Health systems strengthening: a common classification and framework for investment analysis

Abstract

Significant scale-up of donors’ investments in health systems strengthening (HSS), and the increased application of harmonization mechanisms for jointly channelling donor resources in countries, necessitate the development of a common framework for tracking donors’ HSS expenditures. Such a framework would make it possible to comparatively analyse donors’ contributions to strengthening specific aspects of countries’ health systems in multi-donor-supported HSS environments. Four pre-requisite factors are required for developing such a framework: (i) harmonization of conceptual and operational understanding of what constitutes HSS; (ii) development of a common set of criteria to define health expenditures as contributors to HSS; (iii) development of a common HSS classification system; and (iv) harmonization of HSS programmatic and financial data to allow for inter-agency comparative analyses. Building on the analysis of these aspects, the paper proposes a framework for tracking donors’ investments in HSS, as a departure point for further discussions aimed at developing a commonly agreed approach. Comparative analysis of financial allocations by the Global Fund to Fight AIDS, Tuberculosis and Malaria and the GAVI Alliance for HSS, as an illustrative example of applying the proposed framework in practice, is also presented.

India's Healthcare Industry: A System Perspective

“…The "health systems strengthening" framework tracks the activities and investments undertaken by different donors/funders to strengthen specific system components. 30 These investments are typically designed to make changes in the healthcare system and accomplish certain system goals. The components targeted include "health services" (staffing infrastructure, operational support systems), the "financing system" (e.g., health financing policies and legislation, resource generation, fund pooling, provider reimbursement system), "monitoring/evaluation and information system" (data analysis and reporting, disease surveillance), and "stewardship and governance" (e.g., planning, priority setting, management).…”

Development assistance, aid coordination and health systems strenghtening: a case study in post-Soviet Mongolia

“…As a result, it is important to choose an applicable framework, or to adapt and combine several frameworks for a given context. Shakarishvili et al also highlighted the complexity and multiplicity of HSS frameworks (107). Shakarishvili et al, 2010 (108) This framework is not meant to add additional dimensions in explaining what a health system is, but rather is a tool to translate concepts -into-actions for improving health systems in developing countries.…”

“…The framework assists in defining the range of processes affecting the components of a health system (five control knobs), and explores policy instruments to influence them (107,112). The five control knobs are:…”

“…For example, some authors do not consider drug and procurement supply for HIV/AIDS as a HSS intervention, since it contributes to consumables in the control of a single disease, and does not contribute to broader and sustainable health systems strengthening (106,128). However, others, have argued than these interventions could still be considered as disease-specific HSS, as they are intended to improve the system or sub-system, despite being confined within certain disease specific targets (40,107).…”

“…With a view of mapping external project funding against HSS priorities, collected data had to be allocated according to standardised categories based on the HSSMP key areas. For these purposes, I drew on current globally known theoretical frameworks of HSS (33,107) (Table 8-1) and the national HSS priority areas to develop and apply a set of HSS criteria. Table 8-3 illustrates this process.…”