The document outlines strategies for enhancing health service delivery in developing countries through case studies from seven nations. It investigates the context of implementation, management, and influencing factors, addressing both intended and unintended outcomes. Research limitations highlight the challenges in drawing general conclusions due to the unique contexts and concurrent strategies involved.

1. IMPROVING
HEALTH SERVICE DELIVERY IN
DEVELOPING COUNTRIES:
FROM EVIDENCE TO ACTION
David Peters, Sameh El-Saharty, Banafsheh Siadat,
Katja Janovsky, and Marko Vujicic
First Global Symposium on Health Systems ResearchFirst Global Symposium on Health Systems Research
Montreux, Switzerland, – November 18, 2010Montreux, Switzerland, – November 18, 2010
Health, Nutrition, and PopulationHealth, Nutrition, and Population
Health Systems Strengthening GroupHealth Systems Strengthening Group

2. The Seven Country Case Studies
 AFGHANISTAN:
 ETHIOPIA
 GHANA
 RWANDA
 UGANDA
 VIETNAM
 ZAMBIA

3. RESEARCH OBJECTIVES
Describe strategies to strengthen HSD in the
real-life context in which they occurred
Illustrate how adoption and implementation of the
HSD strategies relate to their context
Investigate the presumed causal links between
program components and program effects in
real-life interventions that are too complex for
survey research or experimental strategies

4. RESEARCH QUESTIONS (1/2)
Which strategies to improve HSD were adopted
and implemented?
Where did the impetus for the strategy come
from?
How has the implementation of the strategies
been organized and managed, including political
advocacy and management?
What was the pace and degree of
implementation, including sequencing and
relationships to other concurrent strategies?

5. RESEARCH QUESTIONS (2/2)
What factors in the health sector and in the
broader macro environment, including enabling
and inhibiting conditions, have influenced
adoption, implementation, and outcomes?
What results have been achieved?
Are there any discernable intended or unintended
benefits to the poor?
What lessons have been learned that are likely to
be useful for other countries?

6. RESEARCH METHODOLOGY
Mixed methodologies detailed in standardized
terms of reference
Review and analysis of documentation of HSD
strategies in the recent past (5 -10 years)
Quantitative analysis of HSD data (outputs and
outcomes)
Central- and periphery-level field key informant
interviews of critical stakeholders in-country
Identification and analysis of enabling and
inhibiting factors and conditions

7. RESEARCH LIMITATIONS (1/2)
Many of the results observed are highly contextual -
largely driven by factors related to the macro and/or
the micro environments - and hence generalizations
and comparisons across countries are limited.
As the context changes, the health system
components also evolve and adapt in response to
the changing environment. This dynamic relationship
makes it difficult to ascribe some of the enabling and
inhibiting factors to constantly adapting health
system components.

8. RESEARCH LIMITATIONS (2/2)
Difficult to attribute the observed results to a
specific strategy, particularly when there is
usually concurrent implementation of multiple
strategies.
The sequencing of the strategies, often in a
phased manner, or incrementally but not
adhering to plans, further limits the tracing of
causal linkages.