the intertidal species tested were strongly correlated with their vertical zonation on the rocky shoreline (analysis of variance). DIC acquisition efficiency increased with tidal height, but species from the upper edge of the intertidal demonstrated a reversal of this trend. This general pattern associated with tidal height was observed not only among intertidal red algae in general, but also among four species of the genus Porphyra (P. torta V. Krishnamurthy, P. papenfussii Krishnamurthy, P. perforata J. Agardh, P. fucicola Krishnamurthy) and among four populations of the broadly distributed species Mastocarpus papillatus (C. Agardh). The Mastocarpus observations suggest either that individuals of this species may be able to express alternate strategies for carbon acquisition or that intertidal height may select for survivorship of genotypes with different carbon acquisition strategies. Taken together, these data suggest that the carbon acquisition strategy of intertidal red algae may be an important physiological set of adaptations that is under active evolutionary selection. These physiological differences were not related to phylogeny, tested as membership in red algal families and orders.

BackgroundDefinitions of fragile states focus on state willingness and capacity to ensure security and provide essential services, including health. Conventional analyses and subsequent policies that focus on state-delivered essential services miss many developments in severely disrupted healthcare arenas. The research seeks to gain insights about the large sections of the health field left to evolve spontaneously by the absent or diminished state.MethodsThe study examined six diverse case studies: Afghanistan, Central African Republic, Democratic Republic of the Congo, Haïti, Palestine, and Somalia. A comprehensive documentary analysis was complemented by site visits in 2011–2012 and interviews with key informants.ResultsDespite differing histories, countries shared chronic disruption of health services, with limited state service provision, and low community expectations of quality of care. The space left by compromised or absent state-provided services is filled by multiple diverse actors. Health is commoditized, health services are heterogeneous and irregular, with public goods such as immunization and preventive services lagging behind curative ones. Health workers with disparate skills, and atypical health facilities proliferate. Health care absorbs large private expenditures, sustained by households, remittances, charitable and solidarity funding, and constitutes a substantial portion of the country economy. Pharmaceutical markets thrive. Trans-border healthcare provision is prominent in most studied settings, conferring regional and sometimes true globalized characteristics to these arenas.ConclusionsWe identify three distortions in the way the global development community has considered health service provision. The first distortion is the assumption that beyond the reach of state- and donor-sponsored services is a “void”, waiting to be filled. Our analysis suggests that the opposite is the case. The second distortion relates to the inadequacy of the usual binary categories structuring conventional health system analyses, when applied to these contexts. The third distortion reflects the failure of the global development community to recognise—or engage—the emergent networks of health providers. To effectively harness the service provision currently available in this crowded space, development actors need to adapt their current approaches, engage non-state providers, and support local capacity and governance, particularly grassroots social institutions with a public-good orientation.

This research assesses informal markets that dominate pharmaceutical systems in severely disrupted countries and identifies areas for further investigation. Findings are based on recent academic papers, policy and grey literature, and field studies in Somalia, Afghanistan, the Democratic Republic of Congo and Haiti. The public sector in the studied countries is characterized in part by weak Ministries of Health and low donor coordination. Informal markets, where medicines are regularly sold in market stalls and unregulated pharmacies, often accompanied by unqualified medical advice, have proliferated. Counterfeit and sub-standard medicines trade networks have also developed. To help increase medicine availability for citizens, informal markets should be integrated into existing access to medicines initiatives.

This research examines the impact on health-care provision of advanced state failure and of the violence frequently associated with it, drawing from six country case studies. In all contexts, the coverage and scope of health services change when the state fails. Human resources expand due to unplanned increased production. Injury, threat, death, displacement, migration, insufficient salaries, and degraded skills all impact on performance. Dwindling public domestic funding for health causes increasing household out-of-pocket expenditure. The supply, quality control, distribution, and utilisation of medicines are severely affected. Health information becomes incomplete and unreliable. Leadership and planning are compromised as international agencies pursue their own agendas, frequently disconnected from local dynamics. Yet beyond the state these arenas are crowded with autonomous health actors, who respond to state withdrawal and structural violence in assorted ways, from the harmful to the beneficial. Integrating these existing resources into a cohesive health system calls for a deeper understanding of this pluralism, initiative, adaptation and innovation, and a long-term reorientation of development assistance in order to engage them effectively.

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