Evidence review of what works for health systems strengthening, where and when?

This review was commissioned by the UK’s Foreign, Commonwealth and Development Office (at the time known as the Department for International Development – DFID) from the ReBUILD and ReSYST research consortia. It had three main objectives:

1. To support strategic planning work within DFID by identifying evidence on effective health systems strengthening approaches in different contexts;
2. To support advocacy activities by helping DFID Advisers make the case for investment in HSS as a route to achieving improvements in health; and
3. To help DFID Health Advisers make sense of the large volume of evidence on HSS and sign-post health advisers to key pieces of evidence on health systems strengthening.

It provides a rapid evidence synthesis response to the following:

1. What do we know about how health systems strengthening (HSS) interventions work to improve health and health system outcomes, where, for whom, when and at what cost?
2. What is the evidence that HSS interventions lead to (or contribute to) improvements in health and other outcomes? How robust is this evidence? How can we compare scale and cost across different populations?
3. What is the evidence on the relationship between inputs into individual building blocks of the system and the functioning of the system as a whole?
4. What is the evidence on specific health systems strengthening approaches needed in particular contexts, e.g. conflict-affected countries or those transitioning from aid?
5. What are the key gaps in evidence on HSS programming across contexts?
Methods included a systematic literature review of English language studies published from 2000 to 2018, augmented by expert identification of relevant studies (published and grey).

After explaining the review’s methods, the authors start by discussing definitions of the core concept of HSS and issues relating to evidence on its effectiveness. They then rapidly review studies on a range of interventions across health system pillars and conclude by returning to the original questions.

Read the report here.


Contributors included: Sophie Witter, Natasha Palmer, Dina Balabanova, Sandra Mounier-Jack, Tim Martineau, Anna Klicpera, Charity Jensen, Miguel Pugliese Garcia and Lucy Gilson.

Further information

A peer-reviewed paper and presentation were produced from this report:


This resource was produced by the ReBUILD programme – the precursor of ReBUILD for Resilience.