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Transforming Health Systems: Learnings from Four Country Case Studies

Nikita Japra — Former Program Associate
©Last Mile Health/Rachel Larson

Just shy of a decade ago, The Rockefeller Foundation broke from a long tradition of focusing its health-related work on disease-specific interventions. Instead, it began to explore the question of how a health system can transform to ensure that all people can enjoy the right to health.

At the time, the Foundation’s new emphasis on the systems that promote, maintain, and restore health drove a deeper questioning of the roles that stewardship, financing, human resources, information systems, and management could play in whether the populations who need health care most can access it when they need it most. Arguably, these roles had been understudied by the time much of the global health community first faced the challenge of globalization alongside ongoing epidemiologic and demographic transitions.

With the understanding that health systems can vary significantly across cultural and geopolitical contexts, the Foundation invested in country-level work in Bangladesh, Ghana, Rwanda, and Vietnam. The Foundation chose to support projects within these countries to glean learnings that could ground the four strategies underlying its Transforming Health Systems (THS) initiative:

  • Promoting Universal Health Coverage (UHC) Policy and Advocacy
  • Defining health systems stewardship and management
  • Supporting the design and implementation of eHealth systems
  • Developing health financing strategies

Through these investments, the Foundation supported its grantees and partners in achieving a range of outcomes (documented in these four country case studies), including increased awareness of and commitment to UHC, improved and standardized training at medical education institutions, integrated health information systems, increased UHC policy dialogue, improved capacity to implement sustainable eHealth solutions, and strengthened government capacity in health systems management and planning.

Country-level progress on advancing UHC would require a consistent, targeted, unified vision that included partners across government as well as the private sector.

These achievements notwithstanding, the country-level work revealed areas in which the THS strategy could use some refinement in order to achieve greater impact at scale. Key revelations suggested that country-level progress on advancing UHC would require a consistent, targeted, unified vision that included partners across government as well as the private sector. We increasingly saw the value of connecting international technical experts with local research organizations to ensure context-specific capacity building. Additionally, given the time bound nature of the initiative, it became clear that the way we connected the Foundation’s grantees would become a key determinant of whether we could leverage these initial in-country investments to drive a larger global movement for UHC. This called for close transition planning that could lay the groundwork for future impacts on health system reforms even beyond the lifespan of the THS initiative.

These valuable learnings proved critical in refining the course of the THS initiative, which ultimately landed on two priority workstreams: the UHC Movement and the Joint Learning Network (JLN).  Now, the Foundation is taking stock of its THS portfolio and will make the results of this work available over the course of the next few months. For more information on THS, please contact

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