Health systems strengthening refers to initiatives and strategies that improve one or more of the functions of the health system and that leads to better health through improvements in access, coverage, quality, or efficiency, ensuring it can address health threats. A well-functioning health system is built on having trained and motivated health workers, a well-maintained infrastructure, and a reliable supply of medicines and technologies, appropriate service delivery approaches, backed by adequate funding, all these articulated in strong health plans and evidence-based policies.  

Strengthening of health systems involves the development and implementation of primary health care oriented health policies and realistic strategic plans that focuses on improving the institutional and organizational capacity of a country to provide health services to the whole population. These policies and strategies are prepared within the context of national socio - economic development, and the improvement of health services performance in terms of quality safety, effectiveness, efficiency, coverage and equitable access and use. This contributes to the attainment of the goal of Health for All, where the healthcare system is responsive to the needs of all members of society, regardless of their socioeconomic status, ethnicity, culture, gender or other factors.

Health systems governance refers to the processes, structures , institutions, legal frameworks and partnerships that are in place to oversee and manage a country's healthcare system. The public sector/government is entrusted with oversight responsibilities that includes managing the relationships between different actors and stakeholders (state and non-state) involved in healthcare. These include government agencies, public institutions involved in health care and training, funding/donor agencies/initiatives, private sector institutions/initiatives, patients and their families, people and communities and civil society organizations. Effective health systems governance enables a county’s healthcare system to optimally provide health care services that are are accessible, equitable, efficient, affordable, acceptable and of high quality for all.

Health systems governance ensures that strategic policy frameworks exist that guide healthcare delivery, and mechanisms for monitoring, evaluating and reviewing the health system’s performance. This is combined with effective oversight, coalition-building, provision of appropriate regulations, incentives, attention to system design, organizational structures and accountability. Health systems governance enables the different actors and stakleholders to work in a complementary mannerand ensure efficient use of resources and mutual accountability for results.  

In the context of the Sustainable Development Goals (SDG) agenda, WHO is committed to supporting countries to exercise effective health systems governance, with a specific focus on strengthening the capacity of governments to formulate and implement policies/strategies that will lead to the realization of UHC by 2030. 

In line with the Thirteenth General Programme of Work 2019–2023, WHO works collaboratively across its three organizational levels, adopting a horizontal approach to pursue the following key objectives:

call upon countries to strengthen the governance of their health systems for UHC

provide guidance on ways to enhance health systems governance

support regions and countries in strengthening their health systems governance as needed.

WHO’s work on the health systems governance not only supports countries in advancing the UHC agenda but has an impact on reaching the targets beyond SDG 3. Improvements in health systems governance will support achieving results in both health and non-health-related SDGs, such as ending poverty (SDG 1), achieving gender equality (SDG 5), reducing inequalities (SDG 10), building effective, accountable and inclusive institutions (SDG 16), etc.