Health Systems Strengthening

  • Blog post
    Fostering Change eLearning Course Image

    Change occurs frequently in health settings in many different ways. Even the best kind of change can be disruptive to service delivery, and many people are naturally resistant. In light of this struggle, in 2010, the Global Health eLearning Center (GHeL) released a course designed to build the skills of those in a position to support change in health service delivery. This course, Fostering Change in Health Services, focuses on the principles of organizational change and supporting change agents. To date, the course has been taken by 4,775 users; after five years, it is now available with new resources and information updates.

    This important update includes resources from the WHO and Implementing Best Practices Consortium's 2013 revised Guide to Fostering Change to Scale Up Effective Health Services, in particular new materials from ExpandNet/WHO, the USAID Health Care Improvement Project, University Research Co. (URC), the Institute for Healthcare Improvement (IHI), and additional guidance on leading change from Management Sciences for Health (MSH).

    The course only takes 1.5 hours to complete and offers a range of information to help with improvements and change to any health system.

    For more information, take the course or visit the Guide to Fostering Change to Scale Up Effective Health Services toolkit.

  • Blog post
    Battling Ebola Presentation at SwitchPoint

    Keeping people healthy and mortality low is a complicated task involving many different components: prevention, access to care, nutrition, maternal and child health, family, and so much more. There are also many things outside of specific health areas that can impact health, including employment, education, housing, income, and many others.

    One large thing that can impact individual and community health is the health system. This theme came up frequently at IntraHealth International's annual SwitchPoint, recently held over two days in Saxapahaw, North Carolina. Touted as an “unconference,” SwitchPoint brings together people from all over the world to talk about health and development in creative and innovative ways. We saw photos from the frontlines of the Ebola crisis, poetry from IntraHealth’s Roy Jacobstein, dancers trying to ease the effects of Parkinson’s, and many other amazing ideas and interventions.

  • Blog post
    Gender and HSS eLearning Course Image

    Gender and HSS eLearning Course

    For the purposes of full disclosure: I am US graduate student in global public health, with experience in gender in(equality) and women’s empowerment; I consider myself to be a gender-based violence researcher and activist, with limited background on health systems. I recently took the Gender and Health Systems Strengthening eLearning course and participated in the corresponding study group. The course broadened my perspective, looking beyond the interpersonal dimension of gender inequality, to recognize how it manifests within health system and can better be addressed at the structural level, as well as day-to-day.

  • Blog post

    Leah D. Gordon, Knowledge Management Specialist for MEASURE Evaluation, recently posted on the Evaluate blog about the recent V Reunión de RELACSIS in Mexico City, Mexico. She discusses "witnessing true knowledge management in practice that incorporates people, process and technology" and the transformative power it can have on health systems. RELACSIS is an excellent example of a regional knowledge network where successes are offered as models for adaptation, and lessons are shared candidly. What regional knowledge networks have you been involved with? Tell us in the comments.

    Members working together to identify priority components of their Nat’l HIS to improve on.

    Members working together to identify priority components of their Nat’l HIS to improve on.


    This week, I had the unique opportunity to join the V Reunión de RELACSIS in Mexico City, Mexico that brought 80 people together from 25 Latin American and Caribbean countries. Attendees were mostly public health professionals who determine how best to implement practices that will strengthen and improve their country’s health systems. Many components of the health information system were discussed from electronic patient record keeping, to medical coding, to national epidemiological data.

    Health Information System – a set of components and procedures organized with the objective of generating information that will improve health care management decisions at all levels of the health system –Lippeveld et al. 2000

    The most lively discussions were prompted by exchange of how-to knowledge — how records are kept; how coding is taught; how epidemiological data is collected; and how to communicate data to policy makers. This was a meeting of professionals who share ground-truth experiences. Presenters equally shared practices that worked well and not so well, mentorship experiences and standard operating procedures.

  • K4Health Knowledge Management/Health Systems Strengthening Conceptual Framework

    K4Health Knowledge Management/Health Systems Strengthening Conceptual Framework

  • Blog post

    No matter which health system building block you are trying to improve, you need specific data, information, and knowledge to inform your decision-making process—this is where good knowledge management comes in handy.

    The Intersection of Knowledge Management and Health Systems Strengthening: Implications from the Malawi Knowledge for Health Demonstration Project” provides an interesting case study of the connection between improved knowledge management and health systems strengthening.  Even though the K4Health Malawi project was focused on improving gaps in the FP/RH and HIV/AIDS information pathway (specifically links between information use and performance), we saw wider heath system improvements as a result of the KM improvements implemented. A happy turn of events!

    K4Health Knowledge Management/Health Systems Strengthening Conceptual Framework

    K4Health Knowledge Management/Health Systems Strengthening Conceptual Framework

    The project’s evaluation (report forthcoming) highlights 10 ways that this project improved health system performance across five of the six building blocks: health information; health workforce; medicines, vaccines, and technology; service delivery; and leadership and governance. The 6th building block, health financing, was not directly affected, though we can see already ways that KM could improve health financing in other programs.

  • Blog post

    Jonathan D. Quick, MD, MPH of Management Sciences for Health (MSH) talks about health systems innovations and scale-up in this August 29, 2012 blog. This blog is cross-posted from MSH's Global Health Impact blog.

    Each year over 10 million men, women, and children in developing countries die as a result of our collective failure to deliver available safe, affordable, and proven prevention and treatment. A recent analysis of innovations in products and practices for global health, from the Hepatitis B vaccine to use of skilled birth attendants, revealed virtually none of these life-saving interventions reaches much more than half their target population—even after as many as 28 years of availability. This reflects a vast gap between knowledge and action in global health.

    Image for Heath Systems Blog

    Frieda Komba, a licensed drug dispenser in Tanzania (photo credit: MSH)

    Successful Health Systems Innovations

    Low- and middle-income countries (LMIC) benefit from continued innovations in health products and health practices, such as use of misoprostol to prevent post-partum hemorrhage, and technologies such as internet-based mHealth applications to protect the poor from catastrophic health expenditures.  To ensure such innovations achieve large-scale, widespread coverage, they must be accompanied by much more effective health systems innovations.

    In the late 1990s, when there were effectively no public health services in Haiti, MSH worked with USAID and local and international service delivery NGOs for perhaps the first large-scale test of performance-based financing (PBF) for health services in a LMIC. For well over a decade now the areas of Haiti in which this innovation in health financing and delivery has been implemented have consistently out-performed national averages for antenatal care, immunization, and other key measures (PDF).

    In the mid-2000s, as part of our shared commitment to improving maternal and child health in Afghanistan, the ministry of health, the Hewlett Foundation, and MSH worked together to address unmet family planning needs. In a setting initially thought unfriendly to family planning, we found culturally-based innovations in meaning and message could bring together local religious leaders, healthcare providers, community health workers, and families themselves. Within less than two years the intervention districts achieved up to a four-fold increase in family planning acceptance, often exceeding levels in countries active far longer in promoting family planning.

    Other recent global health successes, such as the remarkable scale-up of AIDS treatment over the last decade and the dramatic reduction in malaria mortality in Ethiopia and elsewhere, have each been achieved in part through health systems innovations.