George Shakarishvili, Bob Emrey, and Rifat Atun
Health systems strengthening (HSS) has long been one of the major areas of international health practice and a multi-billion annual investment in low- and middle-income countries resourced by local means and international donors. During the last decade important developments took place in the conceptual, policy, and programmatic approaches to HSS, alongside substantial changes in the global health funding architecture, which have influenced both—theoretical interpretation and practical implementation of HSS at the country and global levels. These developments provide a timely opportunity to take stock and analyze evolving landscape of international HSS support in order to better inform further advancements in the field, and particularly to maximize the impact of investments. This commentary briefly explores important dynamics in the global HSS setting, which occurred during the last 5-7 years, and are essential for considering by international health community while setting the future HSS agenda and investment frameworks.