There is no doubt that one of the biggest buzzwords in global health discussions lately is “Health System Strengthening” (HSS). Everyone, it seems, is doing it these days…or at least trying.

But what is it exactly and are those claiming to do it actually achieving it? The term is broadly speaking used to describe the impact that donor financed global health initiatives are having on health systems in targeted countries. I’ve definitely seen different uses of the term ranging from activities aimed at improving the outcomes specifically targeted by the global health initiatives to a broader definition which includes building up health systems to deliver other types of health services as well.

In this month’s PLoS Medicine journal, there is a review of HSS definitions and an analysis of how the major global health initiatives define and implement HSS activities authored by Bruno Marchal, Anna Cavalli, and Guy Kegels.

The review finds that there is a big gap between the HSS stated goals of the major global health initiatives and the actual practice of these organizations:

Virtually all GHAs claim to support health systems, but instead they focus on disease-specific interventions or on activities targeting system functions essential for implementation of their own programmes.

They conclude that “most current HSS strategies are selective (i.e., they target a specific disease), and their effects may undermine progress towards the long-term goal of effective, high-quality, and inclusive health systems” and argue that “we urgently need a systemic approach to HSS that is contextual and that fits the countries’ agendas first”.

While I would definitely agree with the first conclusion (some of my own research has come to the same conclusion), however, I am not sure their second conclusion necessarily follows from the first. It is not clear to me that just making these global health initiatives operate through some sort of common framework would enable us to achieve broader health system goals, nor should we even want this to be the case. But I think this article makes a great contribution to the literature on this topic and should be a must read for anyone interested in this topic.

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1 Response » to “Are health system strengthening efforts just hype?”

  1. martha says:

    I recently came accross your blog and have been reading along. I thought I would leave my first comment. I dont know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.


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