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New! USAID Health System Strengthening Resources

Recommendations for Strengthening Health Systems during the COVID-19 Pandemic and Beyond

Recommendations for Strengthening Health Systems during the COVID-19 Pandemic and Beyond

Health systems in low resource settings continue to be severely strained by the COVID-19 pandemic. These systems are already fraught by a high incidence of non-communicable and infectious diseases, an inability to adequately provide high quality primary and specialty health care services, and the escalating costs associated with providing health services. These factors continue to undermine access to equitable and quality essential health services, and place further strain on human and financial resources in the health sector. This guide provides a resource for planning and implementing support to host country health system responses. The identified recommendations serve as a starting point, meant to be tailored to the local country context and changing circumstances based on the intersection of the COVID-19 trends, disruption to essential services, and level of vaccinated population.

High Performing Health Care (HPHC) Tool

High Performing Health Care (HPHC) Tool

USAID’s new Vision for Health System Strengthening 2030 calls for a whole-of-society collaborative effort between public health services, communities, and health care institutions to ensure health systems perform in ways that promote the achievement of universal health coverage (UHC). To measure progress toward becoming a high performing health system, USAID and partners developed a web-based tool called the High Performing Health Care (HPHC) tool. USAID believes the HPHC tool can help countries assess their progress for achieving UHC, especially in low- and middle-income countries. The free, web-based application measures strengths and weaknesses in a health system and is part of the Agency’s efforts to improve, track, and report on the impact of USAID’s health systems strengthening programs. The HPHC tool provides real time data analysis and visualization to help countries plan, manage, and monitor the effectiveness of their health system strengthening activities while also providing a basis for comparison of health systems issues and interventions on a global scale. Please check out the tool here.

Health Systems Strengthening Learning Agenda cover image

Health Systems Strengthening Learning Agenda

Through the Health System Strengthening (HSS) Learning Agenda, the Bureau for Global Health, led by the Office of Health Systems (OHS), aims to improve health system strengthening programming by updating or generating, synthesizing, and disseminating evidence related to key HSS learning questions. The Learning Agenda will serve as a platform for continuous HSS learning and adaptation. Evidence from the implementation of the Learning Agenda will be used in the design and management of USAID health system strengthening strategies, programs, projects, and activities. OHS will regularly collate and share this evidence within the Agency and with our donor, implementer, government, private sector and civil society partners, to inform our collective efforts to support sustainable health systems.

Access To Universal Health Coverage Through High-Performing Health Care cover

Universal Health Coverage through High Performing Health Care

Achieving universal health coverage (UHC) requires contributions from public and private health institutions to meet a set of standards that collectively indicate high performing health care. To help deliver on this aspirational goal, we work together to create high quality health care that is Accountable, Affordable, Accessible, and Reliable.

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Blueprint for Global Health Resilience

As the COVID-19 pandemic has demonstrated, much of our global health work is interconnected. Disruptions caused by one event impact the delivery of essential services across the health sector and beyond. Over the past few months, experts from across USAID’s Global Health Bureau worked together to develop a “Blueprint for Global Health Resilience”, which demonstrates the interconnections both within our global health programs and across the Agency. This document outlines several "lessons learned" from COVID-19 and past outbreaks and other system shocks that impact healthcare delivery.

Roadmap for Systematic Priority Setting and Health Technology Assessment (HTA) cover

Roadmap for Systematic Priority Setting and Health Technology Assessment (HTA)

Low- and middle-income countries (LMICs) struggle to reach and sustain universal health coverage due to limited and inefficient allocation of resources. Faced with a widening gap between rising health care needs and available resources, how can LMICs ensure efficient and equal health care? The new, practical guide, A Roadmap for Systematic Priority Setting and Health Technology Assessment (HTA), developed by Management Sciences for Health (MSH) and the USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, with contributions from global experts in the field, can help countries bridge this gap and put them on a path toward self-reliance. Download here.

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The Role of Digital Financial Services in Accelerating USAID's Health Goals

Digital financial services (DFS) provide health programs with opportunities to accelerate progress toward global health goals and outcomes. By leveraging DFS, United States Agency for International Development’s (USAID) global health program managers can improve health systems performance and support programmatic outcomes such as financial protection for vulnerable groups, delivery of essential health services, improved reach to marginalized communities, and increased health service demand and responsiveness.

