Supporting Global Priorities


Certain key challenges to strengthening health systems have proven difficult to remedy. Meanwhile, digital innovations and other advances are opening the door to tantalizing new solutions. LHSS is exploring evidence, identifying promising practices, and testing approaches to learn what works, what doesn’t, and in what contexts. The knowledge we share will provide workable solutions for national governments -- and advance the field of health systems strengthening globally.

Scroll to learn about more about our work in the following areas.

Resource Optimization | Quality of Care | Equity

Learning and Dissemination | PMI Malaria | Supply Chain Political Economy Analysis


Activities to Address Resource Optimization


Strengthen Ministry of Health (MOH) Budget Execution

LHSS is documenting examples of successful MOH efforts that have led to increased health budget execution, and providing technical support to up to five countries to adapt and apply these efforts to improve their health budget execution. This includes applying a joint learning approach in collaboration with the Joint Learning Network (JLN)Over the long term, improved budget execution will contribute to increasing budget allocations for health because demonstrating high budget execution rates is often a pre-condition for ministries of finance. Improved budget execution will also help increase budget effectiveness because health budgets allocated to health priorities will be fully utilized.

Institutionalize Explicit National Health Priority-Setting Processes

LHSS is supporting countries to institutionalize more explicit national priority-setting processes for health. We will facilitate a joint learning process to identify promising practices and lessons learned through efforts to institutionalize explicit national priority-setting processes for health in different contexts and to produce a practical resource that will help more countries to institutionalize such processes. Using more explicit priority-setting processes in national strategic planning will help countries ensure that health policies, strategies, and plans align with national health and development goals, and that scarce human, financial, and other resources are used across the health system in a way that is consistent with and helps to achieve these goals.

Increase Accuracy of Pharmaceutical Expenditures

LHSS will improve the availability of quality data on pharmaceutical expenditures and increase the capacity of stakeholders to use this data for decision-making. LHSS will implement this activity with the USAID-funded Medicines, Technologies, and Pharmaceutical Services Program (MTaPS). LHSS will provide expertise on the current state of pharmaceutical expenditure data in Health Accounts; how pharmaceutical expenditure data can be included in Health Accounts exercises; and how data can be analyzed with other secondary data to produce indicators and analyses that will help decision makers. MTaPS will contribute expertise on how expenditure on different medicines can be collected, compiled, and classified to align with the Health Accounts methodology; and how pharmaceutical expenditure data can be analyzed and packaged to meet the needs of pharmaceutical decision makers. Ultimately this activity aims to improve resource allocation and other aspects of pharmaceutical financing, potentially reducing out-of-pocket payments on pharmaceuticals, and contribute towards project learning on financial risk protection.

Review Evidence on Digital Services to Support Financial Protection

LHSS seeks to reduce financial barriers and increase equitable availability of quality health services. Activity 5 examined the efficacy of DFS in strengthening health system performance and increasing financial protection. Through desk research and key informant interviews, LHSS shared findings, providing an overview of existing digital savings and insurance applications, evidence of their impact on health outcomes, and implementation factors that enabled or inhibited their success. 

Support Country Applications of Common Approach to Sustainable Health Financing

LHSS is developing and implementing a proof of concept for a framework to operationalize a common approach – an approach that will help to facilitate agreement across USAID teams, missions, and bureaus on advocacy and technical support for sustainable financing for health. The activity will strengthen, through collaboration and integration, USAID, MOH, and other host country government stakeholders’ efforts to increase sustainable financing for health. Upon implementation of this proof of concept, missions will have their teams collaborating to develop and implement a plan and timeline for engaging host country governments with a mission agreed upon set of interventions that host countries can implement with or without USG support to increase financing for health. 

Identify and Assess Non-Insurance Pooling Options for Universal Health Coverage (UHC)

The purpose of this activity is to support country efforts to accelerate progress towards UHC by identifying feasible options for pooling risks and prepaid funds that do not include health insurance schemes. To do so, LHSS will distill learnings from normative guidance and country experience with pooling arrangements and assess these options using criteria such as effects on equity, susceptibility to adverse selection, and ability to support large and diverse risk pools. Findings will be used to inform MOH, USAID, and other development partners about feasible non-insurance pooling arrangements that contribute to achieving UHC.

