Analysis of Health Systems Strengthening investment activities by Global Health Initiatives.

BACKGROUND: Global Health Initiatives (GHI) have played an important role in shaping health outcomes in countries through disease- and intervention-focused investments. As key financing mechanisms, GHIs primarily support disease-specific efforts, but their investments have an important role in shaping national health systems. METHODS: We used the Health Systems Strengthening (HSS) Investments Database, available in the Primary Health Care for Global Health Initiatives Toolbox, to examine the budgeted contributions of Gavi and the Global Fund toward HSS in 32 countries, in the period 2007-2024. Investments were categorized across key health system categories: service delivery, health workforce, health products, health information systems, governance, financing, and advocacy. They were also disaggregated across the six World Health Organization Regions. RESULTS: The majority (52%) of intended investments were classified as Health Workforce, including activities such as training, salary costs, and per diem. Service Delivery accounted for 21% of investments. However, there was heterogeneity in distribution across categories by the GHIs and across regions by each GHI. CONCLUSIONS: This analysis raises a series of key questions that should be addressed to better understand GHI's investments and more optimally leverage GHI funding to strengthen primary health care-oriented systems. Those relate to challenges in analyzing GHI funding data, alignment of funds across health systems activities, and use of investments to enhance country ownership and leadership. This series of questions encourages a transformative opportunity to build sustainable health systems in the context of post-donor transition.