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dc.rights.licenseAttribution 4.0 International (CC BY 4.0)
dc.contributor.authorBertone, Maria Paola
dc.contributor.authorPalmer, Natasha
dc.contributor.authorKruja, Krista
dc.contributor.authorWitter, Sophie
dc.contributor.authorHSSEC Working Group 1
dc.identifierdoi: 10.1002/hpm.3607
dc.identifierpublisher-id: hpm3607
dc.identifier.citationBertone, M.P., Palmer, N., Kruja, K., Witter, S., and HSSEC Working Group 1 (2022) ‘How do we design and evaluate health system strengthening? Collaborative development of a set of health system process goals’, The International Journal of Health Planning and Management, p. hpm.3607. Available at:
dc.descriptionFrom Wiley via Jisc Publications Router
dc.descriptionHistory: received 2022-06-14, rev-recd 2022-11-24, accepted 2022-12-06, pub-electronic 2022-12-28
dc.descriptionArticle version: VoR
dc.descriptionPublication status: Published
dc.descriptionFunder: Bill and Melinda Gates Foundation; Id:
dc.descriptionFunder: ReBUILD for Resilience RPC
dc.descriptionMaria Paola Bertone - ORCID: 0000-0001-8890-583X
dc.descriptionSophie Witter - ORCID: 0000-0002-7656-6188
dc.description.abstractStrong health systems are widely recognized as a key requirement for improving health outcomes and also for ensuring that health systems are equitable, resilient and responsive to population needs. However, the related term Health Systems Strengthening (HSS) remains unclear and contested, and this creates challenges for how HSS can be monitored and evaluated. A previous review argued for the need to rethink evaluation methods for HSS to examine systemic effects of HSS investments. In line with that recommendation, this article describes the work of the HSS Evaluation Collaborative (HSSEC) in the development of a framework and tool to guide HSS monitoring, evaluation and learning by national and global actors. It was developed based on a rapid review of the literature and iterative expert consultation, with the aim of going beyond a focus on the building blocks of health systems and on health system outputs or health outcomes to think about the features that constitute a strong health system. As a result, we developed a list of 22 health system process goals which represent desirable attributes for health systems. The health system process goals (or rather, progress towards them) are influenced by positive and negative, intended and unintended effects of HSS interventions. Finally, we illustrate how the health system process goals can be operationalised for prospective and retrospective HSS monitoring, evaluation and learning, and how they also have the potential to be used for opening a space for participatory, inclusive policy dialogue about HSS.
dc.rightsLicence for VoR version of this article:
dc.rights© 2022 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
dc.sourceissn: 0749-6753
dc.sourceissn: 1099-1751
dc.subjectEvaluation and learning
dc.subjectHealth system strengthening
dc.subjectHealth system strengthening monitoring
dc.subjectHealth systems
dc.subjectLow‐ and middle‐income countries
dc.titleHow do we design and evaluate health system strengthening? Collaborative development of a set of health system process goals
qmu.authorBertone, Maria Paola
qmu.authorPalmer, Natasha
qmu.authorWitter, Sophie
qmu.centreInstitute for Global Health and Developmenten

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Attribution 4.0 International (CC BY 4.0)
Except where otherwise noted, this item's license is described as Attribution 4.0 International (CC BY 4.0)