Square peg in a round hole: re-thinking our approach to evaluating health system strengthening in low-income and middle-income countries

Summary box To function effectively, health systems require adequate financing; an effective workforce; reliable information for decision making; good governance; and available medicines and health technologies to deliver quality services to their populations.1 In low-income and middle-income countries (LMICs), health systems are often limited in this respect and fail to provide comprehensive population coverage of quality healthcare interventions. Health system strengthening comprises strategies to improve one or more of the functions of the health system in order to improve access, coverage, quality or efficiency,1 and is recognised to be an essential step towards achieving universal coverage goals.2 Only when health systems function efficiently and effectively can they deliver services to meet population needs. …