About the Health System Strengthening (HSS) Learning Series 

The Health System Strengthening (HSS) Learning Series is hosted by USAID’s Office of Health Systems to share, learn, and use HSS evidence for more effective and sustainable health system strengthening. The field of HSS, and USAID’s work, continues to evolve, making this a much-needed opportunity to reflect on emerging needs for new evidence, current priorities, and strategic directions. 

Learning exchanges under the series are designed to relate to a specific question(s) under USAID’s HSS Learning Agenda and to share insights on priority topics in the field of HSS. 

Below is a recap of key takeaways, resources, and lessons learned from the 2023 Learning Series events. 

**USAID invites organizations interested in hosting a webinar under USAID's HSS Learning Series to request more information on submission requirements from HSSlearning@usaid.gov. Please be aware that this is not a Request For Proposals/Applications and is not a solicited or unsolicited funding opportunity.

HSS Learning Agenda Questions:

  1. What are the contributions of systems thinking approaches and tools to changes in health system outcomes? How do systems thinking approaches affect health system outcomes?

  2. What conditions or factors successfully facilitate the institutionalization and/or implementation at scale of good practices that improve health system outcomes, and why? What are lessons learned regarding planning for sustainability and achieving results at scale?

  3. What measurement tools, approaches, and data sources, from HSS or other fields, are most helpful in understanding interrelationships and interactions and estimating impact of HSS interventions on health system outcomes and priority health outcomes?

  4. What are effective and sustainable mechanisms or processes to integrate local, community, sub-national, national, and regional voices, priorities, and contributions into USAID’s health system strengthening efforts?

  5. What are effective and sustainable mechanisms or processes that enable the participation of private sector, civil society, and public organizations in developing locally-led solutions to improve high-performing health care, especially for poor and vulnerable populations? What enables the effective participation or leadership of marginalized populations themselves in the development and implementation of these solutions? Under what conditions is this participation different?

  6. What are key behavioral outcomes that indicate a functioning, integrated health system? In what ways can integrated health system strengthening approaches explicitly include social and behavior change?

HSS Learning Series Takeaways:

November 2023: HSS Case Competition Virtual Showcase  

USAID's annual HSS Case Competition is an opportunity to capture knowledge on what does and does not work when implementing and scaling up health system programs and approaches. Case submissions help inform USAID and our partners’ ongoing work and contribute to learning syntheses and dissemination under the USAID HSS Learning Agenda to strengthen the global HSS evidence base.

The 2023 HSS Case Competition focused on learning questions 1 (systems thinking), 4 (integrating local voices), and 6 (social and behavior change). The three winning cases from India, Philippines, and Ukraine - selected by a panel of judges from the HSS Accelerator and USAID -  highlight strong work in each of these areas. Teams representing each of the winning cases were able to highlight their work at the virtual showcase and engage in discussion with a global audience. 

Key Takeaways:

  • The SAFEMed Program successfully implemented a systemic intervention using market solutions to lower prices of essential medicines and offer financial risk protection to Ukrainians with the highest burden of disease by engaging the private sector; using a staged implementation approach; ensuring technological interoperability and data feedback loops; and galvanizing political will even throughout leadership transitions. 

Resources:

Related HSS Learning Products: 
HSS Evidence Gap Map: Learning Question 1 (Systems thinking)

December 2023: Promoting Medical Product Quality Assurance to Achieve Better Health Outcomes

Substandard and falsified (SF) medicines are on the market in every country and can undermine country health programs and goals. A critical, but often hidden part of the health system, is medical product quality assurance (MPQA), which works to ensure the quality, safety, and effectiveness of medicines and medical products. Improving the MPQA system entails strengthening several health system functions simultaneously, recognizing their interconnectedness, and facilitating interactions among these building blocks. As witnessed during the COVID-19 pandemic, the different actors in this system played critical roles in ensuring medicines, vaccines, and health products are safe and effective.

This webinar shared how USAID’s early and long-term investments in strengthening MPQA systems are paying off in Benin, Kenya, Ghana, Mali, and Pakistan. It also shared a new model that estimates the costs – financial and social – of SF medicines, the findings from which can inform government funding and health priorities.

Key Takeaways:

  • Regulatory systems are critically important – medical products including medicines, vaccines, and diagnostics are required to confront health emergencies. Regulatory system strengthening is a critical part of health systems and health security.

