German Institute for Development Evaluation

Health Systems Strengthening

Health systems strengthening (HSS) is one of three main focal areas within the BMZ Sector Strategy on German Development Policy in the Health Sector (2009) and a key priority within the global health community. Following the active pursuit to fulfil the MDGs, the importance of the overall support of health systems has gained traction. The proliferation of vertical global health initiatives has resulted in poor coordination among donors as well as fractured health systems. The importance of HSS is made all the more imminent in light of recent events: shocks such as epidemics, natural disasters, conflict, etc. necessitate the resilience of stronger health systems.

Objectives of desk study and portfolio analysis

The desk review is taking on the role of formative research prior to the planned health evaluation. The purpose of this desk review is to define the position of the German development cooperation (GDC) in HSS on a strategic level while incorporating insights from the international literature pertaining to HSS and research needs therein. An analysis of HSS as addressed within GDC strategic documents and as planned in partner countries will provide an understanding of how HSS is conceived and approached by the GDC. This analysis would be of use to an evaluation that potentially examined GDC contribution to HSS at an operational level within countries. In this context, practical considerations and recommendations for an evaluation of HSS in the GDC context are to be formulated.

Simultaneously, a portfolio analysis of the GDC contribution to global health is also being undertaken, with the aim to geographically and thematically explore its official development assistance (ODA) in health in the time period 2002 – 2012, as well as analyse Germany’s position among other global health donors. German health ODA is also analysed with respect to G7/8 commitments and international recommendations in health.

Research questions

Health Systems Strengthening Desk Review:

- How has HSS been evaluated by the international donor community?

- How has HSS been addressed in previous GDC evaluations?

- What is the GDC approach to HSS as defined in its central strategic documents?

- What is the GDC approach to HSS as defined by its health programs in partner countries?

- What aspects of the GDC approach to HSS could be best considered for evaluation, and what considerations should be made for such an evaluation?


Portfolio analysis:

- How does Germany perform in terms of international recommendations and commitments in global health?

- What is the thematic focus of Germany’s ODA in global health?

- Where is Germany’s ODA in global health focused geographically?

- How significant is Germany’s multilateral ODA in relation to bilateral ODA?

- How does Germany compare with other donors in global health in view of economic capacity?