Health Systems Strengthening

According to the World Health Organization, health systems strengthening can be defined as (i) the process of identifying and implementing the changes in policy and practice in a country’s health system such that the country can respond better to its health and health system challenges and (ii) any array of initiatives and strategies that improves one or more of the functions of the health system and that leads to better health through improvements in access, coverage, quality, or efficiency.

URC uses a health systems approach, emphasizing a systematic, evidence-based approach designed to bring about significant improvement in:

Patient and population health outcomes, particularly among the poor;
Efficiency and effectiveness of systems and processes of care; and
Social responsiveness and accountability.

Our work strengthens the performance and interconnectedness of the health system building blocks identified by the World Health Organization: service delivery, health workforce, strategic information, commodities, health financing, and leadership and governance. Our key to success is the close and supportive relationships we maintain with Ministries of Health (MOH): we provide high-quality technical assistance that focuses on national priorities and builds on and maximizes the effectiveness of a country’s existing resources. We build the institutional, programmatic, and financial capacities that can usher in a high-performing health sector that adapts to changing situations through continuous quality improvement and innovation.

URC’s experience dates from the 1980s, when we prepared modules for the Aga Khan Foundation’s Primary Health Care Management Advance Program. In the 1990s, we engaged in the Partnerships for Health Reform project, which produced a health systems assessment tool still in use. Since 1990, through four USAID-funded projects (Quality Assurance Projects I, II, III, and the Health Care Improvement Project), URC has adapted approaches such as continuous quality improvement, improvement collaboratives, accreditation, and pay for performance to strengthen the health systems of USAID-assisted countries.

Today, URC manages health systems strengthening projects around the world. We are working in the Zou/Collines region of Benin to improve management systems and mobilize communities. We are having nationwide impact in Cambodia by supporting the MOH’s implementation of the Second Health Sector Strategic Plan. We are strengthening the quality of primary health care delivery in Iraq by developing management systems and processes for delivering clinical care, improving the quality of primary care, building effective community partnerships to ensure that local communities are closely involved in health service planning and implementation, and building the capacity of service providers to develop highly functional health centers able to meet the primary health care needs of Iraqis.

URC has supported Jordan’s MOH since 1988 to strengthen the accreditation of health facilities. We are well positioned to help develop the capacity of health providers and MOHs to redesign and improve processes in their health system’s building blocks.

URC’s technical support continues to have a positive impact on health systems well beyond the life of our projects. In 1998, the Quality Assurance Project (QAP) III worked in the Tver Oblast of the Russian Federation to improve care for neonatal respiratory distress syndrome. After the quality improvement interventions produced significant results in demonstration sites, the intervention was scaled up to the entire region, resulting in further declines in the infant and neonatal mortality rates. As shown in the figure, six years after URC’s technical assistance ended in 2002, the improvements the project had introduced continued to contribute to reduced mortality rates. This experience has been repeated in many countries.

In response to the health workforce crisis in low resource settings, URC supports teams of health workers and managers to innovate and test solutions to address health workforce challenges and improve performance and productivity throughout the health system. Learn more here.

Current Projects

HIV and AIDS Comprehensive Care Initiative (HACCI)
Funded By: US Centers for Disease Control and Prevention through the President's Emergency Plan for AIDS Relief
Project Duration: 2008 to present

Building Human Resource Capacity to Support Prevention, Care, and Treatment: Strategic Information and Other HIV/AIDS Programs
Funded By: US Centers for Disease Control and Prevention
Project Duration: 2008 to present

Better Health Services (BHS)
Funded By: US Agency for International Development
Project Duration: 2009 to present

Essential Obstetric and Newborn Care (EONC) Networks Project in Cotopaxi, Ecuador
Funded By: US Agency for International Development
Project Duration: 2009 to present

Strengthening TB Case Detection and Treatment and TB-HIV Coordinated Activities
Funded By: URC
Project Duration: 2007 to present

South Africa Tuberculosis Program
Funded By: US Agency for International Development
Project Duration: 2009 to present

Increasing Access to HIV Testing and Counseling
Funded By: US Centers for Disease Control and Prevention
Project Duration: 2006 to present

HIV/AIDS and Tuberculosis Laboratory Support
Funded By: US Centers for Disease Control and Prevention
Project Duration: 2009 to present

Global Fund Consulting Services
Funded By: The Global Fund to Fight AIDS, Tuberculosis and Malaria
Project Duration: 2007 to present

Translating Research into Action (TRAction) Project
Funded By: US Agency for International Development
Project Duration: 2009 to present