  • Strong regulatory networks facilitate harmonization and reliance, which is critical during emergencies as it facilitates timely access.

  • Systems and tools are better built before, not during, health emergencies.

  • It is important to decentralize or equitably distribute by geographical areas pharmaceutical manufacturing – particularly pandemic-related medical products, including vaccines. Use of voluntary licensing, technology transfer hubs, and product development partnerships will increase. Therefore, capacity for regulatory oversight in those regions are required.

  • Building sustainable capacity for regional manufacturing and regulation of medical products will improve global access and address profound cases of inequities.

Resources

August 2023: Exploring the Evidence for Health System Sustainability Planning and Achieving Results at Scale 

The webinar featured a facilitated discussion of three case studies focusing on lessons learned regarding planning for the sustainability of health system strengthening interventions and achieving results at scale. The case studies addressed key themes and gaps in knowledge on the sustainability and scale up of HSS interventions identified through the HSS Evidence Gap Map. 

Key Takeaways: 

  • Planning for sustainability requires clear vision, processes, and milestones as showcased in the case study from USAID Health Financing Improvement Program. Planning for sustainability should start at the project design phase and include a shared explicit goal of sustainability and strategies for continuous learning and adaptation.
  • It is important to follow local priorities when planning for sustainability and scale, as evidenced by all three of the case studies. Aligning with local priorities engenders local leadership and ownership, both important elements of success.  
  • Applying a whole-of-society lens for sustainability and scale enables us to identify and build relationships and leverage multi sectoral stakeholders and champions with shared objectives for sustained efforts - driving continuity even as contexts evolve. This came out clearly in the case study from the Local Health System Sustainability Activity in Peru.
  • Communities and community leaders are crucial for sustained outcomes. As illustrated in the case study from Christian Connections for International Health, it is essential to engage such stakeholders in planning for sustainability to better understand local resources, needs, and capacity. 
  • Adequate and appropriately allocated financing is essential but not sufficient to ensure sustainability. It needs to be complemented with adequate organizational capacity, governance structures, and political will.
  • Context drives what sustainability and scale looks like, at both the institutional and system level. It is important to use a data-driven, systems approach to guide such efforts, with the overall goal of strengthening health functions and health outcomes.

Resources:

Related HSS Learning Products: 
HSS Evidence Gap Map: Learning Question 2 (Sustainability and scale)

February 2023: The Health Systems Strengthening Evidence Gap Map 

USAID’s 2023 HSS Learning Series launched in February with an introduction to the HSS Evidence Gap Map. The HSS Evidence Gap Map is a cornerstone of the HSS Learning Agenda implementation, helping to identify current gaps in HSS knowledge as we work to strengthen HSS practice. Users can search through the evidence by key themes, download results, and submit additional resources for inclusion. To facilitate knowledge use, short synthesis briefs summarizing the existing evidence and the identified gaps are also available on the website. 

Key Takeaways:

  • USAID’s Local Health System Sustainability (LHSS) Project followed a four-step evidence mapping and curating process for each question, which was resource-intensive. The Gap Map remains open for additional contributions on a rolling basis.
  • Per poll responses, the audiences’ top two reasons for using the Gap Maps are: 1) to use the evidence to strengthen my programs and activities; and 2) to identify the existing evidence gaps to which my activities can contribute.

Resources:

 

March 2023: State of the Evidence for Measuring Health System Interrelationships and Estimating Impact of Health System Strengthening 

This webinar focused on the relevant evidence identified and collated in the interactive Evidence Gap Map. The webinar included field participation and covered high-level characteristics of the evidence – including key themes and gaps – to inform targeted HSS programming. 

Key Takeaways: 

  • There is strong interest in rapid, complexity-aware methods to capture the interlinked nature of HSS with over 100 complexity aware frameworks and approaches used globally. 
  • There is consensus that monitoring and evaluating HSS continues to be challenging and needs more global focus, despite also needing to be context-specific in application by default.
  • So far, the community has focused on identifying the gaps related to HSS monitoring, evaluation, and learning, and we now need to move forward to action.

Resources:

Related HSS Knowledge Products: 

HSS Practice Spotlight Briefs: Contribution Analysis, Outcome Harvesting
HSS Evidence Gap Map: Learning Question 3 (HSS Measurement)

November 2023: 2023 HSS Case Competition Virtual Showcase 

USAID's annual HSS Case Competition is an opportunity to capture knowledge on what does and does not work when implementing and scaling up health system programs and approaches. Case submissions help inform USAID and our partners’ ongoing work and contribute to learning syntheses and dissemination under the USAID HSS Learning Agenda to strengthen the global HSS evidence base.

