The Components of Health Systems Strengthening
How Pathfinder Works to Build Better Health Systems
By Crystal Lander, Executive Director of Global Affairs
Building Blocks of Health Systems Strengthening
For more than 60 years, Pathfinder International has worked in the arena of health systems strengthening. But we haven’t always called it that.
“Health Systems Strengthening” is a blanket term that captures the numerous pieces needed to achieve Universal Health Coverage (UHC)—when all people have access to the health services they need, when and where they need them, without financial hardship. To achieve UHC, we first need to strengthen Primary Health Care (PHC) systems, a suite of services across health facilities and communities for physical, mental, and social well-being. PHC is more than a focus on treating illness—it’s a holistic approach to preventing ill health and promoting the health and wellness of people.
While Pathfinder’s central focus has remained sexual and reproductive health and rights (SRHR), we understand that SHRH cannot be achieved without strong health systems. So how do we, at Pathfinder, work to achieve this larger goal? By building integrated, people-centered systems in partnership with governments, communities, and civil society organizations—and by working with local partners to advocate for change.
We undertake programs that share a few core elements, including:
Strengthening Service Delivery & the Health Workforce
Pathfinder works with community and facility-based health workers, advocates, and public health officials across the globe to improve the quality and reach of health services.
The foundational elements of all Pathfinder programs are the people who do the work day-to-day, and the local partners who help us build systems and infrastructures that remove barriers to health. In Pakistan, Pathfinder’s Lady Health Workers, community midwives, and youth champions work together to reach women across the country. In Mozambique, health facility providers and community health workers collaborate alongside advocates to provide and encourage people to use sexual and reproductive health care. Our work is locally driven and people-centered , and our efficacy lies in our partnership with facility and community-based health workers. During the COVID-19 pandemic, Pathfinder’s Naya Qadam program developed a comprehensive crisis response strategy by ensuring support for family planning at the policy level, developing a digital communications campaign, providing digital mentorship to providers, and engaging with communities online to offer continued SRH care.
Pathfinder’s Naya Qadam partners with Lady Health Workers, community midwives, policy makers, academics, and youth champions. Through these partnerships, we have advocated for gender equality and tackled harmful gender norms and practices, such as gender-based violence and early marriage.
MAIS (MORE Quality, Access and Health)
Pathfinder’s MAIS project worked with health facility-based providers and managers in Mozambique to provide information, education, and communication trainings and technical support to community health workers.
Removing Barriers to Health
Pathfinder programs work to address structural barriers to health.
Health systems strengthening can’t take place without knowing what challenges people face to attaining good health. Focused programs like Beyond Bias and (re)solve work to understand the social, cultural, and personal challenges and biases that create barriers to uptake of contraceptive services and reproductive health care, going far beyond distribution or trainings and addressing the many underlying factors that lead to poor health outcomes. Pathfinder programs like Shukhi Jibon in Bangladesh and USAID/Uganda Family planning Activity work to decrease structural barriers through improvements in health infrastructure, supply and commodity access, and decreasing the distance people have to travel for services.
The Beyond Bias partnership recognizes that health provider bias is pervasive, complex, and that the drivers of bias are diverse—even among providers working at the same health facility. Our approach arrives at tailored solutions that allow us to help providers work through specific attitudes and behaviors that prevent them from providing young people quality contraceptive services.
USAID/Uganda Family Planning Activity
USAID/Uganda Family Planning Activity works with the Government of Uganda to meet Uganda’s Family Planning 2020 objectives, working to address underlying social, cultural, and structural barriers to family planning access, particularly among adolescents, youth, first-time parents, and low-parity women in 11 districts across Uganda.
Pathfinder brings together services, sectors, and systems.
Pathfinder programs don’t operate in a vacuum. For years, Pathfinder has worked on ‘integrated systems,’ taking a holistic approach to the varied needs of clients, and the numerous approaches needed to serve them. In Ethiopia, Pathfinder’s USAID: Transform Primary Health Care program works to understand the numerous factors that impact health, develops interventions to address those factors, and integrates them to address health needs comprehensively. Transform includes interventions like community-based health insurance, social and behavior change campaigns, and building women’s leadership, alongside support that strengthens the quality and reach of primary health care.
In Burundi, Pathfinder’s Tubiteho program is working with local partners to accelerate the delivery and uptake of family planning; maternal, newborn, child and adolescent health; nutrition; malaria; and, gender-based violence prevention and treatment services. In Tubiteho’s first year, Pathfinder procured medical equipment for distribution, trained community health workers, conducted community awareness sessions, and trained participants on gender-based violence integration.
