While health spending has increased dramatically around the world, access to affordable, quality services has not, particularly in developing countries. Achieving good and equitable health outcomes for poor people around the world depends, in part, on the performance of health systems—networks of organizations, people, and government entities with the primary intent of promoting, maintaining, or restoring health.
In recent years, global health has focused on disease and population-specific programs, while health systems have been neglected. This has resulted in weakened stewardship of health systems, dysfunctional service delivery, and inequitable financing, especially for poor people. Many in under-resourced areas have no access to health services, millions are impoverished by catastrophic personal health expenditures every year, and quality care is considered a luxury. While the challenge of creating high-performing health systems is universal, the problems are especially acute in developing countries, where nearly 10 million children and over 500,000 women die every year from addressable causes.
Yet as globalization advances, new technologies and demographic, epidemiologic, and economic shifts are transforming health systems in countries around the world. There is a window of opportunity to promote strategies that steer this transformation toward better health outcomes and financial protection through improved health systems performance and the expansion of universal health coverage in low- and middle-income countries.
The Rockefeller Foundation’s Transforming Health Systems (THS) initiative aims to catalyze system-strengthening activities that create broader access to affordable health services in developing countries. The initiative includes both global and country-specific work. At the global level, the initiative focuses on research and agenda setting to generate the evidence needed to elevate the profile of health systems on the global agenda and promote concerted action by the international community. At the national level, Rockefeller supports cross-cutting and synergistic activities in selected sub-Saharan African and Southeast Asian countries that can serve as demonstration projects for replication and expansion.
Like all systems, health systems are complex and holistic—not just the sum of its parts; and the parts are also similar to other organizational systems which include governance, human resources, financing, technology, etc. THS does not take on every component of health systems; while important, THS will not build hospitals, develop millions of clinical cadres, or provide drugs and vaccines for particular diseases. Instead, THS will focus on strategic levers selected because of their neglect by the international and donor community and their potential for catalytic transformation and impact.