Sec. 206. Strengthening health systems
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It shall be the policy of the United States to ensure that bilateral global health assistance programs are effectively managed and coordinated to contribute to the strengthening of health systems in each country in which such programs are carried out, as necessary and appropriate. The Administrator of the United States Agency for International Development (referred to in this section as USAID ) shall work with the Director of the Centers for Disease Control and Prevention, the Global Malaria Coordinator, and the United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy at the Department of State to identify areas of collaboration and coordination in countries with global health programs and activities undertaken by USAID pursuant to the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 ( Public Law 108–25 ) and other relevant statutes to ensure that such activities contribute to health systems strengthening.
The Administrator of USAID should identify not fewer than 5 countries in which the United States has significant bilateral investments in global health to develop an integrated approach toward health systems strengthening that takes advantage of all sources of funding for global health in such country, with the aim of establishing a model for coordinating health systems strengthening activities in additional countries in the future. In the countries selected under paragraph (1), USAID missions, in consultation with USAID’s Office of Health Systems Strengthening, should conduct an assessment that— takes a comprehensive view of the constraints in the country’s health system that prevent the achievement of desired outcomes of United States Government-supported health programs; identifies the best opportunities for improving health systems to achieve improved outcomes, including obstacles to health service delivery; maps the resources of the country and other donors in the health sector with a focus on investment in health system strengthening; and develops and implements a new or revised 5-year strategy for United States assistance, based on the results of the assessment described in subparagraph (A), to strengthen the country’s health system that— provides a framework for implementing such strategy; identifies key areas for United States Government investments to strengthen the health system in alignment with other donors; specifies the anticipated role of health programs undertaken by each of the relevant Federal departments and agencies operating in the country in implementing such strategy; and includes clear goals, benchmarks, outputs, desired outcomes, a means of measuring progress and a cost analysis.
USAID missions in countries identified pursuant paragraph
(1)should develop a strategy to strengthen health systems based on the assessment developed pursuant to paragraph
(2)that— ensures complementarity with priorities identified under any other action plan focused on strengthening a country’s health system, such as the World Health Organization’s Joint External Evaluation and National Action Plans for Health Security; identifies bureaucratic barriers and inefficiencies, including poor linkages between government ministries and between ministries and donor agencies and the extent of any corruption, and identify actions to overcome such barriers; identifies potential obstacles to the implementation of the strategy, such as issues relating to lack of political will or poor governance of an effective health system at all levels of the country’s public health systems, especially with respect to governing bodies and councils at the provincial, district, and community levels; includes proposals for mobilizing sufficient and durable financing for health systems; identifies barriers to building and retaining an effective frontline health workforce with key global health security capacities, informed by the International Health Regulations (2005), including— strengthened data collection and analysis; data driven decisionmaking capacity; and recommendations for partner country actions to achieve a workforce that conforms with the World Health Organization’s recommendation for at least 44.5 doctors, nurses, and midwives for every 10,000 people; identifies deficiencies in information systems and communication technologies that prevent linkages at all levels of the health system delivery and medical supply systems and promotes interoperability across data systems with real time data, while protecting data security; identifies weaknesses in supply chain and procurement systems and practices, and recommends ways to improve the efficiency, transparency, and effectiveness of such systems and practices; identifies obstacles to health service access and quality and improved health outcomes for women and girls, and for the poorest and most vulnerable, including a lack of social support and other underlying causes, and recommendations for how to overcome such obstacles; includes plans for integrating innovations in health technologies, services, and systems; identifies barriers to health literacy, community engagement, and patient empowerment, and recommendations for overcoming such barriers; includes proposals for strengthening community health systems and the community-based health workforce informed by the World Health Organization guideline on health policy and system support to optimize community health worker programmes (2018), including the professionalization of community health workers; and describes the role of the private sector and nongovernmental health providers, including community groups engaged in health promotion and mutual assistance and other institutions engaged in health delivery, including the extent to which the local population utilizes such health services. In developing a strategy pursuant to paragraph (3), each USAID mission should consult with a wide variety of stakeholders, including— relevant partner government institutions; professional associations; patient groups; civil society organizations (including international nongovernmental organizations with relevant expertise in program implementation); and the private sector. The Secretary of State, in coordination with the Administrator of USAID, should work with the Global Fund to Fight AIDS, Tuberculosis, and Malaria, Gavi, the Vaccine Alliance, bilateral donors, and other relevant multilateral and international organizations and stakeholders to develop— shared core indicators for strengthened health systems; agreements among donors that reporting requirements for health systems come from country systems to reduce the burden placed on partner countries; structures for joint assessments, plans, auditing, and consultations; and a regularized approach to coordination on health systems strengthening. The country strategies developed under subsection (c)(3) should include a section that— discusses the role of the private sector (including corporate, local, and international organizations with relevant expertise); and identifies relevant opportunities for the private sector— to accelerate research and development of innovative health and information technology, and to offer training related to its use; to contribute to improvements in health administration and management processes; to improve system efficiency; to develop training related to clinical practice guidelines; and to help countries develop systems for documenting outcomes and achievements related to activities undertaken to strengthen the health sector. Amounts authorized to be appropriated or otherwise made available to carry out section 104 of the Foreign Assistance Act of 1961 ( 22 U.S.C. 2151b ) may be made available to carry out this section.
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- Pub. L. 108-25
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