Strengthening Health Systems to Support HIV and AIDS Prevention, Care and Treatment

Photo of a man holding a box of antiretroviral drugs
Pharmacist Kennedy Aduol receives a delivery of US-funded antiretroviral (ARV) drugs at the Sena Health Center on Mfangano Island in Lake Victoria.
Riccardo Gangale/USAID


Progress toward an AIDS-free generation is dependent upon the ability of at-risk individuals and people living with HIV and AIDS to find and access quality health services, providers and products. A well-functioning health system meets these needs, effectively supporting prevention, care and treatment for HIV and AIDS. Building strong health systems is a crucial step on the path toward universal access to comprehensive HIV programs and a country-led, sustainable response to the epidemic. Unfortunately, many health systems are weak, overburdened and unable to meet the needs of the people they serve.

Six interconnected building blocks outline the functions of the health system:

  1. Service Delivery: delivery of effective, safe, high-quality health interventions to those who need them, when and where needed, with minimum waste of resources
  2. Leadership and Governance: ensuring strategic policy frameworks exist and are combined with effective oversight, coalition building, appropriate regulations and incentives, attention to system design and accountability
  3. Financing: mobilization of adequate resources from reliable sources, pooling of resources to foster efficiency and spread costs and allocation of resources to promote efficiency, equity and health impact
  4. Medical Products, Vaccines and Technologies: equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use
  5. Information: production, analysis, dissemination and use of reliable and timely information on health determinants, health systems performance and health status
  6. Human Resources for Health: ensuring a sufficient number and mix of staff and volunteers that are fairly distributed, efficient, responsive and competent to achieve the best health outcomes possible given available resources and circumstances


Under the 2008 reauthorization of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), special emphasis was placed on strengthening health systems and workforce capacity and deeper integration of HIV and AIDS programs into health systems. This shift toward greater emphasis on sustainability and country ownership of the HIV and AIDS response has yielded significant gains against this global epidemic. As a key implementing agency of PEPFAR, the U.S. Agency for International Development’s (USAID’s) health systems strengthening (HSS) efforts enable PEPFAR to reach its ambitious targets for prevention, care and treatment.

USAID’s Office of HIV/AIDS engages in HSS in three ways:

  1. Focused interventions in HSS to address health system gaps specific to the achievement of PEPFAR and host country goals for HIV and AIDS prevention, care and treatment (for example, developing information systems to improve antiretroviral drug [ARV] delivery).
  2. Intentional spillovers, which are achieved when PEPFAR designs and implements HIV-focused activities in anticipation that these activities can and will benefit non-HIV and AIDS elements of the health system at no or very low additional cost (for example, capacity building for ARV procurement systems can also be used to purchase maternal and child health commodities).
  3. Targeted leveraging of funds, which is achieved by partnering with other development or entities to jointly sponsor broad-based health system improvement efforts that have an HIV and AIDS link (for example, joining other donors in developing a comprehensive national health insurance program that includes coverage for HIV and AIDS services).

The Office of HIV/AIDS collaborates closely with the Bureau for Global Health Office of Health Systems to help support HIV and AIDS and PEPFAR HSS efforts.


Photo of a man getting his blood pressure taken.
Community health workers trained by USAID provide basic health services.

Global Health Evidence Summit on Community and Formal Health System Support for Enhanced Community Health Worker Performance

The global shortage of skilled, motivated and supported health workers is a key development challenge and a barrier to strengthening health systems, improving the prospects for universal health coverage and addressing inequity and poverty around the world. An important dimension of the U.S. Government response to this challenge has been a resurgence of interest in and attention to community health workers (CHWs). Many countries are increasing their investments and implementing large-scale CHW programs to extend the reach of inadequate health systems to hard-to-reach and underserved populations and to expand coverage of key interventions. However, more evidence is needed to understand how best to support CHWs to ensure scale-up and sustained, optimal performance. Recognizing the need for greater clarity, USAID initiated a year-long evidence review process that culminated in an Evidence Summit event on May 31–June 1, 2012. The Evidence Summit brought together low- and middle-income country governments and non-governmental organizations, the U.S. Government and non-governmental agencies, bilateral and multilateral agencies and domestic and international academic institutions to discuss existing evidence and make recommendations for policy, practice and future research. For the full summit report, visit the Global Health Evidence Summits page.

Monitoring HIV Policy

The USAID-funded Health Policy Project, in collaboration with the Centers for Disease Control and Prevention and the University of Washington, works to strengthen country ownership of and accountability for HIV programs through support to country stakeholders in the planning, implementing and monitoring of progress of policy intervention commitments in PEPFAR Partnership Framework Implementation Plans. Central to these efforts is the Road Map for Implementing and Monitoring Policy Interventions, a tool that strengthens the capacity of U.S. Government teams, partner governments and civil society organizations to monitor progress of policy interventions.

PEPFAR Expenditure Analysis

Women being counseled on health choices
Beatrice, holding Gabriel, and Grace, with baby Mary, listen as CHW Jane Akoth (right) counsels them on their health choices.

The PEPFAR Blueprint for an AIDS-free Generation [PDF, 2.8MB] highlights the importance of improved collection and use of economic and financial data for increasing the efficiency, effectiveness and sustainability of HIV and AIDS programs. In 2009, PEPFAR began to pilot the Expenditure Analysis Initiative, an effort to track expenditures of PEPFAR programs to:

  • Provide a better understanding of the expenses the U.S. Government incurs to provide a range of HIV services in the countries in which it works.
  • Highlight areas for improved efficiency and improve alignment of future investments to program needs.
  • Estimate the resources needed to support future programs.
  • Better understand unit expenditures by program area and service provider.

Read more about the expenditure analysis.


Last updated: November 05, 2013

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