What is Health Systems Strengthening?

Last week I had the pleasure of participating in a workshop on Health System Strengthening organised by the Humanitarian Centre in Cambridge. Led by Eva-Maria Hempe of the Engineering Design Centre, who did a PhD on how ‘systems thinking’ can improve the NHS, the workshop discussed definitions of health systems, their place within broader global health goals, and what efforts to ‘strengthen’ health systems mean.

I had emphasised that health systems are essential to improving the world’s health, and that investments and efforts in global health, whether they involve disease control, quality of health care delivery, health promotion, or policy-making, will fail if the health system itself is absent or ineffectual. That’s because most global health interventions depend upon an existing infrastructure and set of services that in many countries around the world are weak. Thus, health systems are fundamental to global health and their strengthening is now seen as vital by the global health community.

But I was struck in Eva’s talk by the sheer number of frameworks out there to describe and explain what health systems are. And, as other commentators like Robert Terry and colleagues and Robert Chad Swanson and colleagues have argued, the amount of diversity and uncertainty there is with regards to health systems strengthening.

It showed a rich but unclear path to understanding how we can best strengthen health systems. Eva’s handout provides an outstanding, clear introduction to the main issues.

The Humanitarian Centre is a Cambridge-based network for international relief and development.