Vulnerable households, communities, and countries face many challenges to better health and economic outcomes. Barriers to health, education, and livelihoods must be managed or overcome to identify pathways to resilience and prosperity. USAID defines resilience as “the ability of people, households, communities, countries, and systems to mitigate, adapt to, and recover from shocks and stresses in a manner that reduces chronic vulnerability and facilitates inclusive growth.” Simply, resilience is the ability of households, communities, and countries to manage and adapt to adversity without compromising their well-being. Research identifies sources of resilience that transcend sectors, underscoring the importance of a holistic approach to programming. Financial inclusion is one such source of resilience. It is defined as a state where individuals and businesses have access to useful and affordable financial products and services—transactions, payments, remittances, savings, credit, and insurance—that meet their needs, delivered in a responsible and sustainable way. Financial services contribute to resilience through investments that build assets that households and communities draw on in times of need. They also help speed recovery.


The Joint Statement from USAID and International Organizations on the Implementation of Primary Health Care [PDF, 73KB]

In anticipation of the renewed Declaration on Primary Health Care, USAID and several international organizations agreed to this statement identifying key principles for primary health care implementation. 


HSS Monitoring, Evaluation and Learning Guide

The Health System Strengthening (HSS) Monitoring, Evaluation and Learning (MEL) Guide by USAID and MEASURE Evaluation is designed to help change common perceptions that HSS is “too complex to measure.” Intended for USAID staff and HSS practitioners, the guide provides methods and techniques on how to monitor the progress of HSS projects and how to assess the linkages between HSS interventions and health system outcomes and impact.


Community Engagement for Health System Strengthening

Community Health Worker Assessment and Improvement Matrix [PDF, 1.6MB]

To harness the potential of community health workers (CHWs) to extend health services to poor and marginalized populations, there is an urgent need to better understand how CHW programs can be optimized.

To support quality CHW program design and implementation, USAID, UNICEF, the Community Health Impact Coalition, and Initiatives Inc. have updated and adapted the Community Health Worker Assessment and Improvement Matrix (CHW AIM) Program Functionality Matrix tool. This tool can be applied at district, regional, and national levels to identify and close gaps in design and implementation and, ultimately, enhance program performance.


Community Health Systems Catalog

Utilizing comprehensive country profiles, the Advancing Partners and Communities "Community Health Systems Catalog" shows trends in community health across 25 countries. The catalog provides the latest information on these countries’ community health systems, including how policies are supporting community health programs and access to key interventions.


Legacy USAID Health Systems Reports

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USAID's Vision for Health Systems Strengthening (2015-2019)

[PDF, 1.6MB]

Health Systems Strengthening (HSS) has been at the core of the USAID mission in health for the last 20 years. Governments and donors acknowledge USAID as a valued partner in HSS because of our contributions of critical resources, technical expertise, leadership, and in-country presence. Many actors – development partners, non-governmental organizations, other civil society organizations, and public-private partnerships – increasingly are targeting their substantial resources to HSS. USAID’s Vision for Health Systems Strengthening focuses on our work to achieve four strategic outcomes: financial protection, essential services, population coverage, and responsiveness.

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Impact Of Health Systems Strengthening On Health

The effects of health systems strengthening on health status and related outcomes, have not been comprehensively reviewed or captured in a single document. To address this knowledge gap, the Health Finance and Governance (HFG) Project conducted a review of published systematic literature reviews that assessed the effects of health systems strengthening interventions on health status and health system outcomes (service utilization, quality service provision, uptake of healthy behaviors, and financial protection) in low- and middle-income countries (LMICs).  


Marshalling the Evidence: A Status Report [PDF, 2.0MB]

Marshalling the Evidence Initiative is an integrated approach synthesizing and generating evidence to enhance our understanding of the impact of HSS on health systems performance and health outcomes.

As low- and middle-income countries embark on a path toward universal health coverage, this evidence gap could continue to hinder support for HSS from numerous stakeholders. The field of HSS is relatively young, and systems-level interventions are inherently complex; consequently, the evidence base for HSS reforms and interventions and their impacts on health outcomes is limited and less robust than for technical health interventions. To enhance its understanding of the impact of HSS on health systems performance and health outcomes, USAID has adopted an integrated approach to marshalling the evidence on this relationship. This initiative comprises 11 activities.