Catalog Approaches for Achieving Efficiency in Health Systems

WHO and the Organization for Economic Co-operation and Development (OECD) estimate that a large portion of health expenditures (roughly 20-40%) is wasted due to inefficiency. USAID has placed efficiency at the heart of its policies, as demonstrated by inclusion of resource optimization as a key outcome in USAID's Vision for Health System Strengthening 2030. LHSS will catalogue approaches to improving technical efficiency in health systems from the literature, key informant interviews, and a learning exchange. The activity will capture promising practices that have been used in identifying and tackling inefficiencies, which will be packaged into a learning brief to be shared with USAID and country partners.



Activities to Address Quality of Care


Strengthen Governance to Improve the Quality of Health Service Delivery

LHSS finalized a study assessing the progress in 37 USAID priority countries towards developing, implementing, or refining their NQPS. We will share the analysis of current progress with the priority countries, USAID Missions, and development partners, so they too better understand the opportunities to support countries towards achieving UHC. We will finalize deep-dive country case studies to identify key lessons and recommended practices for successfully operationalizing National Quality Policy Strategy (NQPS) and compile practical tools, including existing resources and outputs from the NQPS research and case studies, to support countries as they operationalize and achieve their NQPS objectives. 

Improve Quality and Measurement

This activity explores key health systems processes that should be prioritized for process improvement intervention/institutionalization by USAID countries to improve health system quality as defined by the USAID Vision for Health System Strengthening 2030. Based on analysis from one to two case study countries with high performing health systems, LHSS will identify and define key processes that are foundational to quality health systems that successfully converted certain health system inputs into the desired outcomes; and propose a measurement approach to track functionality and improvement in these foundational processes.

Support Creation of Quality Health Systems Technical Working Group

In Year 2, LHSS supported USAID in its efforts to set up an internal technical working group/advisory group that will consolidated the Agency’s thought leadership in quality health systems (QHS), and establish a cohesive, evidenced-based approach across the Agency to advance the QHS agenda and improve quality of care. This activity provided resources for continued professional development for USAID staff; and resulted in an implementation plan to guide and monitor QHS programming progress at the mission level.



Activities to Address Equity


Support Inclusive Health Access Prize (IHAP) Winners

Private health sector innovators can fill gaps in service and population coverage, and provide financial protection. Previous challenge funds and equity investors have reported that the effectiveness of funds to help sustain start-up was superseded by the need for capacity-building. However, innovators often lack the TA and support needed to reach scale and achieve sustainability.[1]  As part of this activity, LHSS provided technical assistance to the five winners of USAID’s IHAP in areas where they expressed needs as part of the prize submission process. The aim was to enable these five winners to scale up their businesses and increase population coverage of the health services they offer.

Integrate Social Determinants of Health into Health Workforce Training

LHSS is working to identify, analyze, and document examples of successful efforts in integrating social determinants of health into health (SDoH) workforce education, training, and service delivery for improved quality and equity in health outcomes. The current body of knowledge on health workforce education and SDoH links to learning outcomes, but is limited in terms of information about downstream impacts related to quality and equity outcomes. Lessons learned will be used to inform USAID, development partners, MOHs, and professional and educational associations and institutions and aims to improve understanding of systemic barriers to achieving population equity in health outcomes and equitable use of essential health services. 

Expand Financial Protection

Building on previous work on health equity by the World Bank, USAID, and others to identify promising approaches and strategies to ensure more equitable financial protection, particularly for underserved and socially excluded populations, LHSS is focusing on other non-financial barriers such as distance from health facilities, behavioral challenges, lack of knowledge of the benefits, bureaucratic enrollment requirements, a lack of trust in the program, and cultural factors that need to be considered in order to optimize coverage of the poor and vulnerable. We will delve into the context and political economy surrounding the barriers to expanding financial protection and how to overcome them, the process and timeline, the key changes/interventions implemented, and lessons learned. Using the findings, we will develop a compendium of approaches to guide countries in extending equitable financial protection schemes.

Identify Provider Competencies in Social Determinants of Health 

LHSS is working to identify provider competencies in SDoH through a briefing document, and by developing a process guide for country stakeholders to adapt and implement according to the local context. As part of earlier research, we found a lack of agreement on SDoH terminology and related provider competencies, which presents a potential barrier to country efforts to develop and support a health workforce that provides equitable, person-centered care. A brief on SDoH provider competencies, along with a process guide for local stakeholders to collaboratively identify key SDoH challenges in their contexts, will provide a synthesis of key questions and suggested approaches for stakeholders to consider when integrating SDoH-related competencies into health workforce education, training, and practice. 

