Health Systems Strengthening – A Literature Review

Author(s): Diana M, Yeager V, Hotchkiss D

Year: 2017

Abstract:

Health systems strengthening (HSS) has become part of a strategy of the United States government (USG) to help developing countries improve population health outcomes. A key premise of this core principle is that weak health systems have limited the effectiveness of governments and their international partners to scale up the availability and use of priority health services. By helping countries to strengthen the components of their health systems—health financing, human resources for health, health information, service delivery, the medicine supply chain, and leadership and governance—the USG hopes that cost-effective technologies for combating disease and other health problems will be more effectively delivered and sustained.

Measuring progress in HSS requires careful planning and sound metrics to assess changes in how health systems function and perform. Health systems frameworks are being used to inform HSS efforts. These frameworks cover a variety of perspectives and scopes, and focus on such diverse topics as performance, supply and demand, health reforms, building blocks, “control knobs” (explained later in this review), and funds and payments. Many health policy analysts argue that health systems are complex adaptive systems with both intended and unintended effects . Each of these frameworks has its own approach to monitoring and evaluation, with different metrics and indicators of health systems functioning. In addition, manuals and other publications provide guidance on assessing health systems functioning, including those developed by the World Health Organization (WHO) and by the Health Systems 20/20 project of the United States Agency for International Development (USAID).

The purpose of this review is to assess the availability of guidance on monitoring and evaluating HSS, and to list and summarize these resources for others in this field. This review is part of a suite of documents that MEASURE Evaluation is releasing that also includes Health Systems Strengthening: A Compendium of Indicators (Diana, Yeager, & Hotchkiss, 2017) and Health Systems Strengthening: Monitoring, Evaluation, and Learning Guide (Aqil, Silvestre, & Hotchkiss, 2017).

This is not an exhaustive review of the resources providing guidance on monitoring and evaluation or on HSS, but we believe it captures the most relevant ones that contribute to work in these realms. We hope this review will offer field staff and project partners guidance to fit their needs.