Health Systems Strengthening

What is Health Systems Strengthening?

Well-functioning health systems deliver the quality health care people need, when they need it, where they need it, and at prices they can afford. Strengthening health systems, however, is challenging given their complexity.

USAID captured this challenge in its definition of health systems strengthening: “A process that concentrates on ensuring that people and institutions, both public and private, undertake core functions of the health system (governance, financing, service delivery, health workforce, information, and medicines/vaccines/other technologies) in a mutually enhancing way, to improve health outcomes, protect citizens from catastrophic financial loss and impoverishment due to illness, and ensure consumer satisfaction, in an equitable, efficient and sustainable manner.”

As this definition implies, health systems encompass many subsystems, such as human resources, information systems, health finance, and health governance, all of which can be weakened by different types of constraints. For instance, health care may cost too much, causing people to delay seeking care or forgo it altogether. A country’s health budget may not cover all its population’s health needs, especially services for tuberculosis, HIV/AIDS, malaria, maternal and child health, reproductive health, and other priority issues. As a result, a country’s health outcomes may suffer.

To strengthen health systems and expand access to priority health services, USAID has supported a variety of global and bilateral health systems strengthening projects since 1989. They include Health Systems 20/20 and now the Health Finance and Governance (HFG) Project. HFG is designed to fundamentally strengthen health systems, with a focus on improving the health financing and governance functions, so the systems more efficiently and equitably deliver the life-saving health services that people, especially children, women, and poor and vulnerable populations, need.

 We will not be successful in our efforts to end deaths from AIDS, malaria and tuberculosis unless we do more to improve the health systems around the world.

President Barack Obama, 2009

The HFG team views health systems strengthening as a nonlinear process that demands holistic systems thinking rather than a traditional, vertical approach. The holistic approach pays attention to how individual components of the overall system and subsystems interact and affect one another. Working simultaneously on multiple components of the system, such as governance and financing, yields greater impact than addressing an individual constraint. Effective interventions should target constraints that will have maximum benefit across multiple health programs.

Put another way, supporting the health system refers to any activity that improves services, from upgrading facilities and equipment to distributing mosquito nets. In contrast, strengthening the health system requires more comprehensive changes to policies and regulations, financing mechanisms, organizational structures, and relationships across the entire system. Both supporting and strengthening efforts are important and necessary, and the balance between them should be driven by a country’s context and priorities. Above all, country ownership is essential to building a health system’s sustainability and its ability to promote universal health coverage

Categories: Health Section