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The Local Health System Sustainability Project (LHSS) is USAID’s flagship initiative in integrated health systems strengthening. Its goal is to help low- and middle-income countries achieve strong, sustainable health systems as a means to support access to universal health coverage.

Whether finding solutions to widely-shared challenges or providing tailored assistance for unique country needs, LHSS prioritizes engagement with diverse local actors. LHSS will equip countries to sustain health system progress after the project ends, supporting them in their journey to self-reliance.



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Supporting Resource Optimization

  • Ministries of health know that increasing budget execution can free up significant resources for health services, but often lack the capacity to take the necessary steps. LHSS is identifying successful MOH efforts to increase budget execution and sharing the lessons learned.
  • Pharmaceuticals are a major part of health spending, but governments and their development partners often lack the data and analysis needed to make informed decisions about how much funding to allocate to them. LHSS is producing a practical resource on pharmaceutical expenditure tracking to accompany the System of Health Accounts 2011 tool to help governments plan for sustainable mobilization of necessary resources.
  • Although USAID-supported countries often need additional revenues, donor-supported programs can wind up fragmenting host country health financing systems and placing governments in the difficult position of managing multiple different donor priorities. LHSS supports implementation of USAID’s “common approach” – a cohesive and integrated method for working with host country governments to efficiently increase resource levels for the entire health system.

Promoting Equitable Access

  • Many governments lack an explicit, accountable way of setting health priorities. This can result in irrational resource allocation, inattention to the health needs of certain groups, and health systems that do not respond well to overall population needs. LHSS is identifying promising practices for use in institutionalizing explicit national priority-setting in different country contexts.
  • While evidence shows that digital financial services – financial services accessed and delivered through the internet, mobile phones, and other digital channels – can expand financial inclusion, less is known about their impact on protecting vulnerable people from impoverishing health care costs or improving health system performance. LHSS is collecting evidence in these areas to enable policy makers, donors, and program managers to make investments in digital solutions with proven impact in advancing social equity and universal health coverage.
  • To provide high quality medical care, health workers must understand how social determinants of health – the social, economic, and physical conditions in which people live – can powerfully affect their patients’ health. LHSS is documenting health workforce education programs that include teaching on the social determinants of health, and the resulting impact on health care service delivery and health outcomes.
  • Countries often struggle to enroll the most vulnerable groups in schemes to protect against devastating health care costs. LHSS is identifying promising practices for increasing enrollment of underserved and socially excluded populations to ensure equitable financial protection. In particular, we are exploring approaches that address non-financial factors such as discriminatory behavior on the part of health workers, poor awareness of the benefits of health insurance, bureaucratic enrollment requirements, and failure to involve targeted beneficiaries in the design of health insurance schemes.

Advancing Quality of Care

  • Many countries have adopted national quality policies and strategies as an important step toward ensuring that the services provided through their health systems are of high quality. LHSS is packaging new and existing tools and resources in user-friendly formats to help governments operationalize their quality strategies, and creating opportunities for countries to learn from each other’s successes in solving quality challenges.
  • An abundance of guidance exists for improving the quality of reproductive, maternal, newborn, and child health care services. However, much of it concerns clinical care, and countries sometimes struggle to improve their performance due to a lack of metrics and indicators to measure system-level quality. LHSS will explore quality measurements currently in use and propose a cohesive set of systems quality indicators for inclusion in USAID quality assessment tools.

Supporting Private Sector Innovation

  • In 2019, USAID awarded cash prizes to five entrepreneurial businesses in West Africa and India that demonstrated evidence-based solutions to increase the accessibility, affordability, accountability and reliability of essential health care. LHSS is providing technical assistance and support to these Inclusive Health Access Prize winners to ensure that they can competently scale up their businesses and offer their services to a wide population.
  • Private sector innovation and expertise can play an important role in malaria control efforts. LHSS is reviewing relevant private sector activities in Cote d’Ivoire, Uganda, Democratic Republic of Congo, and Liberia, and developing recommendations for ways countries can expand their engagement with private sector actors to move towards sustainable malaria elimination.