Health Systems Strengthening

A health system is defined as consisting of all people, institutions, resources, and activities whose primary purpose is to promote, restore, and maintain health. Strengthening a health system means initiating activities in the six internationally accepted core Health Systems Strengthening (HSS) functions:

  • Human resources for health (HRH);
  • Health finance;
  • Health governance;
  • Health information;
  • Medical products, vaccines, and technologies; and
  • Health service delivery.

A well-performing health system is one that achieves sustained health outcomes through continuous improvement of these six inter-related HSS functions.   

USAID invests in HSS to guarantee the sustainability of the life-saving impact of all our global health programs, including our investments toward Ending Preventable Child and Maternal Deaths, AIDS-Free Generation, and Protecting Communities against Infectious Diseases.  USAID’s comparative advantage in HSS stems from a unique combination of assets that includes: cross-sectoral integration, internal staff capacity, expert implementing partners, local solutions, implementation science culture, and strong private sector engagement.  

Our overarching Vision for HSS is to achieve four strategic outcomes that together improve financial protection and access to high-quality services that reach underserved, marginalized, and high priority groups.  These four strategic outcomes are:  

  • Financial Protection so that the cost of essential health services permits people to use necessary services without impoverishing them;
  • Essential Services so that the package of high-quality prevention, promotion, treatment, and care services are available to all;
  • Population Coverage so that those who are poor and underserved have the same access to essential health services as other citizens; and
  • Responsiveness so that quality health services are delivered in a timely and confidential manner that ensures dignity and respect for each client.

Indicators for the four strategic outcomes include: reducing out-of pocket (OOP) expenditures as a percentage of total health expenditures; advancing the development stage of a country’s essential health services package; ensuring equity in access to skilled birth attendance; and improving client satisfaction with health services measured through available survey instruments. Illustrative indicators for the specific priority objectives range from increasing the total number of health care workers relative to population in each priority country to increasing the median availability of essential generic medicines in public facilities.

USAID maintains a holistic view of health systems that recognizes the links between health systems functions and the effects activities to improve one function may have on another.  To advance that view, USAID maintains expertise across the health systems functions. HSS will ensure that the life-saving impact of our global health support extends beyond those we can reach directly today to tomorrow.  HSS fosters country ownership, utilizing country systems to build durable health systems functions.  HSS is an approach to sustaining programs and hastening the time when external assistance no longer is required. 

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Last updated: October 07, 2015

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