About This Site

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Welcome to the HSA Website.  This website is a central location for sharing health system assessment approaches, tools and resources for the benefit of those seeking to strengthen their health system through-out the world. Here you will find a wealth of information to help you assess your current health system and identify entry points for health system strengthening efforts.

This site offers strategies, assessment tools, publications, and other helpful resources to measure the performance of your health system. It also accepts contributions of additional assessment tools and reports, feedback, and comments.

Partners and Contributors

This site was created using USAID funding through the Health Systems 20/20 Project.

About Health System Strengthening

WHO defined a health system as consisting of “all organizations, people and actions whose primary intent is to promote, restore or maintain health.” It is much broader than the public health service delivery system that is often the focus of public health officials. It includes the full range of stakeholders in a health sector, for example, private for-profit and not-for-profit service providers, health insurance organizations, public safety legislation, community outreach workers, educators, researchers, patients, and consumers, as well as mothers caring for sick children. WHO (2007) also defined health system strengthening, as:

…improving [the] six health system building blocks and managing their interactions in ways that achieve more equitable and sustained improvements across health services and health outcomes.

As part of the HSS framework described above, WHO (2000) organized the health system into six functions, or building blocks: 1. Leadership and governance, 2. Health financing, 3. Service delivery, 4. Human resources for health, 5. Medical products, vaccines and technologies, and 6. Health information systems. This WHO enumeration and definition of the building blocks has been adopted widely, and now provides a common terminology for discussing key health system functions.

Nevertheless, other HSS approaches exist. They include, for example, the comprehensive framework for identifying areas for reform presented by Roberts, Hsiao, Berman, and Reich (2004), which describes five “control knobs” for influencing health sector performance: financing, payment, organization, regulation, and behavior. This approach emphasizes system-wide analysis of policies that affect health system performance, with an emphasis on realigning incentives to reward desired behavior.