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Health Systems Strengthening

Strong health systems provide access to essential, quality health services for all people.


Strong health systems provide access to essential, quality health services for all people. Health systems are the institutions, resources, people, and communities focused on improving health — including hospitals, health workers, pharmaceuticals, supplies, and financial and information systems. These systems lead to increased resilience from infectious disease outbreaks, reduce prolonged economic hardship, and provide high quality and affordable services to the individuals and communities with the least access to care, including women, children, the rural poor, refugees and displaced peoples, and religious and ethnic minorities.

Health systems strengthening (HSS) refers to the policies and processes that improve a health system’s equity, efficiency, quality, accessibility, or effectiveness. HSS spans from the national level to the community level.  

Resilient health systems promote global health security by ensuring that emerging health threats are detected early, disease outbreaks are contained, and epidemics and pandemics are prevented.

Well-functioning health systems are essential for sustainable progress in global health, including meeting U.S. commitments to address global health security threats, end preventable maternal and child deaths, and combat infectious diseases such as HIV/AIDS.

HSS is central to countries’ self-reliance – supporting overall economic growth and poverty reduction. A strong, well-functioning health system allows countries to provide the health care necessary for its citizens to engage in the education and productive work that spurs economic development. U.S. government resources focused on strengthening health systems are important in amplifying the impact of countries’ own domestic resources.


Mandate that all future investments and programs related to global health help strengthen partner country primary health care systems, scaling their capacity to deliver essential, quality health services to all communities. Investments should focus on advancing health equity, quality, and efficient and effective use of resources – allowing every individual, including the most vulnerable, to access high-quality and affordable essential health services to attain the highest level of health. 

Require federal agencies to develop a cross-agency strategy to foster quality, resilient, and integrated health systems in low- and middle-income countries. This strategy should integrate across health sectors, leverage multi-sector investment, and build self-reliance. It should also include well-defined targets and clear accountability mechanisms. 

Integrate local communities, including faith based organizations (FBOs) and other faith-centered groups, into the U.S. government approach to HSS. Community participation is essential to well-functioning health systems. The U.S. government should actively include local communities in decision-making around HSS, particularly through social-accountability mechanisms.

Prioritize HSS in global health security strategies – including the U.S. Global Health Security Strategy and the Global Health Security Agenda. By integrating global health security into HSS programming, countries will be able to stop outbreaks closer to the source, reducing negative outcomes and limiting economic and social hardships associated with epidemic and pandemic events.

Photo Credit: Annie Spratt

Photo Credit: Doug Linstedt


With improved technologies and sustained public and private investments, significant strides have been made to strengthen health systems globally. As a result, deaths due to preventable causes have decreased and equitable access to quality health services have improved. Many countries still face severe inequities in access to health services,[1] critical gaps in access to qualified health workers, weak information systems, and irregular supply chains. HSS efforts can address these challenges by focusing on access to safe medicines, increasing capacity to detect and contain infectious disease threats, strengthening financial management systems, and training and equipping frontline health workers, including community health workers, with digital tools, to deliver essential services. In its Vision for Health Systems Strengthening, USAID has identified four strategic HSS outcomes that support sustained health impact: financial protection for individuals accessing health services; the availability of essential health services for all; service coverage that ensures equitable access; and responsiveness that ensures quality, respectful health care. 

Strong health systems are essential to global health security, playing a vital role in the Global Health Security Agenda, a global initiative to strengthen capacity to address infectious disease threats, and in the U.S. Government Global Health Security Strategy and the U.S. National Biodefense Strategy. The COVID-19 pandemic underscores how easily global health threats can cross borders and how vital strong health systems are for all countries, regardless of income level – especially in areas of conflict and states with weakened security. Investments in supporting countries’ health systems are incredibly modest in comparison to the multi-trillion dollar cost associated with the COVID-19 outbreak.

As the U.S. government continues to promote health system sustainability and self-reliance in low- and middle-income countries, HSS will grow increasingly important. Investments in HSS have multiplier effects that enhance inclusive economic growth.[2]  Investments in HSS create a path toward systems that provide timely  and financially accessible essential health services. Underutilization of essential health services by the poor leads to an ongoing cycle of poverty, as people who are sick and vulnerable are less able to participate in the labor market. HSS can assist in stopping this cycle of poverty and guiding countries toward a more holistic approach to improving health.


COVID-19 has stretched health systems to – and beyond – capacity. Many low- and middle-income countries experienced a disruption of routine health services due to health system resources being redistributed for pandemic response. Governments have also restricted population movement, negatively affecting economies. According to The Lancet, lost income, increased prices, and overburdened social safety nets will increase financial and other barriers to healthcare access [3]. 

Countries prioritizing strong community and primary health care systems with a robust frontline health workforce and adequate national stockpiles of PPE and essential medicines, alongside strong leadership from the government that includes evidence-based decision making and clear communication with the public have made significant progress in mitigating the impacts of the pandemic.


  1. USAID’s Vision for Health Systems Strengthening
  2. USG Global Health Security Strategy 



Ashley Arabasadi, Management Sciences for Health, 

Mandy Folse, IntraHealth International,

Sarah Lindsay, Living Goods,


[1] “Tracking universal health coverage: First global monitoring report,” WHO/World Bank Group.

[2] “Working for health and growth: Investing in the health workforce,” WHO.

[3] Roberton, Timothy & Carter, Emily & Chou, Victoria & Stegmuller, Angela & Jackson, Bianca & Tam, Yvonne & Sawadogo-Lewis, Talata & Walker, Neff. (2020). Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. The Lancet Global Health. 8. 10.1016/S2214-109X(20)30229-1.