SCI Foundation is now Unlimit Health. Learn more about what the change means for our ongoing efforts to eliminate neglected tropical diseases

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 one billion treatments for schistosomiasis and soil-transmitted helminths since our establishment in 2002.

In light of 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?

Graphic with icons representing the different parts of a health system: financing, service delivery, leadership and governance, workforce skills and capacity, medical products, vaccines and technologies, health information systems

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 also laid 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 is health systems strengthening important? 


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

Health system strengthening is important because it enables people to have access to quality health care services. It considers the whole system, making sure all aspects are working efficiently so that health programmes are supported and more effective. This is particularly important for NTDs, which disproportionally affect the most marginalised populations. Additionally, a strong health system can better respond to emergencies and outbreaks, which is critical for protecting public health. 


Health systems strengthening 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


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

We aim to reinforce the work we have done to date within health systems and expand it to maximise the potential of our knowledge and experience to support our partners to eliminate NTDs as a public health problem. We have always worked with our partners and made a conscious decision not to have offices in endemic countries that would replicate or deviate away from existing health systems. We are looking forward to developing our approach, facing the current global challenges and allowing space to adapt to the specific needs of each context, with the aim of increasing the resilience of the health systems in the countries we support. 

Carolyn Henry, Deputy Director: Health Systems
Carolyn Henry, Deputy Director: Health Systems

If you’d like to know more about health systems strengthening, please contact our HSS lead Carolyn Henry on