Health systems strengthening

Countries and the global health community broadly agree that the cornerstone of achieving universal health coverage is to develop and strengthen all aspects of countries’ health systems.

A main purpose of UHC2030 therefore is to help improve coordination to ensure the most effective approach to health system strengthening.

UHC2030 encourages partners and related initiatives to coordinate their efforts on health systems strengthening, and provides concrete tools and approaches to help improve such coordination. This particularly applies in low- and middle-income countries with weaker health systems, where multiple partners provide development cooperation to support health systems strengthening (HSS).

Action on health systems, for universal health coverage and health security

Read UHC2030’s strategic narrative to guide advocacy and action on strengthening health systems here. Strengthening health systems, with a focus on equity and resilience, is crucial for UHC and health security and contributes to wider socioeconomic progress.

Health systems for universal health coverage: a joint vision for healthy lives

Read about our joint vision for health systems strengthening here. This publication is a key reference document for UHC2030 and a broader resource for the global community to inform collaboration on the health systems strengthening (HSS) and universal health coverage (UHC) agenda. The vision outlines performance and policy entry points to promote UHC through HSS, including critical action for the way forward and principles to guide action.

In relation to HSS, UHC2030 works to:

Improve coordination of HSS efforts at global level, including synergies with related related initiatives
Strengthen multi-stakeholder policy dialogue and coordination of health systems strengthening efforts in countries, including adherence to principles of effective development cooperation in countries receiving external assistance.
Continue to prioritise impact at country level through developing tools and approaches that can improve coordination, including facilitating coordinated technical assistance.
Other areas of UHC2030 work such as knowledge exchange and learning, and some of the Technical Working Groups also contribute to facilitating better coordination of health systems strengthening.

Effective development cooperation

For countries that receive external donor assistance to develop health systems, adhering to effective development cooperation principles is still the most important way to ensure coordination around health systems strengthening.

UHC2030 draws on lessons from the IHP+ experience, about what has worked well and what has not, including how to better promote the principles of effective development cooperation, like the Seven Behaviours. These principles are anchored in country ownership and guide the actions of all partners towards more effective and aligned efforts towards HSS and thereby UHC.

Learn more about "7 behaviours for effective development cooperation"

UHC2030 continues to pay particular attention to country contexts where the alignment and coordination of global partners around country leadership and systems is critical but not a given, particularly in post-conflict and fragile contexts.

Action on health systems, for universal health coverage and health security

The COVID-19 pandemic puts global health and well-being at a pivotal moment. Individually and collectively, countries need to do better on both universal health coverage and health security. Strengthening health systems, with a focus on equity and resilience, is crucial for UHC and health security and contributes to wider socioeconomic progress.

UHC2030’s new paper, Action on health systems, for universal health coverage and health security provides a strategic narrative for strengthening health systems, to guide national, regional and global advocacy and action. It brings together recommendations from recent high-profile initiatives and reports, focusing on priority actions and the roles of different partners and constituencies.

This “shared script” provides the basis for UHC2030’s diverse membership to:

Promote political leadership for stronger health systems
Mobilize better-aligned resources for health systems, for UHC and for health security
Demand and act for solidarity and equity in health systems

As the established multi-stakeholder partnership for health systems and UHC, UHC2030 is well-positioned to mobilize action. This includes advocacy and policy dialogue between UHC2030 partners and governments (especially ministries of health and ministries of finance). Internationally, UHC2030 will help identify key moments and opportunities in relevant regional and global initiatives, political processes and governing bodies. The paper will also inform priorities for the UHC movement ahead of the UN High-Level Meeting on UHC in September 2023.

Download: Action on health systems, for universal health coverage and health security

Health Systems Policy Areas and Actions

Health systems strengthening should focus on five dimensions of health system performance:

Equity
Quality
Responsiveness
Efficiency
Resilience

Improved health systems performance also requires national, regional and global action in three interrelated health systems policy areas:

1. Service delivery

Expanding frontline services, particularly primary health care
Scaling up investment in skilled health workers
Improving access to medicines and health technologies
Innovating to meet the health needs of vulnerable and marginalised groups
Expanding engagement with non-state providers
Improving patient safety and quality of health services
Implementing International Health Regulations and service delivery models that promote resilience
Fostering multi-sectoral action to address the social determinants of health.

2. Health financing

Mobilising resources through progressive taxation and prioritising health, within a sustainable macroeconomic framework
Expanding pooling arrangements to improve financial protection for all
Strategic purchasing to increase efficiency of health spending, with a focus on public goods and public health.

3. Governance

Fostering citizens’ platforms and people’s voice mechanisms
Promoting freedom of information and expanded use of quality data
Adopting legal frameworks supporting access to quality health services
Developing policy dialogue platforms and multi-sectoral action
Promoting regional and global mechanisms for collective action and partnership
Strengthening research and development, including technology transfer mechanisms.

There is no one-size-fit all approach to health systems strengthening. The following principles have been identified to guide action in prioritising and implementing HSS:

Leaving no one behind: a commitment to equity, non-discrimination and a human rights-based approach
Transparency and accountability for results
Evidence-based national health strategies and leadership
Making health systems everybody’s business with engagement of citizens, communities, civil society and private sector
International cooperation based on mutual learning across countries and development effectiveness principles.

Tools and approaches to improve coordination of HSS

UHC2030 continues to update existing tools, such as the Joint Assessment of National Health Strategies and Joint Annual Reviews below. We also consider the development of new tools to assist countries to translate the principles of strengthening health systems for UHC into practice.

Here are the tools associated with coordination of health systems strengthening efforts.

Useful resources

Download: Statement on sustainability and transition from external funding

Download: UHC2030 Guidance document to assess a health care arena under stress

Download: Public financial management - Policy notes

Download: Covid19 and fragile settings - Policy notes

Country Compacts

Joint Assessment of a National Health Strategy (JANS)

Joint Financial Management Assessment

Country planning database

Monitoring, evaluation and review of national health strategies - a country-led platform for information and accountability

Joint Annual Health Sector Reviews (JARs)