Health Systems Strengthening

CHS - About1

Class instructor and Student. Photo by Brian Donnelly

The World Health Organization (WHO) defines health systems strengthening as 1) the process of identifying and implementing the changes in policy and practice in a country’s health system such that the country can respond better to its health and health system challenges and 2) any array of initiatives and strategies that improves one or more of the functions of the health system and that leads to better health through improvements in access, coverage, quality, or efficiency.

CHS and its affiliate University Research Co., LLC (URC) use a health systems-strengthening approach, emphasizing systematic, evidence-based methods that will bring about significant improvement in:

  • Patient and population health outcomes, particularly among the poor;
  • Efficiency and effectiveness of systems and processes of care; and
  • Social responsiveness and accountability.

Our work strengthens the performance and interlinkages of the WHO-identified health system building blocks: service delivery, health workforce, strategic information, commodities, health financing, and leadership and governance. Our success is based on the close and supportive relationships we maintain with Ministries of Health (MOH): we provide high-quality technical assistance that focuses on national priorities and builds on and maximizes the effectiveness of a country’s resources. We build the institutional, programmatic, and financial capacities that can usher in a high-performing health sector that adapts to changes through continuous quality improvement and innovation.

Our experience dates to the 1980s, when we prepared modules for the Aga Khan Foundation’s Primary Health Care Management Advance Program. In the 1990s, we participated in the Partnerships for Health Reform project, which produced a health systems assessment tool still in use. Since 1990, through four USAID-funded projects (Quality Assurance Projects I–III and the Health Care Improvement Project) and other projects, CHS and URC have adapted approaches such as continuous quality improvement, the improvement collaborative, accreditation, and pay for performance to strengthen the health systems of USAID-assisted countries.

Today, CHS and URC manage health systems strengthening projects around the world. We are working in the Zou/Collines region of Benin to improve management systems and mobilize communities. We are having nationwide impact in Cambodia by supporting the MOH’s implementation of the Second Health Sector Strategic Plan. We are strengthening the quality of primary health care delivery in Iraq by developing management systems and processes for delivering clinical care, improving the quality of primary care, building effective community partnerships to ensure that local communities are closely involved in health service planning and implementation, and building the capacity of service providers to develop highly functional health centers able to meet Iraqis’ primary health care needs.

We have supported Jordan’s MOH since 1988 to strengthen the accreditation of health facilities. We are well positioned to help develop the capacity of health providers and MOHs to redesign and improve processes in their health system’s building blocks.

Our technical support continues to have a positive impact on health systems well beyond the life of our projects. For example, the Quality Assurance Project (QAP) III worked in 1998 in Russia’s Tver Oblast to improve care for neonatal respiratory distress syndrome. After producing significant results in demonstration sites, quality improvement interventions were scaled up to the entire region, further reducing the infant and neonatal mortality rates. Six years after our technical assistance ended, the Tver improvements continued to contribute to reduced mortality rates (see figure). This experience has been repeated in many countries.

Furthermore, in response to the health workforce crisis in low-resource settings, we support teams of health workers and managers to innovate and test solutions to address health workforce challenges and improve performance and productivity throughout the health system. Learn more here.