Resources from Former USAID Health Systems Projects

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USAID's Public Sector Systems Strengthening (PS3) Project in Tanzania: Case Briefs

If you have the people, the resources, and the means to deliver services, then you have the right elements to improve the quality of service delivery. USAID and the Government of Tanzania (GoT) used this principle to guide their approach for designing the Public Sector Systems Strengthening (PS3) project by examining how resources are mobilized and applied into planning and budgeting for public services. The system approach for designing PS3, combined with consistent stakeholder engagement and commitment, has made this multi-sector project successful in integrating people and systems to improve the quality of public services delivered. USAID developed these seven case briefs that examine the different facets of this health systems strengthening project.

Improving Health Care in Low- and Middle-Income Countries

Improving Health Care in Low- and Middle-Income Countries: A Case Book

USAID and the Applying Science to Strengthen and Improve Systems (ASSIST) Project published this new open access resource for health care improvement. The book features 12 cases on quality improvement from 11 countries in Africa, Asia, Eurasia, and Latin America that provide in-depth descriptions of what health services improvement efforts look like in practice. The book is useful for a range of audiences, including Ministry of Health policymakers, health care managers, health professionals, schools of public health and students of healthcare improvement, technical assistance agencies, and implementing partners. Download the book for free here.

USAID ASSIST Project: Applying Science to Strengthen and Improve Systems

25 Essential Resources for Health Care Quality Improvement: A Compendium of Resources from the USAID ASSIST Project 2012 - 2020

Since 2012, the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project has worked in over 40 countries, building the capacity of service delivery organizations and implementing partners to improve the effectiveness, efficiency, client-centeredness, safety, accessibility, and equity of the health and social services provided. As the project's parting contribution upon its closure in June 2020, ASSIST created this curated collection of 25 quality improvement (QI) resources that capture key learning. Bookmark this compendium of resources at In addition, all video content from ASSIST will be available at


Health System Assessment Approach (HSAA)

Health System Assessment Approach (HSAA) has been widely used in the developing world to diagnose health systems performance and to capture system-wide information to better inform health sector planning. The HSAA looks at the entire health system, including governance, health financing, health services delivery, human resources, pharmaceutical management, and health information systems, plus the private sector, which is an important yet often overlooked part of the health system.

The HSAA v3.0 represents the collective experience of application in 25 countries across Asia, Africa, and Latin America and the Caribbean between 2006 and 2012. USAID and its partners have used the health system assessment results to inform national strategic plans, PEPFAR partnership frameworks, grant applications, and numerous other health systems strengthening and programmatic activities. Stakeholder engagement is emphasized throughout the application of the approach, to ensure buy-in to the assessment process and findings, and sustainability of follow-up.


Health Systems Benchmarking Tool

Donors and country health planners need to compare health system performance among countries and administrative units to benchmark performance and make informed investments and decisions. Before, no global tools were available for benchmarking health system functions, outcomes, and impact. USAID's Health System Benchmarking Tool (HSBT) is designed for health system managers and administrators, policy makers, and monitoring and evaluation experts. The HSBT helps to standardize the process of tracking health systems indicators to provide answers to policy and programmatic questions. These include indicators for low- and middle-income countries, including indicators ones focusing on the ending preventable child and maternal deaths, achieving an AIDS-free generation, and protecting communities from infectious disease.

HSBT can highlight a health system’s strengths and weaknesses, especially when compared with other countries with similar socio-economic, demographic, or gender empowerment characteristics. A unique feature of the tool is its clustering function. Users can match countries’ socio-economic characteristics to control for their effects before comparing health system indicators. The Excel-based tool can be downloaded to be accessed offline.

Additional highlights of HSBT:

  • Displays data sets for 142 countries covering socio-economic, demographic and gender and health system functions, outcomes, and impact indicators (2000–2014).
  • Allows for comparison of indicator(s) over time by countries, countries within regions, and countries by income groups.
  • Recognizes trends in health system indicators from 2000 to 2014.
  • Can identify countries with best and worst health system indicators by region, income group, or by a selected group of countries.
  • The data set can be imported in any statistical software for inferential analysis.

Last updated: September 03, 2021

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