Converging Health Systems Frameworks: Towards A Concepts-to-Actions Roadmap for Health Systems Strengthening in Low and Middle Income Countries

George Shakarishvili, Rifat Atun, Peter Berman, William Hsiao, Craig Burgess, and Mary Ann Lansang

Debates around health systems have dominated the international health agenda for several decades. A wealth of contributions has been made to define, describe and explain health systems through multiple conceptual frameworks proposed to date. The array of health systems frameworks arguably provides an opportunity for identifying different appropriate approaches to meeting various country-specific challenges. At the same time, multiplicity of health systems frameworks also creates confusion at the country level as to which conceptual model to refer to for designing health systems strengthening interventions. Additionally, most debates have focused on conceptualizing health systems objectives, functions and performance measurement approaches, with rather less focus on identifying practical approaches to collective actions to strengthen health systems. The paper reviews multiple health systems frameworks available to date. The review finds that the frameworks, despite variations in terms of focus, scope, categorization and taxonomy, contain sufficient complementary elements to develop a comprehensive synergistic model. The paper proposes a converged conceptual framework for health systems as a departure point for further discussions. A frameworks-to-actions roadmap for collective approach to health systems strengthening is also proposed as the basis for developing a translational reference for harmonized planning and implementation of health systems strengthening interventions.