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Health system strengthening – reflections on its meaning, assessment and our state of knowledge

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Witter, Sophie, Palmer, Natasha, Balabanova, Dina, Mounier-Jack, Sandra, Martineau, Tim ORCID: https://orcid.org/0000-0003-4833-3149, Klicpera, Anna, Jensen, Charity, Pugliese-Garcia, Miguel and Gilson, Lucy (2019) 'Health system strengthening – reflections on its meaning, assessment and our state of knowledge'. The International Journal of Health Planning and Management, Vol 34, Issue 4, e1980-e1989.

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Abstract

Comprehensive reviews of health system strengthening (HSS) interventions are rare, partly because of lack of clarity on definitions of the term but also the potentially huge scale of the evidence. We reflect on the process of undertaking such an evidence review recently, drawing out suggestions on definitions of HSS and approaches to assessment, as well as summarising some key conclusions from the current evidence base. The key elements of a clear definition include, in our view, consideration of scope (with effects cutting across building blocks in practice, even if not in intervention design, and also tackling more than one disease), scale (having national reach and cutting across levels of the system), sustainability (effects being sustained over time and addressing systemic blockages), and effects (impacting on health outcomes, equity, financial risk protection, and responsiveness). We also argue that agreeing a framework for design and evaluation of HSS is urgent. Most HSS interventions have theories of change relating to specific system blocks, but more work is needed on capturing their spillover effects and their contribution to meeting overarching health system process goals. We make some initial suggestions about such goals, to reflect the features that characterise a “strong health system.” We highlight that current findings on “what works” are just indicative, given the limitations and biases in what has been studied and how, and argue that there is need to rethink evaluation methods for HSS beyond finite interventions and narrow outcomes. Clearer concepts, frameworks, and methods can support more coherent HSS investment.

Item Type: Article
Subjects: W General Medicine. Health Professions > W 1-28 Reference works
W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84.4 Quality of Health Care
W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care
WA Public Health > WA 20.5 Research (General)
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1002/hpm.2882
Depositing User: Jan Randles
Date Deposited: 07 Aug 2019 09:00
Last Modified: 23 Jan 2020 15:52
URI: https://archive.lstmed.ac.uk/id/eprint/11364

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