Technical Assistance and Support Contract 3: Global Health (TASC3 Global Health)
Funded By: United States Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Afghanistan
Funded By: US Agency for International Development
Project Duration: 2008 to present

USAID Health Care Improvement Project (HCI) | Bolivia
Funded By: US Agency for International Development
Project Duration: 2008 to present

USAID Health Care Improvement Project (HCI) | Ecuador
Funded By: US Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Ethiopia
Funded By: US Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Guatemala
Funded By: US Agency for International Development
Project Duration: 2008 to present

USAID Health Care Improvement Project (HCI) | Honduras
Funded By: US Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Cote d’Ivoire
Funded By: United States Agency for International Development
Project Duration: 2008 to present

USAID Health Care Improvement Project (HCI) | Global
Funded By: US Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Mali
Funded By: US Agency for International Development
Project Duration: 2009 to present

USAID Health Care Improvement Project (HCI) | Nicaragua
Funded By: United States Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Niger
Funded By: US Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | South Africa
Funded By: US Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Swaziland
Funded By: US Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Tanzania
Funded By: US Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Uganda
Funded By: US Agency for International Development
Project Duration: 2007 to present

Lesotho Health Sector (LHS) Project
Funded By: Millennium Challenge Corporation
Project Duration: 2009 to present

Strengthening Uganda’s Systems for Treating AIDS Nationally (SUSTAIN)
Funded By: US Agency for International Development (USAID)
Project Duration: 2010 to present

PrevenSIDA
Funded By: United States Agency for International Development
Project Duration: 2010-present

USAID Health Care Improvement Project (HCI) | Senegal
Funded By: US Agency for International Development
Project Duration: 2010 to present

Developing Strategies in the Central America and Panama Region to Strengthen Reponses to the HIV Epidemic
Funded By: Centers for Disease Control and Prevention (CDC)
Project Duration: 2010 to present

TB CARE II
Funded By: United States Agency for International Development (USAID)
Project Duration: 2010 to present

USAID Primary Health Care Project in Iraq (PHCPI)
Funded By: US Agency for International Development (USAID)
Project Duration: 2011 to present

Diagnosis and Management of Severe Febrile Illness: Tibu Homa
Funded By: US Agency for International Development
Project Duration: 2011 to present

Improving TB Detection and TB-HIV Services Integration
Funded By: URC
Project Duration: 2011 to present

USAID Health Care Improvement Project (HCI) | Malawi
Funded By: The President’s Emergency Plan for AIDS Relief through the US Agency for International Development
Project Duration: 2011 to present

Control and Prevention of Malaria (CAP-Malaria) Project
Funded By: US Agency for International Development Regional Development Mission for Asia (USAID RDMA)
Project Duration: 2011 to present

Georgia Tuberculosis Prevention Project (TPP)
Funded By: US Agency for International Development (USAID)
Project Duration: 2011 to present

USAID Health Care Improvement Project (HCI) | Georgia
Funded By: US Agency for International Development (USAID)
Project Duration: 2011 to present

Nutri-Salud: Community Nutrition and Health Project
Funded By: US Agency for International Development
Project Duration: 2012 to present

Production for Improved Nutrition
Funded By: US Agency for International Development (USAID)
Project Duration: 2012 to present

Community Empowerment of People Against Tuberculosis (CEPAT)
Funded By: US Agency for International Development (USAID)
Project Duration: 2012 to present

Past Projects

Malaria Control in Cambodia (MCC) Project
Funded By: US Agency for International Development
Project Duration: 2007-2011

Data Quality Audit (DQA) Framework
Funded By: The Global Fund to Fight AIDS, Tuberculosis and Malaria
Project Duration: 2008-2010

Benin Integrated Family Health Project (Projet Intégré de Santé Familiale, PISAF)
Funded By: US Agency for International Development and the President’s Malaria Initiative through USAID for malaria activities
Project Duration: 2006–2012

Promoting Malaria Prevention and Treatment (ProMPT)
Funded By: US Agency for International Development through the President’s Malaria Initiative
Project Duration: 2009-2013

USAID Health Care Improvement Project (HCI) | El Salvador
Funded By: US Agency for International Development
Project Duration: 2009 to 2012

USAID Health Care Improvement Project (HCI) | Namibia
Funded By: US Agency for International Development
Project Duration: 2008-2012

USAID Health Care Improvement Project (HCI) | Russia
Funded By: US Agency for International Development (USAID)
Project Duration: 2007-2012

USAID Health Care Improvement Project (HCI) | Vietnam
Funded By: US Agency for International Development
Project Duration: 2007 to March 2011

