John M. Janzen's Health in a Fragile State: Science, Sorcery, and Spirit in the Lower Congo (Wisconsin University Press, 2019) offers a granular and insightful view of the state of healthcare services in the Manianga region of the Lower Congo (Democratic Republic of Congo), and examines the extent to which said services are able to improve the health of the communities that inhabit this region. 
The collapse of the Congolese state during the 1980s and 1990s resulted in the deterioration and virtual disappearance of state-sponsored healthcare institutions. This vacuum came to be filled by organisms such as the World Health Organization, other NGOs and health-based institutions organized under the new framework of the health zone. 
As a result, a precarious healthcare system emerged, one that combines the ingenuity and resources of the local population with those from external sources. Unfortunately, this system is only able to offer a limited and fragile solution to the health needs of the populations it seeks to serve. Janzen uses this examination to remind us that positive health outcomes are not merely a factor of adequate knowledge and resources, but also require that those in charge of creating and implementing health policies are seen as legitimate within their communities. 
To support this argument, he starts by describing the population history of the region in relation to policies of the colonial and postcolonial era, and the ways in which specific diseases affected the lives peoples in the region. He then explores the different kind of institutions that support the social reproduction of health and the ways in which people in this region explain what it means to be healthy. Finally, he looks at theories of legitimation, both in Western thought and in the Kongo culture, and argues that legitimacy is a key element in the creation of a robust and effective healthcare system.
Esperanza Brizuela-Garcia is an associate professor of history at Montclair State University.
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