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Health Systems Strengthening Evaluation Collaborative

Collective impact to improve health system strengthening evaluation: developing a focused, common agenda and a shared understanding towards better HSS evaluation methods in the future


Download: Health Systems Strengthening Evaluation Collaborative – introductory briefer

Health systems play a vital role in ensuring sustainable improvements to health outcomes.

Investment in health systems requires better methods for evaluating and understanding its effects, so that health systems strengthening (HSS) investments can be better designed, understood and managed. Itad convenes the HSS Evaluation Collaborative to work with stakeholders to develop a focused, common agenda and a shared understanding towards better HSS evaluation methods in the future.

The Challenge

HSS evaluation is a developing and historically underfunded field that faces several challenges. Health systems are complex and varied, and there is a lack of clarity on the precise meaning of HSS. It is also difficult to attribute outcomes to particular investments.

Recent work to define and evaluate HSS has highlighted both a lack of consensus on what constitutes HSS and a lack of comprehensive evaluation frameworks for HSS interventions. Approaches to evaluating HSS are still in their infancy, which is especially challenging for work that needs to compare findings across countries or approaches.


The HSS Evaluation Collaborative has been formed to work with HSS evaluation stakeholders to develop a focused, common agenda and a shared understanding of how to tackle their HSS evaluation needs.

The Collaborative has initially identified three discrete but interlinked pieces of work:

  1. ‘Understanding audiences for HSS evaluation’: A stakeholder analysis and communications strategy

This workstream will focus on understanding who the audiences are for HSS evaluation results and what evidence they need. .  Understanding stakeholders’ evidence needs will  significantly shape evaluation practice.  It will also mean creating outputs that our audiences find useful.

  1. ‘Shared understandings for language, methods & outcomes in HSS evaluation’ Working Group.

Potential areas of focus include:

  • Boundaries and definitions for HSS;
  • Learning from previous evaluations;
  • A framework to help conceptualise how health systems become stronger and how this can be measured;
  • Developing guidelines on relevant methods, for instance modelling for health outcomes.
  1. ‘Understanding HSS Evaluation from a Country Perspective’ Working Group

A need to better understand what will and won’t work at country level in terms of HSS evaluation, as well as what countries need   have come out clearly from our early consultations. We believe that a county-level perspective will help reconceptualise how to approach HSS evaluations at global level.

Potential areas of focus include:

  • Understanding the process by which HSS investors engage with health systems and what implications this has for designing successful HSS evaluation
  • What are the interests and needs related to HSS evaluation expressed by country stakeholders and can HSS investors better address these?
  • Are there potential innovations in methodology or approach to evaluation at country level that can strengthen HSS evaluation?
  • What capacity do countries currently have to implement HSS evaluations? What would be priority investments to enhance this capacity?

The Working Groups will be made up of HSS investors, country actors and evaluators.

A varied group of stakeholders will be the main driver of the strategic direction of this work and the custodian of its outputs as the Collaborative works to improve HSS evaluation. The Core stakeholders in this Collaborative include The Bill & Melinda Gates Foundation, The Global Fund for Aids, TB and Malaria, USAID, the World Bank, The Global Financing Facility and the Global Alliance for Vaccines Initiative. Other key stakeholders are country level HSS actors and the evaluation/academic community.