Community-Based Maternal, Neonatal, and Child Health Innovation
Funded By: US Agency for International Development through a sub-award from ChildFund International
Project Duration: 2009 to 2012

Infant and Young Child Nutrition (IYCN)
Funded By: US Agency for International Development
Project Duration: 2006-2011

Jordan Healthcare Accreditation Project (JHAP)
Funded By: US Agency for International Development
Project Duration: 2007 - 2013

Integrated Infectious Disease Capacity Building Evaluation (IDCAP)
Funded By: Accordia Global Health Foundation
Project Duration: 2008-2012

Food and Nutrition Interventions (NuLife)
Funded By: US Agency for International Development through the President’s Emergency Plan for AIDS Relief
Project Duration: 2008-2011

Improving Primary Health Care in Albania I and II (Pro Shëndetit)
Funded By: US Agency for International Development
Project Duration: 2003–2009

Multi-Sector Alliance Program (Alianzas II)
Funded By: US Agency for International Development through RTI International
Project Duration: 2010 to 2012

Nongovernmental Organization Service Delivery Program in Bangladesh
Funded By: US Agency for International Development/Bangladesh
Project Duration: 2002-2006

Benin Integrated Family Health Project (PROSAF)
Funded By: US Agency for International Development/Benin
Project Duration: 1999-2006

Health Systems Strengthening (HSS)
Funded By: US Agency for International Development/Cambodia
Project Duration: 2002-2008

Cambodia Health Equity Funds
Funded By: US Agency for International Development
Project Duration: 2006-2009

Central America Health Consultancies
Funded By: The World Bank
Project Duration: 1990-1995

Dominican Republic Health Systems Management Project
Funded By: US Agency for International Development
Project Duration: 1986–1988 and 1989–1990

Egypt Cost Recovery for Health Project
Funded By: US Agency for International Development/Egypt
Project Duration: 1995-1998

Egypt Management Information Systems Technical Support
Funded By: Ministry of Health and Population
Project Duration: 1998-1999

Egypt Quality Assurance Consultancy
Funded By: US Agency for International Development/Egypt
Project Duration: 1994

El Salvador Health Systems Support Project I and II
Funded By: US Agency for International Development/El Salvador
Project Duration: 1987–1996

El Salvador Strengthening Health Project Technical Assistance and Support Contract 2 (TASC2)
Funded By: US Agency for International Development
Project Duration: 2006–2009

Eritrea Technical Assistance and Support Contract 2 (TASC2)
Funded By: US Agency for International Development/Eritrea
Project Duration: 2003–2006

The Maram Project: Healthier Palestinian Families
Funded By: US Agency for International Development
Project Duration: 2002-2004

Health Planning and Health Delivery Systems
Funded By: US Agency for International Development
Project Duration: 1983-1990

Integrated Management of Childhood Illness Computer-Based Learning Tool
Funded By: World Health Organization
Project Duration: 2001-2002

Primary Health Care Management Advancement Program
Funded By: The Aga Khan Foundation
Project Duration: 1991-1993

Partnerships for Health Reform Project and Partners for Health Reformplus
Funded By: US Agency for International Development
Project Duration: 1995–2005

Primary Health Care Operations Research Project (PRICOR) I and II
Funded By: US Agency for International Development
Project Duration: 1981–1991

Maternal and Child Health: Technical Assistance and Support Contract (TASC)
Funded By: US Agency for International Development
Project Duration: 1998–2003

Water and Sanitation for Health
Funded By: US Agency for International Development
Project Duration: 1988–1994

WHO/Global Programme on AIDS Senior Managers’ Training Course
Funded By: World Health Organization
Project Duration: 1990-1993

Quality in Health (Calidad en Salud)
Funded By: US Agency for International Development
Project Duration: 1999-2009

Quality Improvement System Design Consultancy
Funded By: The World Bank/Population and Reproductive Health Project and the Ministry of Health of Guinea
Project Duration: 2001

Haiti Voluntary Agencies for Child Survival Project
Funded By: US Agency for International Development
Project Duration: 1989-1995

Indonesia Private Sector Family Planning Project
Funded By: US Agency for International Development/Indonesia
Project Duration: 1990-1996

Indonesia Information System Services
Funded By: National Family Planning Coordinating Board of Indonesia
Project Duration: 1992–1994

Indonesia Manpower Assessment Project
Funded By: The World Bank
Project Duration: 1993-1994

Indonesia Management Information System Consultancy
Funded By: The World Bank
Project Duration: 1994-1996

