Eliminating NTDs» Health systems strengthening

Health systems strengthening

Over the last twenty years, we have been working closely with partners in countries affected by neglected tropical diseases (NTDs).

Through these partnerships, especially with the ministries of health, we have shared knowledge and expertise and supported the delivery of treatment to tackle these diseases. We have done this through the existing health systems. As a result of this collaboration, we’ve supported the delivery of over one billion treatments for schistosomiasis and soil-transmitted helminths since our establishment in 2002.

As documented in our new strategy, we will continue our close partnerships with ministries of health, exploring wider opportunities where our skills, expertise and relationships can support and strengthen health systems in the countries we support.

What is a health system?

The World Health Organization (WHO) defines a health system as “all organizations, people and actions whose primary intent is to promote, restore or maintain health”. This definition is the most widely used and refers to the structures that need to be in place to support the goals of improving health and health equity, while removing financial barriers to health care.

This report lays out the six building blocks that make up a health system: service delivery; health workforce; information; medical products, vaccines and technologies; financing; and leadership and governance (stewardship).

What is health systems strengthening?

Health system strengthening (HSS) is defined as improving the six health system building blocks and managing their interactions in ways that achieve more equitable and sustained improvements across health services and health outcomes.

HSS requires both technical and political knowledge and action. It can be seen as a programme or project, but can also be a method of implementation, where projects are delivered in a way that supports the existing health system, empowering it through technical support.

Why does health systems strengthening matter?

Community Drug Distributor, Asha Salim Shaibu, goes door-to-door administering praziquantel, the treatment used against schistosomiasis, during a mass drug administration in Pemba, Zanzibar. Image by: Unlimit Health/William Mgobela

HSS enables people to have access to quality health care services. Without a strong framework, healthcare can quickly become fragmented, creating inequalities. It considers the whole system, making sure all aspects are working efficiently so that health programmes are supported and more effective, especially when responding to emergencies and outbreaks.

With the current shift in global development assistance, HSS is more important than ever. By supporting the systems, we impact on all aspects of health.

HSS and NTDs

Although HSS has been a cross-cutting theme in the NTD space for a number of years, the WHO roadmap highlights three key topics; mainstreaming, integration and coordination, which strengthen health systems when combined.

These themes have been identified through consultation and research, looking at the challenges of current NTD programmes, such as disease silos or programmes being externally funded and run outside of existing health systems. These work streams can impact both the national level system, by improving health workforce capacity, or the global level, through policy and advocacy. By having these themes outlined in the roadmap, organisations working on NTDs can align and support the health systems of endemic countries.

Integration aims to align all NTD services into the national health systems of endemic countries. By moving away from siloed NTD programmes and structures, integration will facilitate a holistic perspective of what the health system needs to deliver for each community, enabling all those who support health [including community members, health workers, etc.,] to work together through the existing national health systems to deliver effective programmes. For example, aligning treatment for several NTDs through mass drug administration (MDA) could support efficiency in combined delivery and reduce the burden on health care workers from being trained multiple times a year and delivering similar programmes repeatedly.

Mainstreaming is the process of including NTD programmes within routine healthcare structures and systems, ensuring that appropriate budgets for all NTD activities are planned and committed to at a national level. For example, securing funds for MDAs within national healthcare budgets rather than external funding or effectively treating women affected by female genital schistosomiasis (FGS) at local health centres, free at the point of entry, without requiring specific funding.

Coordination focusses on the relationships between departments and sectors that impact NTDs. For instance, schistosomiasis and soil-transmitted helminths will coordinate with other sectors such as water and sanitation, agriculture and the department of education, as treatments are delivered in schools. The One Health approach is an example of coordination which aims to improve human health as one of the outcomes. It could also include intra health sector collaboration, such as maternal health programmes to treat women of reproductive age or sexual and reproductive health programmes in relation to FGS. These are critical networks to enable cost effective NTD programmes but also an opportunity to explore and engage those who can support the health system and the pathways to eliminate NTDs. Coordination is therefore the process of sharing activities such as advocacy and social mobilisation or aligning knowledge and experience to optimise impact.

How Unlimit Health supports health systems strengthening

We are supporting our partners to create the enabling environment for the elimination of NTDs as a public health problem. In the endemic countries we support, we co-create sustainable and feasible action plans to support HSS.

Naomba Ally Amor, a health worker of twelve years, tends to a woman and baby in a health clinic in Zanzibar. Image by: Unlimit Health/William Mgobela

The overall aim is to collaborate with ministries of health to integrate NTD services into health service delivery, through enabling the policy, governance and financing environment for integration. Specifically, this work will support programmatic integration and resource mobilisation efforts by the NTD programme, to ensure an end-to-end process of sustainable integration.

We work alongside national health authorities to strengthen the foundations of health systems so that countries can sustainably prevent and manage neglected tropical diseases (NTDs). Our support focuses on bringing stakeholders together, building skills, improving the use of data, and helping countries plan and secure the resources they need for long‑term, country‑led action.

For example, in Mauritania we partnered with the Ministry of Health to facilitate a workshop that brought government teams, researchers, and partners around one table to explore practical ways to increase national investment in NTD services. This collaborative approach—rooted in country priorities—helps build stronger systems, supports better coordination across sectors, and creates momentum for lasting improvements that protect communities from NTDs. To ensure our work is sustainable, we embrace the One Health approach in our systems strengthening work.

One Health Systems Strengthening

One Health recognises the interconnections between human, animal and environmental health. One Health Systems Strengthening (OHSS) is a holistic, systems-based approach to health that acknowledges this deep interconnection between human, animal and our shared environment. It emphasises that our health systems and the way we work within them – must reflect this interconnected reality.

Rather than addressing the impact of diseases in isolation, OHSS fosters collaboration across different sectors and disciplines, uniting efforts towards shared goals and more resilient, integrated health systems.

The four core pillars of One Health implementation: Communication, Coordination, Collaboration and Capacity Building. — The four core pillars of One Health implementation.

OHSS workshops

In Zanzibar, we have been working with our ministry of health partners to deliver a series of OHSS workshops. The workshops are grounded in the four core pillars of One Health implementation. The 4 C’s: Communication, Coordination, Collaboration and Capacity Building.

As part of this work, we have supported the establishment of a community of practice for staff whose roles intersect across NTDs, human health, animal health and environment health.

This has fostered unique opportunities for cross-sector collaboration and sparked innovative ideas which better consider everyone’s strategic priorities, while maximising the impact of available resources.