Based on extensive field research in the Manianga region of the Lower Congo, Health in a Fragile State is an anthropological account of public health and health care after the collapse of the Congolese state in the 1980s and 1990s. This work brings into focus John M. Janzen's earlier books on African health and healing, revealing the collaborative effort by local, national, and international agencies to create viable alternative institutions to those that represented the centralized state. This book documents and analyzes the realignment of existing institutions and the creation of new ones that shape health and healing.

Janzen explores the manner in which power and information, including science, are legitimized in the preservation and improvement of health. Institutional validity and knowledge empower citizens and health practitioners to gain the upper hand over the region's principal diseases, including malaria, tuberculosis, typhoid, and HIV/AIDS.