Resource Type: Study Design
Authors: Abigail Conrad, Daniela Rodriguez, Adam Koon, Joseph Naimoli, Sweta Saxena, & Catherine Connor
Published: October 2017

Resource Description: Evidence is scarce, scattered, and not widely disseminated on how interventions to strengthen health system performance contribute to sustained improvements in health status, particularly toward ending preventable child and maternal deaths and fostering an AIDS-free generation. Without this evidence, decision-makers lack a sound basis for investing scarce health funds in health system strengthening (HSS) interventions in an environment of competing investment options. This evidence gap impedes support for HSS from numerous stakeholders, both within and outside of USAID. This study will help address this evidence gap by exploring the dynamics of successful HSS interventions in low-income countries. The study seeks to address four key questions:

1. How were a range of successful HSS interventions implemented in different countries?
2. What factors facilitated and constrained the successful implementation and documented outcomes of the interventions?
3. What were important factors about implementation that emerged across the different cases?
4. What are the implications of this study for implementing future HSS interventions?

The study will comprise three main activities:

1. Six qualitative, retrospective case studies of successful USAID-supported HSS interventions to explore what factors contributed to successful implementation
2. Qualitative cross-case analysis to identify patterns of policy processes, circumstances, relationships, and characteristics that may be associated with successful HSS reforms
3. Develop and propose a set of strategic recommendations for introducing and sustaining HSS reforms in low-income countries