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Mainstreaming Health Systems Strengthening Initiative
Health Systems Assessment Approach

USAID’s Office of Health, Infectious Diseases and Nutrition (HIDN) requested the development of a Health Systems Assessment Approach (Please note that this manual is a draft; all the chapters are currently being revised. A revised version of the manual will be available in July 2006.) as part of its global Mainstreaming Health Systems Strengthening Initiative.

The Assessment Approach was developed by Partners for Health Reformplus (PHRplus), Rational Pharmaceutical Management Plus (RPM Plus) and the Quality Assurance Project (QAP). It is designed to provide a rapid yet comprehensive assessment of key health systems functions and related resources. The approach is organized around technical modules which guide data collection, and cover the following areas:
  • Stewardship
  • Health financing
  • Service delivery
  • Human resources
  • Pharmaceuticals
  • Health information systems
  • Private sector engagement

Each module provides guidance for the user according to an indicator-based approach. The assessment approach is flexible and may encompass all modules for a more comprehensive view of the health care system, or may focus on selected modules, according to the objectives of the assessment. A required core module provides basic background information. Data collection entails a desk review of relevant documents, and guided stakeholder interviews. A stakeholder workshop is held to present and verify findings, and to elicit inputs into the analysis and recommendations.

Application & Results
The Health Systems Assessment Approach has the following applications:

  • To enable USAID missions to assess a country’s health system, possibly during early phases of program development or sector planning. This will include diagnosing the relative strengths and weaknesses of the health system, prioritizing key weakness areas, and identifying potential solutions or recommendations for interventions
  • To inform PHN officers and Mission health teams about the basic elements and functions of health systems
  • To improve the capacity of bilateral projects to achieve USAID’s health impact objectives through increased use of health systems interventions
  • To aid health systems officials at USAID to conceptualize key issues, increase the use of health systems interventions in technical program design and implementation, and to improve the role of the Health Systems Division
  • To inform Ministries of Health and other stakeholders on the relative strengths and weaknesses of the health system, priority issues, and potential solutions or recommendations for interventions and programs

The primary target user of the assessment approach is the USAID country mission, particularly PHN officers. The PHN officer may carry out an assessment independently or with a team of USAID staff and/or consultants. The approach was pilot tested in Angola in August 2005 and in Benin in April 2006. The materials are available in a manual format, which is now undergoing revision. The next draft version will be available in July 2006.

Please note that the chapters available for downloading are drafts; all chapters are currently being revised. A revised version of the manual will be available in July 2006. Note that some annexes are not available for download because they are currently under revision.

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