Credit: MamaYe!/Sierra Leone

Health systems strengthening

Strong, functioning health systems will be essential to the achievement of the Sustainable Development Goals. Yet many governments struggle to provide the right preventive care or treatment at the right time, in the right quantity and at the right cost.

We bring expertise to health organisations at all levels in order to strengthen the fundamental building blocks of the health system. Key to this is working in partnership with governments, businesses, civil society and other local partners to develop countries’ capacity to plan, finance, monitor and deliver affordable, accessible and more effective health services.

Our expertise lies in: strengthening financial systems and public financial management; health policy and planning; the supply and distribution of drugs and medical supplies; health management information systems; and improved access, equity and quality of care across services delivered.

Our work to strengthen health systems includes:

  • Working in partnership with national health ministries to develop tailored and integrated strategies aligned to national health sector policy and plans
  • Placing teams of long-term advisors alongside national government counterparts to strengthen core areas of the health system
  • Strengthening human resource development and management systems to improve the recruitment and retention of qualified health workers
  • Supporting staff from national to district level to strengthen governance and foster joint planning, coordination and communication across departments and with other key ministries
  • Working with health ministries to find innovative ways of harnessing and focusing the energies of communities, NGOs and the private sector to expand coverage and access.

In Nepal, nearly two decades of working with the Ministry of Health and Population (MoHP) to strengthen the health system has contributed to significant improvements in maternal and child health, and Nepal has now achieved MDGs 4 and 5. Following the devastating earthquakes in early 2015, we are now supporting the MoHP to provide essential health services in the most affected districts. Our work includes delivering rehabilitation and psychosocial support, as well as restoring finance, procurement and health management systems.

We have worked in Sierra Leone since 2006 to support the Ministry of Health and Sanitation (MoHS) in the development of strategies to improve RMNCH. During the Ebola outbreak, we supported the government to meet the increased demand for services. This included working with the Laboratory Technical Working Group (LTWG) to improve data systems so that rapid diagnosis of suspected Ebola cases could be made.

In Malawi, we work with the Ministry of Health and National Local Government Finance Committee to support Malawi's Health Sector Strategic Plan.  We are strengthening stewardship, coordination, planning and financial management to ensure the delivery of high quality public health services. We have supported the MoH to revitalise its most senior government committee, the Health Sector Working Group, which is now meeting on a quarterly basis to tackle priority health sector issues.

In India, our work with the Government in Odisha since 2008 has led to significant improvements in health outcomes. We have supported an expansion in health services, reforms to the management of human resources and the introduction of cash transfer schemes to target resources where they are most needed. Since 2007, the proportion of women giving birth in a facility has increased from 35 per cent to 82 per cent. The under-five mortality rate has dropped from 90 to 35 per 1,000 live births. 


Nepal has achieved MDGs 4 and 5. Maternal mortality has dropped from 790/100,000 births in 1990 to 190/100,000 in 2013

In Odisha deliveries in health facilities increased from 35% in 2005/6 to 82% by 2014

Better management of human resources in Odisha led to a 39% increase in the number of doctors over a five year period

Our experts

  • Alison Dembo Rath
    Alison Dembo Rath leads Options’ health systems work, with a particular focus on South Asia. She has over 20 years’ experience in design, management, monitoring and evaluation of health systems development programmes at policy and implementation levels. Building on her early career in nursing in the UK, Alison has particular expertise in delivering quality maternal and newborn health care services. Alison has experience of working across Sub-Saharan Africa and Asia, managing DFID-funded maternal health and health sector programmes in India and Nepal.
  • Azam Ali, PhD
    For over 30 years Dr Ali Azam has played leading roles in public health and health systems strengthening programmes in Bangladesh and elsewhere in South Asia, with a particular focus on urban health care. He is the Team Leader of the DFID-funded Bangladesh Urban Health Systems Strengthening Programme (UHSSP). Azam has worked with DFID, ADB, CIDA, DANIDA, EU, GIZ, UNICEF, USAID, World Bank and numerous national and international organisations. His skills include health systems strengthening, strategic planning, capacity building, monitoring and evaluation, assessment, policy advice and team and financial management.
  • Dr Kwalombota Kwalombota
    Dr Kwalombota Kwalombota is a trained clinical professional with over ten years’ experience in health systems strengthening, comprehensive emergency and obstetric care, reproductive health and family planning. He is experienced in providing technical advice for maternal and child health and public-private partnerships in health. Kwalombota has worked for international NGOs, private sector consultancies, universities, and the Zambian Ministry of Health, where he established the only district paediatric antiretroviral treatment and care programme. He has worked in Ethiopia, Malawi, Nigeria, Sierra Leone, South Sudan and Uganda.
  • Rachel Cullen
    Rachel Cullen is a population and health specialist with 19 years’ experience providing monitoring, evaluation and research support to international and UK health sector organisations. She has skills in methodological design, data collection and analysis for the evaluation of studies ranging from small-scale pilots to large district-wide quantitative and qualitative surveys. She combines technical monitoring and evaluation skills with practical experience as a UK NHS commissioner, performance manager and trustee of health services and applies her understanding of the challenges in health service delivery in the UK to promoting improved quality of care in Africa and Asia.

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Established in 1992, Options has worked in over 50 countries. We lead and manage health sector programmes on behalf of international donors and national governments.
Established in 1992, Options has worked in over 50 countries. We lead and manage health sector programmes on behalf of international donors and national governments.

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