“Health Systems Strengthening” by Rethink Priorities

Editorial note

This report is a “shallow” investigation, as described here, and was commissioned by Open Philanthropy and originally produced by Rethink Priorities from September to October 2024. Open Philanthropy does not necessarily endorse our conclusions, nor do the organizations represented by those who were interviewed.

Our report focuses on exploring health systems strengthening (HSS) as a potential new cause area for Open Philanthropy. We examined a range of interventions to improve health system performance, analyzed case studies of successful systems in low- and middle-income countries, and highlighted promising opportunities for philanthropic funding. We reviewed the scientific and gray literature and spoke with six experts to describe the state of the field as of late 2024. In early 2025, we revised the report for publication; we also added a short addendum based on a second round of interviews with a different group of experts to incorporate updates related [...]

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Outline:

(00:12) Executive summary

(00:16) Scope

(00:40) Research process

(01:34) Key findings

(07:02) Key uncertainties

(08:17) Health systems strengthening as a cause area

(08:21) Shortcomings in LMIC health systems are large and comparatively neglected

(14:44) What is health systems strengthening?

(16:57) A taxonomy of typical HSS interventions

(22:05) Challenges in evaluating HSS interventions and their cost-effectiveness

(24:30) Country case studies: Lessons from high-performing health systems

(27:39) Bangladesh

(31:33) Thailand

(35:32) Ethiopia

(41:09) Ghana

(44:33) Kerala

(47:31) Valuable case studies recommended by experts

(48:14) Rwanda

(49:27) Sri Lanka and Cuba

(49:53) South Africa

(50:35) Vietnam

(50:55) Highlighted HSS interventions

(50:59) Our research and prioritization process

(55:29) Integrated Management of Childhood Illness (IMCI)

(55:34) What is it?

(56:56) Reasons in favor

(59:22) Reasons against

(01:01:06) Crucial considerations

(01:02:13) Potential grants

(01:02:40) Our take

(01:04:03) Supervision and mentorship for IMCI providers

(01:04:09) What is it?

(01:04:47) Reasons in favor

(01:07:44) Reasons against

(01:08:39) Potential grants

(01:10:07) Our take

(01:10:59) Community health workers (CHW) / service extensions and health posts

(01:11:06) What is it?

(01:12:17) Reasons in favor

(01:15:26) Reasons against

(01:17:30) Crucial Considerations

(01:19:43) Potential grants

(01:21:03) Our take

(01:21:38) Social accountability interventions / Community score cards

(01:21:44) What is it?

(01:22:23) Reasons in favor

(01:25:36) Reasons against

(01:26:57) Crucial Considerations

(01:27:40) Potential grants

(01:28:20) Our take

(01:29:14) Continuous Quality Improvement (CQI)

(01:29:19) What is it?

(01:30:46) Reasons in favor

(01:32:23) Reasons against

(01:33:13) Crucial Considerations

(01:34:15) Potential grants

(01:34:28) Our take

(01:35:05) Drug delivery system reform

(01:35:09) What is it?

(01:36:11) Reasons in favor

(01:38:13) Reasons against

(01:40:28) Crucial considerations

(01:41:31) Potential grants

(01:42:47) Our take

(01:43:19) Interventions discussion

(01:43:23) Our impression from the studied interventions

(01:45:22) Leadership & governance

(01:47:01) Health workforce

(01:48:25) Financing

(01:49:47) Health information

(01:51:35) Supply chain strengthening

(01:52:20) Service delivery

(01:53:51) Other recommendations from experts

(01:56:04) Spotlight on two implementing organizations

(01:57:48) mPharma

(01:57:51) What is it and what does it do?

(02:00:01) How well does it work?

(02:01:14) Our takes

(02:02:29) Last Mile Health

(02:02:33) What is it and what does it do?

(02:04:22) How well does it work?

(02:05:50) Our takes

(02:06:24) Recommendations for further exploration

(02:08:51) Higher-level takes on health systems strengthening

(02:10:43) Reasons HSS interventions might be more effective than vertical programs

(02:10:50) Broader, longer-term, and leveraged impact

(02:11:45) Resilience to respond to crises

(02:13:12) Reduction of duplication and administrative overhead

(02:14:02) Addendum: Reflections on USAID withdrawal and emerging gaps in HSS

The original text contained 44 footnotes which were omitted from this narration.

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First published:
April 19th, 2025

Source:
https://forum.effectivealtruism.org/posts/c7b4Dmu84QHfD6cLK/health-systems-strengthening

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Narrated by TYPE III AUDIO.

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