[1] Barbary, V. et al. 2011. Promise and Progress: Market-Based Solutions to Poverty in Africa. Monitor Group.



Learning and Dissemination


Produce Health Systems Strengthening Practice Spotlights

LHSS will produce, publish, and disseminate Practice Spotlight briefs that discuss specific HSS approaches and how they were successfully applied in USAID-supported or other HSS programming settings. The briefs will include key lessons learned from application of the approaches, including lessons pertaining to aspects that worked well and, if appropriate, aspects that encountered unexpected challenges. By documenting approaches that work, these briefs will inform strategic planning, program design, and implementation in the HSS space. The briefs will support implementation of USAID’s Vision for Health System Strengthening and will be a major contribution to the global knowledge base for HSS practice.

Share Knowledge on COVID-19 Surge Capacity Strategies

Health systems worldwide are being severely tested under the strain of COVID-19 and its associated health system disruptions. Multiple countries have expressed an urgent need to build surge capacities as part of reinforcing key health system functions in the short term while also promoting and preparing for long-term health system resilience during and after the pandemic. With this activity, LHSS aims to provide countries and health system leaders with immediate access to proven global strategies related to surge capacities during health system shock and stressor events, and facilitated connections to fora and knowledge hubs where emerging evidence and technical resources are being shared for COVID-19 and health system resilience.

Conduct Evidence Mapping for Health System Strengthening Learning Agenda

LHSS is conducting an evidence review and mapping as part of implementing USAID’s health system strengthening learning agenda. LHSS will work closely with USAID to curate, map, and analyze existing evidence for up to four selected learning questions (part of USAID's HSS Vision 2030); synthesize relevant learnings; and identify gaps. This will result in findings that contribute to a better understanding of the current evidence landscape for the learning questions; and data-driven insights that can inform the design and implementation of USAID’s future HSS investments to support sustainable health systems.

Create E-Learning Modules for Health Budget Execution and Priority Setting

LHSS will create approximately two hours total of e-learning content on institutionalizing explicit national health priority setting processes and strengthening MOH budget execution. The e-learning modules will translate promising practices identified through the learning exchanges and resources into guidance for policymakers and practitioners for adapting findings in their particular countries. 



PMI/Malaria Activities


Expand President's Malaria Initiative (PMI) Private Sector Engagement

The purpose of this activity is to support PMI in its strategic efforts to expand country-level engagement with private sector actors in alignment with USAID’s Private Sector Engagement (PSE) Policy. The goal is to drive toward country self-reliance in maintaining gains in malaria control and sustainably working toward malaria elimination. LHSS is developing a PSE toolkit with resources tailored to build the capacity of PMI in-country teams and national malaria programs’ staff to identify, pursue, and establish PSE opportunities. The toolkit will build off of a comprehensive landscape of relevant private sector activities in selected PMI priority countries; and recommendations on priority opportunities for strategic partnerships with the private sector in those countries.



Activities to Address Supply Chain Political Economy Analysis


Conduct Population and Reproductive Health Supply Chain Political Economy Analysis

LHSS is supporting the Commodity Security and Logistics Division (CSL) in the Office of Population and Reproductive Health at USAID in its strategic efforts to understand political and economic barriers to effective procurement and distribution of family planning (FP) commodities. In support of USAID’s approach of “thinking and working politically” (TWP), LHSS will conduct an applied political economy analysis in one PRH priority country to identify political economy barriers related to supply chain challenges or reform for FP commodities, and to make actionable recommendations to address these barriers. The PEA findings and country-specific recommendations will enhance USAID’s understanding of potential barriers to supply chain operation and will inform strategies for supply chain technical assistance and advocacy – thus building the capacity of the selected country to ensure access more effectively to health products and FP commodities. 

Develop Primer on Supply Chain Political Economy Analysis

LHSS is supporting the Commodity Security and Logistics Division (CSL) in the Office of Population and Reproductive Health at USAID in its strategic efforts to understand and address political and economic barriers and drivers to effective procurement and distribution of family planning (FP) commodities. LHSS is currently implementing a political economy analysis (PEA) in Cote d’Ivoire to explore specific barriers to effective supply chain management for FP commodities. Findings from the PEA will inform approaches for interventions and/or reforms and will help to ensure that they lead to stronger supply chains and improved access to FP and other commodities. Building on this work, LHSS will develop a primer that integrates lessons learned from existing PEAs, as well as from experts, in both the supply chain and PEA technical areas. This activity will focus on FP commodities but will be designed for generalization to other health commodity supply chains.