Credit: MamaYe!/Sierra Leone
Health Systems Strengthening

Health systems strengthening

Strong, functioning health systems are essential to achieve the Sustainable Development Goals. Yet many governments struggle to provide quality health services to all people, when and where they need them.

We work in partnership with governments, communities, services providers and other stakeholders to strengthen the fundamental building blocks of health systems. Key to this is ensuring that more affordable, equitable, accessible and quality health services are achieved through effective use of available resources.

To strengthen health systems, we:

  • Build systems and processes for better and more transparent governance and leadership by supporting evidence-based planning and policy making by governments, to be aligned with national and international health sector strategies.
  • Establish robust health financing systems and public financial management for the effective and transparent use of available resources.
  • Strengthen human resource policies and management systems to improve the recruitment and retention of qualified health workers.
  • Enhance capacity for more effective management of health services by government staff at national and district levels. We foster joint planning, coordination and communication across departments.
  • Support the delivery of quality health services by establishing evidence-based quality improvement systems and developing legislation and accreditation systems.
  • Develop stronger health management information systems to enable evidence-based decision making by government and service providers.
  • Bring together government, civil society, and public and private health service providers to work towards more accountable health systems.

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. Our guidance and support in analysing the 2015/2016 health sector budget contributed to enhanced democratic accountability at the parliamentary level. We also supported the Ministry of Health 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 Nigeria, we supported the National and State level Agency for Control of HIV/AIDS to put a financial management strategy and plan in place, enabling the more efficient and transparent allocation of resources. We conducted Maternal Death Reviews across Kaduna, Kano, Katsina, Jigawa, Yobe and Zamfara States, enabling the government and health providers to jointly identify problems and work together to improve the quality of care provided to mothers and babies. Our community engagement work has led to more than 800 Village Health Committees to actively engage with governments and service providers to hold health facilities and governments to account for providing better health services.

In Nepal, nearly two decades of working with the Ministry of Health to strengthen the health system has contributed to significant improvements in maternal and child health, and Nepal was one of the few countries to achieve MDGs 4 and 5. Our Advisors are working alongside colleagues in the Ministry of Health and Family Health Division to deliver Nepal’s five year health sector strategic plan. Following the devastating earthquakes in early 2015, we supported recovery of essential health services in the most affected districts. Our work has included delivering rehabilitation and psychosocial support; coordinating rehabilitation of damaged facilities; and restoring crucial finance, procurement and health management systems.

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.


Over 800 Village Health Committees in Nigeria effectively holding governments and service providers to account for better health services.

Maternal mortality in Nepal dropped from 281/100,000 births in 2006 to 190/100,000 in 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 UKAid-funded maternal health and health sector programmes in India and Nepal.

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More about Options
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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