Clarifying and framing the concept of health systems strengthening

Over the last decade a proliferation of global health initiatives have appeared that address specific diseases.  More recently, organizations involved in global health have paid attention to the idea of strengthening health systems in whole. These developments reflect the latest in a series of pendulum swings between vertical and horizontal approaches in global health.

Historically, political leaders have more readily grasped and been energized by the aims of vertical initiatives.  Presidents understand what it means to eradicate polio from their country, and publicly have displayed enthusiasm for goals of this kind.  In contrast, political leaders have rarely been inspired by the aim of ‘strengthening health systems’. 

Defining an issue clearly and positioning it in a way that appeals to political leaders are critical first steps for the success of health initiatives. This paper explores how global health actors have understood the concept of ‘health systems strengthening,’ and whether they have developed effective frames for the idea.  Our hypotheses are that proponents remain in a disadvantaged position to advance this agenda, particularly in comparison to advocates for many vertical health initiatives, because they (1) disagree on what the idea means; (2) cannot yet articulate the concept in a way that is clear to many critical target audiences; and (3) have yet to find a framing of the issue that inspires these and other target audiences to act.

The paper is grounded in theory on framing. Empirically, it draws on interviews with 20 global health actors who have promoted the idea of health systems strengthening for low income countries.  It also analyzes published and unpublished literature on health systems strengthening.  Preliminary results show support for all three hypotheses.  The paper will elaborate on ways of framing and clarifying the issue of health systems strengthening in ways that resonate with political leaders.