Health Systems Strengthening

At its broadest, health system strengthening (HSS) can be defined as the process of identifying and implementing the changes in policy and practice in a country’s health system, so that the country can respond better to its health and health system challenges. Any array of initiatives and strategies that improves one or more of the functions of the health system and that leads to better health outcomes through improvements in access, coverage, quality, or efficiency.


health-1The World Health Report 2000 (WHO 2000) identifies the six essential building blocks of a health system:

Leadership and Governance

The stewardship or governance function reflects the fact that people, entrust their lives and resources to the health system. This involves overseeing and guiding the whole health system, private as well as public, in order to protect the public interest. It requires both political and technical action, reconciling competing demands for limited resources, in changing circumstances. CAGISC’s strategies to improve this function include:

  • Collaboration and coalition building. Across sectors in government and with actors outside government, including civil society, to influence action on key determinants of health and access to health services; to generate support for public policies, and to keep the different parts connected – so called ‘joined up government’.
  • By supporting community-level microfinance groups to address healthcare priorities such as HIV, health literacy and substance abuse.
  • Educate community leaders to actively engage the government and private sector in larger community and development issues.


health-2Health Financing

Health financing is a key determinant of health system performance in terms of equity, efficiency, and quality. Health financing refers to “the methods used to mobilize the resources that support basic public health programs, provide access to basic health services, and configure health service delivery systems”. Health systems in developing countries are financed through a mix of public, private, and donor sources. CAGISC’s strategies to enhance this function include:

  • Raising additional funds where health needs are high, revenues insufficient, and where accountability mechanisms can ensure transparent and effective use of resources;
  • Taking additional steps, where needed, to improve social protection by ensuring vulnerable groups have access to needed services and that paying for care does not result in financial catastrophe;
  • Identify opportunities to improve resource flows and maintain transparency of all sources to specific programs.

health-3Health Workforce

forceThe health workforce involves recruitment, training, deployment, and retention of qualified human resources; the procurement, allocation and investment in physical health infrastructure. WHO notes that human resources are the most important part of an efficient and functional health system. Many developing nations of the world are struggling with this function. Our strategy for improvement includes:


  • Working in partnership with country governments to provide incentives and expand training in health care careers
  • Advocate for policy changes that allow for task shifting of health care worker duties to a broader pool of trained individuals who will assume tasks formerly provided by doctors and nurses.

health-4Health Information System

A well-functioning health information system is one that ensures the production, analysis and information dissemination using reliable and timely health information technologies by decision-makers at different levels of the health system, both on a regular basis and in emergencies. Our strategy for this function involves working with other NGOs and country governments to



  • Develop public-private partnerships to encourage utilization of cell phones as a tool for health information reporting and communication.
  • Educate providers on the benefits and use of basic health information technology.
  • Advocate for the implementation of electronic medical records (EMR) beginning at provincial and district levels.

health-5Health Services

This health system function includes a broad array of health sector components, including the role of the private sector, government contracting of services, decentralization, quality assurance,and sustainability. Use of government health services is too low to affect quality indicators such as child mortality without the contributions of private sector health services, including NGO services.

  • Our strategy to enhance this function focuses on encouraging private and public partnerships such as contracting to prevent delays in addressing health care issues and promote quality and efficiency.
  • Encourage the use of quality indicators for data collection, analysis and continues education for providers to improve the quality of services provided.

health-6Medical Products, Vaccines & Technologies

A well-functioning health system ensures equitable access to essential medical products,Vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their
scientifically sound and cost-effective use. Access to essential medicines and supplies is fundamental to the good erformance of the health care delivery system. WHO estimates that one-third of the world’s population lacks access to essential medicines. Our strategies for this function include:

  • Support for rational use of essential medicines, commodities and equipment, through
  • guidelines to assure adherence, reduce resistance, maximize patient safety and training.
  • Procurement, supply, storage and distribution systems that minimize leakage and other waste.
  • Work in collaboration with donor partners and stakeholders to improve access to essential medications, medical products and technologies.

Selected health system constraints and possible disease-specific and health -system responses
ConstraintPossible Disease-specific response Possible health system response
Financial Access Difficulty inability to pay fees for services providedPayment exemptions for individual, for a specific diseasePooling pre-paid funds (from households, external agencies, companies) in ways that allow risks to be shared, and decrease individual payments when sick
Physical access difficult e.g. distance to facilityOut-reach for specific diseases; engage private providersRevising plans for the location, construction or upgrading of health facilities
Knowledge and skills low (public and private providersWorkshops and other continuing education for specific diseasesRevised pre-service training curricula; systems for licensing, accreditation, supervision
Staff are poorly motivatedStaff get financial incentives to deliver specific servicesClear job descriptions; performance and salary review; fair, transparent promotion procedures
Weak leadership and managementWorkshops to develop skills in managing staff, budgets etc. (e.g. in public and NGO facilities)Additional actions such as giving managers more control over resources; more accountability for results
Ineffective intersectoral action and partnershipDisease-specific cross-sectoral committees, usually national levelBuilding local government systems with cross-sector representation, and explicit procedures for public accountability