The 2023 HSS Case Competition focused on learning questions 1 (systems thinking), 4 (integrating local voices), and 6 (social and behavior change). The three winning cases from India, Philippines, and Ukraine - selected by a panel of judges from the HSS Accelerator and USAID -  highlight strong work in each of these areas. Teams representing each of the winning cases were able to highlight their work at the virtual showcase and engage in discussion with a global audience. 

Key Takeaways:

  • The USAID RenewHealth Activity successfully integrated local, community, sub-national, national, and regional voices and priorities into its community-based drug rehabilitation program in the Philippines by forming strategic partnerships with various local stakeholders including national government, universities, NGOs and churches. It also anchored activities with the direction and policies set by the government, thereby ensuring a shared vision and engendering the trust and support of national and local officials.

Resources:

Related HSS Learning Products: 
HSS Evidence Gap Map: Learning Question 4 (Integration and engagement of local voices)

May 2023: Improving the Linkages Between Social and Behavior Change and Health System Strengthening 

This webinar featured an interactive panel discussion to share knowledge and experience of how integrated health system strengthening approaches can explicitly include social and behavior change (SBC) interventions. 

Key Takeaways:

  • Five tips on how to start integrating and ultimately scale-up and institutionalize SBC within HSS programming: 
    • Get key stakeholder perspectives informally, and if possible, through research
    • Build in strong mechanisms for community engagement
    • Take time to understand both the system aspects (e.g., policies, supervision tools, opportunities in existing job descriptions) and the behavioral drivers (e.g., what motivates people to change behavior)
    • Analyze the patient experience through methods such as patient pathways analysis, journey mapping, and empathy analysis
    • Consider how to address providers’ emotional and social needs before focusing on other types of behavior change

Resources:

Related HSS Learning Products: 
HSS Practice Spotlight Briefs: Financial Protection and Social and Behavior Change, Social Accountability and Social and Behavior Change, Digital Social and Behavior Change in HSS
HSS Evidence Gap Map: Learning Question 6 (Social and Behavior Change)

November 2023: HSS Case Competition Virtual Showcase  

USAID's annual HSS Case Competition is an opportunity to capture knowledge on what does and does not work when implementing and scaling up health system programs and approaches. Case submissions help inform USAID and our partners’ ongoing work and contribute to learning syntheses and dissemination under the USAID HSS Learning Agenda to strengthen the global HSS evidence base.

The 2023 HSS Case Competition focused on learning questions 1 (systems thinking), 4 (integrating local voices), and 6 (social and behavior change). The three winning cases from India, Philippines, and Ukraine - selected by a panel of judges from the HSS Accelerator and USAID -  highlight strong work in each of these areas. Teams representing each of the winning cases were able to highlight their work at the virtual showcase and engage in discussion with a global audience. 

Key Takeaways:

  • The USAID NISHTHA Project in India addressed social and behavioral determinants of health, such as knowledge, attitudes and community norms, to bring about sustainable changes in behavior and foster positive health outcomes. The project’s theory of change posited that by effectively utilizing social and behavior change methods, targeting specific actors within the health system, and addressing the social and behavioral factors influencing behavior adoption, the activity would contribute to positive changes in health behaviors, leading to improved health outcomes and a more responsive health system.

Resources:

Related HSS Learning Products: 
HSS Evidence Gap Map: Learning Question 6 (Social and behavior change)

April 2023: Climate Adaptation for Better Health Outcomes

Climate change impacts need to be considered when designing and implementing health programs in order to ensure equitable access to quality services that meet the needs of the population. This learning series event highlighted USAID recommendations on integrating climate resilience into health programs and featured country examples where resilience capacity and program adaptation was used to ensure continuity of services or improve quality of services in climate impacted programs. 

Key Takeaways:

  • Cross-sectoral integrated approaches hold promise to spur increased program attention and action to address the links between health and climate change
  • Recommend ensuring health is central to sub-national, national, regional and global climate change action and demonstrating the health benefits across various development sectors
  • Recommend engaging communities to increase participation in community-based climate change management including raising awareness, waste management, and water and energy conservation

Resources: