Health system strengthening interventions

Overview

For drugs and medical technologies, the standard of efficacy is the randomized controlled trial. The strongest evidence is required prior to technology use – even in the case of cosmetic drugs. In contrast, health systems interventions are frequently implemented based on theoretical grounds of potential effectiveness rather than actual evidence.

In low-income settings, enormous numbers of lives are lost because of continued long-standing weaknesses in health systems that impede performance and absorption capacity, and prevent sustained gains in coverage and health outcomes. Investing in large-scale health system strengthening interventions requires concomitant investments in impact evaluation to understand what works, given the immense consequences of failed health systems on morbidity and mortality worldwide.

Generating knowledge about the kinds of programs that are really effective in strengthening health systems, however, has proven difficult for a number of reasons. There are few incentives to conduct research and evaluation among governments, bi- and multi-lateral donors, and aid agencies; in many contexts political and financial obstacles exist, and technical capacity required to design rigorous evaluations and analyze the data to demonstrate impact is weak.

This paper focuses on impact evaluation, defined as an evaluation of change caused by an intervention. This is distinct from formative and process evaluations, which aim to provide feedback for improving program performance and implementation.