And, Pathfinder works to integrate resilience into its programs. Pathfinder’s Endangered Ecosystems of Northern Tanzania (EENT) program partners make communities more resilient to environmental shocks through interventions that empower women and girls and contribute to gender equality. And Pathfinder’s HOPE-LBV project worked to address the complex connections between communities, their health, and their environment by implementing integrated activities that simultaneously improve access to health services, including sexual and reproductive health and family planning, while also helping communities manage their natural resources and conserve the critical ecosystems on which they depend.
In Ethiopia, community-based health insurance increases health service utilization, decreases financial hardship, improves maternal and child health outcomes, creates more predictable and sustainable financing for health facilities, and empowers women.
Partnerships, Governance & Leadership
Pathfinder works in partnership with communities, governments, and civil society organizations.
Pathfinder’s programs collaborate with key players at every level – from those working to protect the Northern Rangelands in Tanzania’s Great Rift Valley, to young advocates for safe abortion care in Burkina Faso, to the Government of Côte D’Ivoire on the distribution of long-acting reversible contraceptives. Across its programs, Pathfinder supports the establishment and strengthening of community-facility management teams that bring community voices and participation to the management and governance of health facilities. We also engage community leaders in things like community maternal health audits and organizing community emergency transport and referral systems for women in labor that are linked to public-sector facilities, and religious leaders to encourage the use of family planning services.
Through strong local partnerships, Pathfinder increases its reach, incorporates local expertise, and drives local ownership of SRHR programs and systems.
Nigeria, We Care Solar
Partnerships across sectors in Nigeria led to the integration of new technologies into our work. We used an app called HelloMama—adapted from Johnson and Johnson’s Baby Center®—to distribute information on maternal and newborn health to mothers in Cross River State. Through We Care Solar, we equipped health facilities suffering from chronic power outages with solar electric suitcases.
Burkina Faso, Ministry of Health
From 2012-2021, the Evidence to Action (E2A) Project partnered with governments across sub-Saharan Africa, including Burkina Faso’s Ministry of Health, to strengthen critical reproductive health and voluntary family planning services.
Technology, Data & Evidence
Pathfinder works with digital technology and incorporates innovative data collection and analysis platforms to create scalable programs.
Strong health systems require adaptation and growth as the health landscape evolves. Pathfinder integrates new technologies into our programs, seeking innovative solutions that allow our programs to reach more people, and our staff to better understand the data we collect, and what it means to ensure the strongest outcomes. Most recently, our Evidence to Action project developed WhatsApp groups to stay in communication and problem-solve in real-time with youth in Niger. We’ve used digital platforms and remote technical assistance in countries around the world to stay relevant and effective throughout the COVID-19 pandemic. In addition, Pathfinder uses new technology and data collection to inform decision making and the adoption of strong interventions, and for the mentorship of health workers around the world.
At the onset of the COVID-19 pandemic, Pathfinder rapidly adapted its mCenas mobile platform to share information with Mozambicans about how to protect and prevent the spread of the COVID-19 virus.
A new mobile app, mPari, is designed to support Indian health providers and peer educators to engage in counseling and conversations about contraceptive choice. mPari stands for ‘Mobile Parivaar,” or family in Hindi.
Pathfinder advocates locally, nationally, and globally for robust donor funding and domestic resources as well as strong policies to improve access to and quality of sexual and reproductive health care for women and youth. Pathfinder works directly with local leadership in the countries where we work, providing them with support as they advocate to their local, regional, and national governments to strengthen and improve primary health care services. Pathfinder works in coalitions to share innovations and best practices from our experiences across 20 countries with multilateral bodies such as the World Health Organization and bilateral agencies.
In India, Pathfinder, in partnership with the Government of Rajasthan, rolled out the Advanced Family Planning (AFP) program, which advocated for the utilization of resources in family planning.
The PAI project uses data from the three districts where Pathfinder implements family planning interventions to demonstrate to national and local governments the importance of providing women with free contraceptive products, especially in the immediate postpartum and postabortion periods.
Advance Family Planning (Advance FP) aims to increase financial investments and political commitments in quality, voluntary family planning. Advance FP engages and mobilizes local partners in evidence-based advocacy to increase domestic resources for health. The program helped secure $5.2 million allocated for family planning in the state budget and over $1.56 million released from the state budget.
Progress & Sustainability
As an organization, we need to ensure that we have the right building blocks in place, so that solutions are sustained long after our staff leave, or programs end. This means ensuring that we transfer capacities in health program management and implementation to our local partners. It means continuing to make sure our programs contribute to gender equity.
We need to learn from our work as we go, and document these learnings, like we did in our COVID-19 learning briefs. And as new challenges emerge, we need to remain nimble and adaptable, build resilience in our programs, and most importantly, never lose sight of our underlying values: respect, courage, innovation, collaboration, and integrity.