More Guidance and Tracking Would Bolster USAID's Health Systems Strengthening Efforts

Audit Report
Report Number
4-936-20-001-P

Recognizing the importance of strengthening health systems to meeting overall health goals and improving countries’ abilities to react to large-scale health emergencies, USAID issued its vision for health systems strengthening (HSS) as guidance to USAID missions in September 2015.

We reviewed 11 missions with HSS activities and determined they designed activities that aligned with this vision. However, funding dedicated through Federal appropriations to achieving USAID’s primary health goals contributed to some missions’ perceptions of limited flexibility to program HSS. Since HSS lacks a dedicated funding source, and would typically take longer than direct interventions providing a particular health service or product to yield results, HSS was a secondary priority. Missions we reviewed reported being satisfied with the technical assistance and guidance provided by the Bureau for Global Health’s Office of Health Systems. However, limited information on the progress of HSS activities affected the office’s ability to assess where additional HSS guidance and support was needed across the Agency. Further, USAID had no centralized mechanism for tracking HSS progress at the country level or results of HSS activities across missions.

We made three recommendations to bolster USAID’s HSS efforts by providing more guidance to missions and enhancing the way the Agency tracks its progress in achieving its vision.

Recommendations

Recommendation 1

USAID Bureau for Global Health develop and disseminate guidelines to help each mission determine an appropriate balance between health systems strengthening activities and direct health interventions.

Questioned Cost:
$0
Recommendation 2

USAID Bureau for Global Health in coordination with USAID's Office of the Chief Financial Officer, implement a mechanism to track obligations and disbursements of HSS activities to identify all HSS activities across missions.

Questioned Cost:
$0
Recommendation 3

USAID Bureau for Global Health identify and disseminate a set of indicators for missions to track HSS progress, such as implementation, achievement, and improvement at the country level.

Questioned Cost:
$0