MSH Case Studies Selected as Part of USAID’s Top Ten Health Systems Strengthening Cases

USAID’s Office of Health Systems (OHS) has announced selections for its Top Ten Health Systems Strengthening Cases. Two MSH case studies were selected in the Top Ten Health Systems Strengthening Cases as well as one honorable mention. The cases can be accessed here.

USAID’s Office of Health Systems Marshalling the Evidence Initiative invited all USAID partners engaged in Health Systems Strengthening (HSS) projects to share their experiences by submitting case examples of HSS work. The purpose of the Global Call for Cases was to understand the impact of USAID’s substantial investments in HSS. According to USAID, “the cases also serve to stimulate an exchange of information, experiences, and ideas on how to strengthen developing country health systems.” Over 145 cases were voluntarily submitted to USAID from programs in USAID’s 24 priority countries. The Global Health Bureau’s OHS review panels and senior leadership evaluated the cases, using objective criteria to determine which cases demonstrated compelling evidence for sustainably improving country health system performance and/or health impact. The ten top cases and two honorable mention cases may be accessed here.

The MSH health systems strengthening cases selected include:

Liberia Rebuilding Basic Health Services (RBHS)

USAID/Liberia through RBHS helped the Liberian Ministry of Health and Social Welfare (MOHSW) establish a performance-based financing (PBF) unit. PBF supports quality health service delivery by rewarding health facilities and providers with incentives for achieving performance targets. The unit has supervised PBF implementation in 250 health facilities in 12 of Liberia's 15 counties. As part of the project, an operations manual was created to standardize implementation across counties and master trainers were certified to oversee training of health workers. RBHS also assisted with harmonization of the PBF approaches among all the donors, including the World Bank, DFID, UNICEF, and USAID.

Rwanda Community-Based Health Insurance (CBHI)

Rwanda Integrated Health Systems Strengthening Project (IHSSP)

In 2004, Rwanda introduced CBHI, targeting about 94% of the population. Beginning in 2009, USAID/Rwanda's Integrated Health Systems Project (IHSSP) worked side-by-side with the Rwandan Ministry of Health (MOH) to redesign the CBHI scheme to enhance equity of access. To implement the new CBHI scheme, MOH had to group the country's 1.8 million households by financial status. IHSSP and the MOH designed and built a computerized data base to collect and house the household financial status information. The database allows CBHI managers to charge members the correct fees, using a sliding scale. Now, the highest and middle income groups pay an annual CBHI membership fee plus a copayment at health centers and 10% of cost of care at referral facilities. The poorest Rwandans, about 25% of the population, do not pay for their insurance and are not charged for health services at any public facility.

Afghanistan Local Governance (Honorable mention)

Leadership, Management and Governance (LMG) Project

Through the flagship GH Leadership, Management, and Governance (LMG) Project, USAID/Afghanistan addresses the gap for sustainable governance capacity in the health sector. USAID collaborated with the Government of Afghanistan (GOH) to improve the governance of decentralized local health entities. In Afghanistan, three key health bodies—Provincial Public Health Coordination Committees (PPHCCs); District Health Coordination Committees (DHCCs) and community health shuras (collectively 'local governing bodies')—perform a governance role that includes coordination, monitoring, and supervision of service delivery at local level. The LMG Project developed detailed governance guides on four governing domains: cultivating accountability, engaging stakeholders, setting a strategy direction, and stewarding resources. The guides were piloted with all local governing bodies in 3 provinces and 11 districts. Based on the successful pilot, they were evaluated and revised according to feedback and the Afghan Ministry of Public Health (MOPH) approved the governance guides for national scale up. They are being used for MOPH governance capacity development as well. 

More details of these and the other top ten cases are available at the USAID Global Call for Health Systems Strengthening Cases website. 

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