This document discusses the difference between supporting and strengthening health systems. Supporting focuses on filling short-term gaps, while strengthening aims to make systems function better long-term by revising policies, relationships, and resource use. The document proposes criteria to distinguish strengthening interventions, including having cross-cutting impact, addressing multiple disease areas, and influencing performance drivers like policies beyond just inputs. It emphasizes that strengthening requires understanding a country's specific system constraints to design effective, sustainable interventions.

1. Abt Associates
In collaboration with:
I Aga Khan Foundation I Bitrán y Asociados
I BRAC University I Broad Branch Associates
I Deloitte Consulting, LLP I Forum One Communications
I RTI International I Training Resources Group
I Tulane University’s School of Public Health
Strengthening Health Systems
Moving Beyond Supporting the Health System
Ann Lion
Health Systems 20/20 Project Director, Abt Associates
Global Health Council Satellite Session
Health Systems Strengthening:
What is Everyone Doing?
June 13, 2011

2. Goal of this presentation
 Clarify existing HSS definition
 Supporting vs. strengthening health systems
 Propose criteria to distinguish what activities are
HSS interventions (support vs. strengthen)
 Scope
 Longevity
 Approach

3. What is health system strengthening?
 Strengthening health systems goes beyond
supporting the system
Supporting focuses on filling gaps to
produce better short-term outcomes
Strengthening is about making the system
function better in the long term

4. Strengthening vs. supporting health systems
Parameter Health System
Support
Health System
Strengthening
Scope May be focused on a
single disease or
intervention
Activities have impact across
health services and outcomes
Longevity Effects limited to period of
activity
Effects will continue after
activities end
Approach Provide inputs to address
identified system gaps
Revise policies and
institutional relationships to
change behaviors and
resource use to address
identified constraints

5. What is not health system strengthening
 Most common misunderstanding of HSS is that it is
any activity that supports a HS building block
 Focus tends to be on increasing inputs
 Often covers only one HS block or disease area
 Tends to be short-term solution
 Misconception of HSS often leads to investment in
activities that, in effect, only support the system
temporarily but posture as HSS

6. The 3 dimensions of health systems
1) Health system building blocks
2) Program/disease areas
3) Performance drivers
 Inputs
 Policies and regulations
 Organizational structures
 Behaviors of HS actors

7. A “cube” view of the health system
© Abt Associates, 2001

8. The 3 dimensions of health systems
 But focus on performance driver tends to be on
inputs, while the remaining drivers are often
overlooked by HSS programs

9. Inputs vs. other key HSS performance drivers
© Abt Associates, 2001

10. © Abt Associates, 2001

11. How to design HSS interventions?
 There is no “menu” of HSS interventions
 Design will be affected by a number of factors specific to
country context and system constraints
 A health system strengthening intervention should:
 Include all 3 dimensions shown in the HS cube illustration
 Affect more than one program/disease area
 Address country-specific constraints

12. Guidance for identifying HSS interventions
Is it Health System Strengthening?
 Does the intervention have cross-cutting benefits beyond a
single disease?
 Does the intervention address policy and organizational
constraints or strengthen relationships between the building
blocks?
 Will the intervention produce long-term systemic impact beyond
the term of the project?
 Is the intervention tailored to country-specific constraints and
opportunities with clearly defined roles for country institutions?

13. Acknowledgements
 Grace Chee**
 Nancy Pielemeier
 Catherine Connor
 Mark McEuen
 Sheila O’Dougherty
 Hong Wang
** lead drafter
 Slavea Chankova
 Joe Kutzin
 Marty Makinen
 David Evans
 Tahgreed Adams
 Abdo Yazbeck

14. Abt Associates
In collaboration with:
I Aga Khan Foundation I Bitrán y Asociados
I BRAC University I Broad Branch Associates
I Deloitte Consulting, LLP I Forum One Communications
I RTI International I Training Resources Group
I Tulane University’s School of Public Health
Thank you
www.HealthSystems2020.org