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Drivers of health system strengthening: learning from implementation of maternal and child health programmes in Mozambique, Nepal and Rwanda


Written by Fiona Samuels


This journal article offers a pragmatic approach to exploring the drivers of progress in maternal and child health in Mozambique, Nepal and Rwanda. It recognises that health systems are complex and that much of their success depends on factors operating at different levels and outside the health system, including broader governance and political commitment to health and social development priorities. 

The article builds on a semi-systematic literature review and case study findings, designed and analysed using a multi-level framework. The study demonstrates that a ‘whole-system’ approach can help elicit the key drivers of change and potential pathways towards desirable outcomes. Furthermore, it demonstrates that understanding the challenges and opportunities that are instrumental to progress at each particular level of a health system can help policy-makers and implementers to navigate this complexity and take action to strengthen health systems.

Fiona Samuels, Ana B Amaya and Dina Balabanova