How to Show that Strengthening Health Systems Saves Lives?


I have spent the majority of my professional life monitoring and evaluating Pakistan’s health interventions. Whether I am designing a project monitoring plan, a baseline study, or a rigorous household survey, I am ultimately trying to answer the same basic questions: Is our program improving health? Is it saving lives? Could this intervention improve health more efficiently and sustainably?

I believe that if we are to transform the health sector in Pakistan, we must invest not only in service delivery, but in the system that supports it. Stable health systems help stabilize society by giving people access to the health services they need without incurring financial hardship. My JSI colleagues and I manage the Health Systems Strengthening Component of USAID’s Maternal and Child Health (MCH) Program in Pakistan, which supports efforts to strengthen Pakistan’s health system.

The goal of our five-year project, begun in 2013, is to strengthen Pakistan’s reproductive, maternal, and child health service system to improve health outcomes. Our project is strengthening leadership, governance, the workforce, information systems, and overall financing of the health system in Sindh Province. But because our work is at the system as opposed to the health facility level, it can be quite challenging to show how our interventions improve health outcomes.

At JSI, we want to ensure that our work in Pakistan contributes to the global body of knowledge and evidence in health systems strengthening. We understand that investing in health systems is essential for sustained improvements in health outcomes, and that that this process must be managed over a long period of time. However, we must communicate the impact of our efforts in shorter-term health outcomes to ensure donors’ continued investment in health systems (as opposed to vertical programs).

In May 2015, my colleagues and I convened a meeting in Washington, DC with experts from JSI and USAID to discuss ways to overcome the challenge of measuring health systems strengthening interventions in terms of public health outcomes and impact.

In July 2015, USAID released its The Impact of Health Systems Strengthening on Health report, which summarized an exhaustive review of recent public health literature and came up with no studies or publications showing the link between higher systems-level interventions (such as those that JSI is implementing in Pakistan) and health outcomes. JSI is seizing the opportunity to measure the connection between activities that happen much farther up the chain from the health facility: improving budgetary planning, management, and accountability, ensuring that people make decisions based on sound health data, and increasing the number of people seeking health services. In the coming year, JSI will launch an evaluation in Pakistan to measure these links and fill this gap in the literature. We look forward to sharing results that will support the case for investing in health systems.