How do we design and evaluate health system strengthening?

3 January 2023

Regular visitors to this site will know that the ReBUILD team has a strong interest in health system strengthening (HSS). We have engaged in work which has questioned what the term means, how HSS can it be monitored and evaluated, and which tools and frameworks we might use. (Find a past webinar and associated papers here.)

Health System Strengthening Evaluation Collaborative

Members of the ReBUILD team are also part of the Health System Strengthening Evaluation Collaborative (HSSEC) [opens new tab] – a stakeholder group which seeks to develop a shared agenda and approach for more effective HSS evaluations. The team has recently been engaged in the development of a framework and tool to guide HSS monitoring, evaluation and learning by national and global actors, and a paper has been subsequently published by the group – How do we design and evaluate health system strengthening? Collaborative development of a set of health system process goals [opens new tab].

The framework was developed based on a rapid review of the literature and expert consultation, with the aim of going beyond a focus on the building blocks of health systems, outputs or health outcomes to think about the features that constitute a strong health system.

Professor Sophie Witter of ReBUILD and HSSEC and one of the paper’s authors explains:

“ReBUILD team members are proud to have contributed to this international collaborative, which set out to improve the way we assess and shape health system strengthening interventions. One product is this new paper on health system process goals but there is also a wider range of products to share on the HSSEC webpage [opens new tab].”

The team has developed a list of 22 health system process goals which represent desirable attributes for health systems. The goals (or rather, progress towards them) are influenced by positive and negative, intended and unintended effects of HSS interventions. The paper also describes how the goals can be operationalised for prospective and retrospective HSS monitoring, evaluation and learning, and how they also have the potential to be used for opening a space for participatory, inclusive policy dialogue about HSS.

Read this International Journal of Health Planning and Management Journal paper here. [opens new tab]

Further information

• Health System Strengthening Evaluation Collaborative webpage [opens new tab]
• Webinar recording: Getting on the same page: the concept and assessment of ‘health systems strengthening’
• Evidence review of what works for health systems strengthening, where and when? – a report by the ReBUILD and ReSYST consortia for the UK government
• Other ReBUILD-linked HSSEC work can be found here