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      Why differentiating between health system support and health system strengthening is needed

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          Abstract

          There is increasing recognition that efforts to improve global health cannot be achieved without stronger health systems. Interpretation of health system strengthening (HSS) has varied widely however, with much of the focus to-date on alleviating input constraints, whereas less attention has been given to other performance drivers. It is important to distinguish activities that support the health system, from ones that strengthen the health system. Supporting the health system can include any activity that improves services, from distributing mosquito nets to procuring medicines. These activities improve outcomes primarily by increasing inputs. Strengthening the health system is accomplished by more comprehensive changes to performance drivers such as policies and regulations, organizational structures, and relationships across the health system to motivate changes in behavior and/or allow more effective use of resources to improve multiple health services. Even organizations that have made significant investments in health systems have not provided guidance on what HSS entails. While both supporting and strengthening are important and necessary, it is nonetheless important to make a distinction. If activities fail to produce improvements in system performance because they were incorrectly labeled as system strengthening, the value of HSS investments could quickly be discredited. Not distinguishing supportive activities from strengthening ones will lead to unmet expectations of stronger health systems, as well as neglect of critical system strengthening activities. Distinguishing between these two types of activities will improve programming impact. Copyright © 2012 John Wiley & Sons, Ltd.

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          Most cited references13

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          The Global Health System: Strengthening National Health Systems as the Next Step for Global Progress

          In the second in a series of articles on the changing nature of global health institutions, Julio Frenk offers a framework to better understand national health systems and their role in global health.
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            Everybody business-strengthening health systems to improve health outcomes: WHO’s framework for action

            (2007)
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              Everybody's business -- strengthening health systems to improve health outcomes : WHO's framework for action

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                Author and article information

                Journal
                Int J Health Plann Manage
                Int J Health Plann Manage
                hpm
                The International Journal of Health Planning and Management
                Blackwell Publishing Ltd
                0749-6753
                1099-1751
                January 2013
                09 July 2012
                : 28
                : 1
                : 85-94
                Affiliations
                Abt Associates Inc Bethesda, MS, USA
                Author notes
                *Correspondence to: G. Chee, Abt Associates, Inc, 4550 Montgomery Avenue, Ste 800N, Bethesda, MD 20814, USA. E-mail: grace_chee@ 123456abtassoc.com
                [†]

                Principal Associate.

                [‡]

                Division Vice President.

                [§]

                Principal Associate.

                [¶]

                Principal Associate.

                Article
                10.1002/hpm.2122
                3617455
                22777839
                962ff0aa-884a-4c6b-b1a6-d3f64c637011
                Copyright © 2013 John Wiley & Sons, Ltd.

                Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.

                Categories
                Research Articles

                Economics of health & social care
                health systems strengthening,systems approach,international health,global health initiatives

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