Kazakhstan TB Project
Funded By: Project HOPE
Project Duration: 2000-2001

Latin America and Caribbean Health and Nutrition Sustainability
Funded By: US Agency for International Development’s Latin American and Caribbean Bureau and country Missions
Project Duration: 1990–1995

Malawi Support to AIDS and Family Health Project
Funded By: US Agency for International Development
Project Duration: 1994-1998

Project for Regional Management of Health Services
Funded By: US Agency for International Development/Morocco
Project Duration: 1994-2003

Mozambique Primary Health Care Support Project
Funded By: US Agency for International Development
Project Duration: 1994-1999

Improving Medical Injection Safety in Namibia Project
Funded By: President’s Emergency Plan for AIDS Relief (PEPFAR) through the US Agency for International Development
Project Duration: 2004-2009

Rapid Expansion of Nutritional Recuperation Services for Malnourished Children in Nigerien Facilities
Funded By: American Jewish World Services, US Agency for International Development Office of Foreign Disaster Assistance, and UNICEF
Project Duration: 2005-2007

Niger Family Health and Demography Project
Funded By: US Agency for International Development/Niger
Project Duration: 1989-1995

Peru Strengthening Health Institutions Project, MaxSalud Component
Funded By: US Agency for International Development/Peru
Project Duration: 1994-1999

Peru Consultancy in Quality Assurance and Improvement: Health and Basic Nutrition Project
Funded By: The World Bank
Project Duration: 1999-2000

Quality Assurance Project (QAP) I, II, and III
Funded By: US Agency for International Development
Project Duration: 1990-2008

Romania Health Care Reform Program
Funded By: US Agency for International Development /Romania
Project Duration: 2005-2008

PreventAIDS
Funded By: US Agency for International Development
Project Duration: 2005-2008

Women and Infant Health Strategy
Funded By: US Agency for International Development
Project Duration: 1999-2003

TASC II Tuberculosis/South Africa
Funded By: US Agency for International Development/South Africa
Project Duration: 2004-2009

Senegal Family Health Project
Funded By: US Agency for International Development
Project Duration: 1980-1981

Development of a Population and Family Health Improvement Project in the Solomon Islands
Funded By: Asian Development Bank
Project Duration: 1994-1995

Somalia Family Health Services I and II
Funded By: US Agency for International Development/Somalia
Project Duration: 1985-1991

Integrated Technical Assistance Project
Funded By: US Agency for International Development/South Africa
Project Duration: 2004-2008

Strategic and Policy Assistance to the Agency for Accreditation and Quality Assurance of the Republic of Srpska
Funded By: The World Bank
Project Duration: 2000-2001

Rural Community Health Project
Funded By: US Agency for International Development/Tunisia
Project Duration: 1981-1985

Uganda: REDUCE II
Funded By: Academy for Educational Development
Project Duration: 2000-2001

Communication Support for the National Eye Institute Information and Education Program
Funded By: US National Institutes of Health, National Eye Institute
Project Duration: 1988-1993

Information Technology Support to the District of Columbia Department of Health
Funded By: Washington, DC, Department of Health
Project Duration: 1999

Education Programs of the National Heart, Lung and Blood Institute and the National Heart, Lung and Blood Institute Campaign
Funded By: US National Institutes of Health, National Heart, Lung, and Blood Institute
Project Duration: 1987–1993 and 1997–2002

Instructional Services for the Federal Aviation Administration Center for Management Development
Funded By: US Department of Transportation, Federal Aviation Administration
Project Duration: 1987-1992

UNICEF Malawi and New York
Funded By: UNICEF
Project Duration: 2008-2010

Quality Assurance Evaluation of the Peace Corps Medical Support System
Funded By: The US Peace Corps Office of Medical Service
Project Duration: 1991-1995

Reorganization of the District of Columbia Department of Health
Funded By: US Office of Personnel Management
Project Duration: 1995-1997

Uzbekistan Health Project
Funded By: The World Bank
Project Duration: 2000-2001

Improvement of Maternal and Neonatal Health in Belize
Funded By: Ministry of Health, Belize, Central America
Project Duration: 2009 to 2010

e-Health in Bangladesh: Survey on Strengthening Remote Health Service Facilities
Funded By: Grameen Communication Center
Project Duration: 2008

Technical Assistance and Support Contract 2 (TASC2): Global Health
Funded By: United States Agency for International Development
Project Duration: 2004–2009

Technical Assistance and Support Contract (TASC2) Tuberculosis
Funded By: United States Agency for International Development (USAID)
Project Duration: 2004–2009

Quality Improvement of Family Planning Care
Funded By: Belize Ministry of Health
Project Duration: 2011 to 2012