Health-systems strengthening: current and future activities

In the global health community of donors recipient countries and policy makers there is a strong consensus about the need for greater capacity to produce a better evidence-base for health-system strengthening. However missing clarity on future directions calls for more attention and better analysis in the following areas in health-system strengthening. First a lack of consensus on what health-system strengthening means and consequently on how it should be done and evaluated result results in fragmented efforts. Specifically the work done by institutions such as the GAVI Alliance PEPFAR and the Global Fund demonstrates that it is possible to negatively distort equity in developing countries. Second health systems are highly contextual. Health problems and needs vary across countries and regions as do the systems to respond to these problems. Robust responsive and efficient health systems are needed to reach the Millennium Development Goals (MDGs); this commentary describes some important initiatives and resources for addressing arising challenges.