The aim of this website is to share expertise and experience on health care systems with policy makers, managers of health services, health care providers and health system researchers. The website is a product of a network Switching International Health Policies and Systems (SWHIPS).The articles are publisher versions or author versions, depending on the archiving policies of the publishers. Of all articles, the copyright remains with the editor or author, respectively. Contact us: healthsystems@itg.be.

More information on the aim of this website.

Developing New frameworks for Health System Strengthening

Health system strengthening (HSS) and access to health care have risen on the international agenda, after two decades of diminished attention. A number of WHO publications and initiatives of powerful actors in international health, such as the GAVI HSS taskforce, the Global Fund technical assistance for HSS and the IHP+, are illustrative for this tendency. Despite the growing publications and activities around health system strengthening, there is no obvious consensus about its concepts and strategies.

The World Health Report 2000 discusses the performance of health systems. The WHO framework for action ‘Strengthening health systems for improved health outcomes’ (2007) defines basic elements of health systems in order to identify avenues for action. The World Health Report 2008 focuses on the inequities in health, access to care and quality of health care and it identifies primary health care as a core strategy to strengthen health systems.

This lack of consensus shows that there is a need for better frameworks, to understand the concept of HSS and to design and implement strategies. Many frameworks describe health systems as a static concept and fail to catch the processes of change and strengthening. Most frameworks are instrumental in their description; they don’t specify the relationships between different elements and don’t link the choice for a certain focus inside the framework with the focus on specific objectives.

We aim to contribute to the development of better frameworks for understanding and strengthening health systems. As health system researchers, we contribute to the development of appropriate methodologies to evaluate and design interventions in complex systems such as health systems, and to a better insight in the relation between context determinants, mechanisms and outcomes.

Below is an overview of relevant literature on the development of health system frameworks, with an overview of their content. Our contribution is a dynamic process: we will update the overview with new relevant contributions, both from internal and external sources. Neither do we work in isolation. Any additions and comments on the process and contributions are welcome.

WHO documents

  • WHO. PHC, Now more than ever. World Health Report 2008.
  • Everybody’s business. Strengthening health systems to improve health outcomes, WHO’s framework for action. WHO Geneva, 2007.
  • WHO, 2006. Opportunities for GHI in the health system action agenda. Working paper 4 in Series: Making Health Systems Work.
  • WHO, 2006. Improving health services and strategies. Adopting and implementing innovative strategies. Working paper 5 in Series: Making Health Systems Work.
  • Health systems: improving performance. The World Health Report 2000.

ITM documents

  • Ooms G, et al, 2008. The diagonal approach to GF financing: a cure for the broader malaise of health systems? Globalisation & Health 4;6.
  • Cavalli A, Marchal B, 2008. HSS in times of MDG: from a comprehensive discourse to a selective practice. (Background paper, article at present offered to journal)
  • Van Damme W, Kober K, Kegels G., 2008. Scaling up ART. How will HS adapt. Soc Sc & Med 66: 2018-2121.
  • Unger, JP. Policy options for international health policy. Lecture HSMP 2008.
  • Giusti, Criel. Public versus private health care delivery
  • Unger, etc Quality standards for health care delivery and management in publicly oriented health services
  • Unger. Integrated Care: a fresh perspective for international health policies in low an middle income countries
  • Declaration on HCFA; Antwerp, 25-26 October 2001.

Other documents

  • Dean T. Jamison, Joel G. Breman, Anthony R. Measham, George Alleyne, Mariam Claeson, David B. Evans, Prabhat Jha, Anne Mills, Philip Musgrove, "Pillars of the Health System." 2006. Priorities in Health,ed. , 155-178. New York: Oxford University Press. DOI: 10.1596/978-0-8213-6260-0/Chpt-7.
  • Anne Mills, Fawzia Rasheed, Stephen Tollman, "Strengthening Health Systems." 2006. Disease Control Priorities in Developing Countries (2nd Edition),ed. , 87-102. New York: Oxford University Press. DOI: 10.1596/978-0-821-36179-5/Chpt-3.
  • USAID – Management Sciences for Health. Health systems strengthening: an introduction. Chapter 1 in: Health System assessment approach. A how – to manual. 2007.
  • Rawat S., De Maeseneer J, Starfield B. Form Alma-Ata to Almaty: a new start for PHC. The Lancet 372;9647:1365-1367:
  • Dickinson, C., 2008. GHI & HSS: the challenge of providing technical support HLSP, London.
  • Gilson, L et al. Challenging inequity through health systems. Final report Knowledge network on health systems. WHO Commission on the social determinants of health. June 2007.
  • Healthy development. The World Bank Strategy for Health Nutrition and Population Results. 2007.
  • Reich M et al, 2008. Global action on health systems: a proposal for the Toyako G8 summit. Lancet 371:865-869.
  • Reich R, Takemi, K. G8 & strengthening of HS: follow-up to the Tokyo summit
  • Travis P. Overcoming HS constraints to MDG.