Peter C.Smith, Katharina Hauck; Alec Morton;Ranjeeta Thomas.

How can we evaluate the cost-effectiveness of health system strengthening?  A platforms perspective

Abstract: Many investments in health systems take the form of “health system strengthening” but it is not clear how to rigorously appraise the economic value of such investments. Health interventions often depend on a complex system of human and capital infrastructure that is shared with other interventions, in the form of service delivery platforms. Platforms can be healthcare facilities, hospitals, population-based health interventions or community services. Health system strengthening usually aims to improve the efficiency of such delivery platforms. The paper presents a typology of ways in which investments in health system strengthening can improve the economic efficiency of health services. Three types of health system strengthening are identified and modelled analytically: (1) investment in quality improvement for an existing shared platform that generates positive benefits across a range of existing interventions; (2) relaxing a capacity constraint for an existing shared platform that inhibits the optimization of existing interventions; (3) providing an entirely new shared platform that supports a number of existing or new interventions. The theoretical models are illustrated with examples.