USAID’s Health System Assessment Approach (HSAA) has been widely used in the developing world to diagnose health systems performance and to capture system-wide information to better inform health sector planning. The HSAA looks at the entire health system, including governance, health financing, health services delivery, human resources, pharmaceutical management, and health information systems, plus the private sector, which is an important yet often overlooked part of the health system.
The HSAA v3.0 represents the collective experience of application in 25 countries across Asia, Africa, and Latin America and the Caribbean between 2006 and 2012. USAID and its partners have used the health system assessment results to inform national strategic plans, PEPFAR partnership frameworks, grant applications, and numerous other health systems strengthening and programmatic activities. Stakeholder engagement is emphasized throughout the application of the approach, to ensure buy-in to the assessment process and findings, and sustainability of follow-up.
The Health System Assessment Approach: A How-To Manual was first published in 2007 and made possible through support provided by the U.S. Agency for International Development (USAID) in cooperation with Health Systems 20/20, the Quality Assurance Project, and RPM Plus/Management Sciences for Health. In 2012, the HSAA manual was updated to reflect lessons learned through its application in more than 20 countries.
Version 3.0 was published in 2017 by the Health Finance and Governance (HFG) project, working with USAID’s Office of Health Systems. This latest version of the manual includes updates in three major areas –
- Technical updates from subject experts from the USAID health systems projects (see below) and WHO;
- Guidance on assessing the health system’s ability to effectively undertake core functions to achieve universal health coverage; and
- Guidance and techniques to reinforce ‘Systems Thinking’
The following core health system functions modules were revised by experts working as part of several USAID health systems projects:
- Country and Health System Overview, Health Financing, Governance modules: HFG Project
- Service Delivery module: Applying Science to Strengthen and Improve Systems (ASSIST) Project
- Human Resources for Health module: Human Resources for Health 2030 (HRH 2030) Project
- Medical Products module – Systems for Improved Access to Pharmaceuticals and Services (SIAPS) and Promoting the Quality of Medicines (PQM) Project
The team is grateful to the World Health Organization for providing technical review and feedback on the six health system function modules. A web-based mobile application of the HSAA v3.0 was released in 2018.