Reports / Reports

Transforming Health Systems Initiative Final Evaluation Report

The Transforming Health Systems (THS) initiative was one of The Rockefeller Foundation’s largest global health initiatives. Aligned with the Foundation’s mission to promote the well-being of humanity, THS aimed to improve the health status and financial resilience of poor and otherwise vulnerable populations through activities promoting improved health systems performance and the expansion of universal health coverage (UHC).

This report synthesizes findings from a five-year, multicomponent evaluation of the THS initiative. The objectives of the evaluation were to assess i) the effectiveness of the three core strategies – global advocacy, regional networks, and country-level investments – employed under THS to advance progress toward UHC in low- and middle-income countries in four focus countries, ii) the overall effectiveness and influence of the initiative, and iii) the Foundation’s legacy in the UHC arena. A key component of the evaluation was to document lessons learned from achievements and challenges to inform the development of future initiatives at the Foundation.

Overall, the evaluation found the THS initiative to be successful in its efforts to activate a global movement to accelerate progress toward UHC. The Foundation catalyzed and shaped the global UHC movement and, ultimately, influenced the inclusion of UHC in the Sustainable Development Goals (SDGs) of the post-2015 agenda. It also created enduring cross-learning platforms and tools to support country progress toward the SDGs’ UHC targets. Although THS gained less traction in advancing UHC through its focus country investments, its success in making UHC a global development target and creating networks and coalitions to support UHC reform efforts in LMICs will likely have country-level impacts for years to come.