Save the Children US’ Department of Global Health (SCUS DGH) has identified Health Systems Strengthening (HSS) as one of its priority areas for 2017-2020, and a key contribution to advancing the goals of Universal Health Coverage (UHC), Every Woman Every Child, and the Sustainable Development Goals (SDGs).

We start by clarifying some definitions. Systems strengthening forces a shift of focus from projects themselves to local systems and sub-systems and their interactions within the larger health system. HSS “comprises the means (the policy instruments), while universal health coverage (UHC) is a way of framing the objectives of policy.” Specifically, DGH will favor the concept of systems for health, since the term ‘health systems’ are sometimes reduced in daily use to ‘health care systems’, even if the WHO definition is broad and holistic. Weaknesses in design and implementation of systems strengthening interventions are not a matter of lack of good intentions; they often emerge from inherent constraints in finding solutions to complex problems themselves. This drives a global interest in innovative research, evaluation, and planning through systems thinking.

Beyond its fundamental and non-negotiable principles, SCUS needs principles of practice to guide our programs in the application of tools, methods for design, implementation, and evaluation of HSS. SCUS should most often act as a facilitator in the use of these tools and methods, for the benefit of diversified owners of national systems. We propose seven principles of practice. Operationalization will need to happen through the definition of specific policy, program, and contextual questions. DGH will pursue a three-track strategy to increase its contribution to the edification of national, government-led, multi-partner, people-centered, viable, and resilient systems for health. We will seek to operationalize ‘systems thinking’ in practical ways, and to apply systems strengthening innovations at scale in project design, implementation, monitoring, and evaluation.