title: Strengthening health systems in low-income countries by enhancing organizational capacities and improving institutions.
abstract: BACKGROUND
  This paper argues that the global health agenda tends to privilege short-term global interests at the expense of long-term capacity building within national and community health systems. The Health Systems Strengthening (HSS) movement needs to focus on developing the capacity of local organizations and the institutions that influence how such organizations interact with local and international stakeholders.
  
  
  CONCLUSIONS
  While institutions can enable organizations, they too often apply requirements to follow paths that can stifle learning and development. Global health actors have recognized the importance of supporting local organizations in HSS activities. However, this recognition has yet to translate adequately into actual policies to influence funding and practice. While there is not a single approach to HSS that can be uniformly applied to all contexts, several messages emerge from the experience of successful health systems presented in this paper using case studies through a complex adaptive systems lens. Two key messages deserve special attention: the need for donors and recipient organizations to work as equal partners, and the need for strong and diffuse leadership in low-income countries. An increasingly dynamic and interdependent post-Millennium Development Goals (post-MDG) world requires new ways of working to improve global health, underpinned by a complex adaptive systems lens and approaches that build local organizational capacity.
authors.affiliation: Department of Health Sciences, Brigham Young University, Provo, UT, 84602, USA. swancitos@gmail.com.
authors.forename: Robert Chad
authors.initials: RC
authors.lastname: Swanson
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Harvard University, 665 Huntington Avenue, Boston, MA, 02115, USA. ratun@hsph.harvard.edu.
authors.forename: Rifat
authors.initials: R
authors.lastname: Atun
authors.affiliation: Vancouver Coastal Health Research Institute, 6975 Marine Drive West, Vancouver, BC, V7W 2 T4, Canada. allan.best@in-source.ca.
authors.forename: Allan
authors.initials: A
authors.lastname: Best
authors.affiliation: Health Systems Action Network, K-57 A, Sheikh Sarai Phase -II, New Delhi, 110017, India. arvindcb@gmail.com.
authors.forename: Arvind
authors.initials: A
authors.lastname: Betigeri
authors.affiliation: Nucleus of Research in Public Health, Faculdade de Medicina da UFMG, Avenida Alfredo Balena, 190, Belo Horizonte, MG, Brasil. camposfr@medicina.ufmg.br.
authors.forename: Francisco
authors.initials: F
authors.lastname: de Campos
authors.affiliation: National Health Foundation, Building 1, 1st Floor, Office of the Permanent Secretary, Ministry of Public Health, Tivanond Road, Nonthaburi, 11000, Thailand. nhf1chun@gmail.com.
authors.forename: Somsak
authors.initials: S
authors.lastname: Chunharas
authors.affiliation: World Medical Association, 13 Chemin du Levant, Bâtiment A, le John Keynes, 01210, Ferney-Voltaire, France. tea.collins@wma.net.
authors.forename: Tea
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authors.lastname: Collins
authors.affiliation: Warwick Business School, The University of Warwick, Coventry, CV4 7AL, UK. graeme.currie@wbs.ac.uk.
authors.forename: Graeme
authors.initials: G
authors.lastname: Currie
authors.affiliation: George Institute for Global Health, Level 10, King George V Building, 83-117 Missenden Rd, PO Box M201, Camperdown, NSW, 2050, Australia. sjan@georgeinstitute.org.au.
authors.forename: Stephen
authors.initials: S
authors.lastname: Jan
authors.affiliation: Queen Mary University, London, Blizard Institute, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London, E1 2AT, England. d.mccoy@ucl.ac.uk.
authors.forename: David
authors.initials: D
authors.lastname: McCoy
authors.affiliation: African Centre for Global Health and Social Transformation, Plot 13 B Acacia Avenue, P.O.Box 9974, Kololo, Kampala, Uganda. omaswaf@achest.org.
authors.forename: Francis
authors.initials: F
authors.lastname: Omaswa
authors.affiliation: School of Public Health, University of Western Cape, South Africa, Private Bag X17, Bellville, 7535, Republic of South Africa. sandersdav5845@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Sanders
authors.affiliation: National Health Systems Resouce Centre, NIHFW Campus, Baba Gangnath Marg, Munirka, New Delhi, 110067, India. sundararaman.t@gmail.com.
authors.forename: Thiagarajan
authors.initials: T
authors.lastname: Sundararaman
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium and University of Western Cape, Sint-Rochusstraat 2, 2000 Antwerpen, Belgium, South Africa. wvdamme@itg.be.
authors.forename: Wim
authors.initials: W
authors.lastname: Van Damme
mesh_terms: D057191:Capacity Building; D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000592:standards*; D003906:Developing Countries; D019982:Organizational Case Studies; D058996:Quality Improvement