1. Strengthening Health SystemsMoving Beyond Supporting the Health System Ann Lion Health Systems 20/20 Project Director, Abt Associates Global Health Council Satellite Session Health Systems Strengthening: What is Everyone Doing? June 13, 2011

2. Goal of this presentation Clarify existing HSS definition Supporting vs. strengthening health systems Propose criteriato distinguish what activities are HSS interventions (support vs. strengthen) Scope Longevity Approach

3. What is health system strengthening? Strengthening health systems goes beyond supporting the system Supporting focuses on filling gaps to produce better short-term outcomes Strengthening is about making the system function better in the long term

4. Strengthening vs. supporting health systems

5. What is not health system strengthening Most common misunderstanding of HSS is that it is any activity that supports a HS building block Focus tends to be on increasing inputs Often covers only one HS block or disease area Tends to be short-term solution Misconception of HSS often leads to investment in activities that, in effect, only support the system temporarily but posture as HSS

6. The 3 dimensions of health systems 1)Health system building blocks 2)Program/disease areas 3)Performance drivers Inputs Policies and regulations Organizational structures Behaviors of HS actors

7. A “cube” view of the health system © Abt Associates, 2001

8. The 3 dimensions of health systems But focus on performance driver tends to be on inputs, while the remaining drivers are often overlooked by HSS programs

9. Inputs vs. other key HSS performance drivers © Abt Associates, 2001

10. © Abt Associates, 2001

11. How to design HSS interventions? There is no “menu” of HSS interventions Design will be affected by a number of factors specific to country context and system constraints A health system strengthening intervention should: Include all 3 dimensions shown in the HS cube illustration Affect more than one program/disease area Address country-specific constraints

12. Guidance for identifying HSS interventions Is it Health System Strengthening? Does the intervention have cross-cutting benefits beyond a single disease? Does the intervention address policy and organizational constraints or strengthen relationships between the building blocks? Will the intervention produce long-term systemic impact beyond the term of the project? Is the intervention tailored to country-specific constraints and opportunities with clearly defined roles for country institutions?

13. Acknowledgements Grace Chee** Nancy Pielemeier Catherine Connor Mark McEuen Sheila O’Dougherty Hong Wang ** lead drafter SlaveaChankova Joe Kutzin Marty Makinen David Evans Tahgreed Adams AbdoYazbeck

14. Thank you www.HealthSystems2020.org