Health System Strengthening. From Diagnosis to Programming Guide. v3 2017

In 2010, the international non-governmental organisation Action Against Hunger (ACF) identified the need to develop a user-friendly guide to help identify gaps and bottlenecks in health systems at district level, with a view to implementing a health system strengthening strategy. External experts¹ carried out two studies to improve ACF’s understanding of health system strengthening and to make recommendations on the approach to be adopted. Since 2011, ACF has been learning about health system strengthening through its partners’ experiences and by reviewing the existing literature, tools and methods. The first version of this guide was published in 2013, and the second in early 2015. Both versions of the guide were piloted between 2013 and 2016 in collaboration with the governments (Ministries of Health) of 12 countries.

Action Against Hunger had a reputation for focusing its work on nutrition, but the organisation has gradually shifted its approach over the last 10 years, moving from a vertical approach centred on nutrition interventions (particularly the management of severe acute malnutrition) to a horizontal approach focused on strengthening health systems. The following section explains the reasons behind this change in approach.