International AIDS Society

Health Systems


What is the Challenge?

The effective provision of services needed to achieve Universal Access targets and Millennium Development Goals will require significant investments to strengthen national health systems. Concerns have been raised about the impact of HIV-scale up on other health services, and on the fragile health systems of resource-limited settings. The increasing amount of donor funding available for health, and for HIV/AIDS in particular, has drawn attention to the potential for HIV programmes to divert resources and experienced staff from mainstay health programs. Yet there is evidence that, if managed correctly, the AIDS response represents a unique opportunity to strengthen the wider health sector.

What is a Health System?

The World Health Organization defines a health system as consisting of all organizations, people and actions whose primary purpose is to promote, restore or maintain health.

To address failure of health systems to meet expectations for better performance and respond to challenges of a changing world, The World Health Report 2008 Primary Health Care – Now More Than Ever recommends a set of reforms necessary to refocus health systems towards improved health outcomes and health for all.

What constitutes Health Systems Strengthening?

Health systems’ strengthening entails improving performance and effectiveness of critical components of health systems, needed to improve health outcomes. According to WHO, the process is organized around six essential building blocks including - Service Delivery: improving organization, management and quality of services; Health Workforce: development of sufficient and productive health workers and other key resources; Health Information and Knowledge Systems: ensuring a well functioning system, generation and use of new information; Medical Products, Vaccines and Technologies: ensuring access to essential drugs, equipment and infrastructure; Health Financing: ensuring adequate, fair and sustainable financing, including financial risk protection; Leadership and Governance: developing sector strategies, clarifying roles and managing competing demands (also known as stewardship, providing oversight and guidance of the whole system).

Priority areas for the IAS

  • Promoting strategies to strengthen the Global Health Workforce and build Health Systems capacity;
  • Promoting integration of HIV into primary health care and other health services
  • Acceleration of research on the impact of HIV programmes on health systems strengthening
  • Promoting research on improved performance of delivery mechanisms in HIV scale up – access, coverage, quality, effectiveness, efficiency and equity
  • Advocating for adequate funding for Universal Access; innovative financing mechanisms; social and financial risk protection
Conference Proceedings and Abstracts

AIDS 2010

Non-Commercial Satellite Pre-conference Posters
  • Achieving high volume efficiency and sustainability through an integrated model of delivering
  • Strengthening the community contribution to health systems the case of autonomous MSM
IAS 2009

Non-Commercial Satellite Pre-conference
AIDS 2008

Special Session
Strengthening Health Systems Through the AIDS Response
Richard Horton, M.B.
Editor-In-Chief The Lancet

AIDS 2008 Road-Map: Health Systems Strengthening and Integration

IAS 2007

IAS Members Working Together for a Stronger Health Workforce
Dr. Pedro Cahn
IAS President 2006-2008

AIDS 2006

Poster discussion
Learning from practice
Bridging Session
IAS Initiatives

Strengthening health systems for an AIDS-free generation

HIV and Health Systems Pre-conference,
20-21st July 2012, Washington D.C , USA

HIV and Health Systems: Leveraging HIV scale-up to Strengthen Chronic Disease Services

HIV and Non-Communicable Diseases Pre-Conference
16th July 2011, Rome, Italy

Bridging the Divide: Inter-Disciplinary Partnerships for HIV and Health Systems

HIV and Health Systems Pre-conference Meeting
16th-17th July, Vienna, Austria

Accelerating the Impact of HIV Programming on Health Systems Strengthening

Pre-Conference Meeting of Health Systems Experts, HIV Researchers and Implementers
17-18 July 2009, Cape Town, South Africa


G8 Hokkaido Toyako Summit Follow Up – Global Action for Health System Strengthening: Policy Recommendations to the G8

Download the report 

Additional Links and Resources

World Health Organization: Health system strengthening based on primary healthcare

Health Systems 20/20

Leveraging HIV Scale-Up to Strengthen Health Systems in Africa 

The Rockefeller Foundation Health Initiative - Transforming Health Systems

The Kaiser Network

Key Publications

Leveraging HIV Scale-Up To Strengthen Health Systems in Africa
Bellagio Conference
Report September 2008

World Health Organization: World Health Report 2008: “Primary Health Care – Now More Than Ever”

World Health Organization: “Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes: WHO’s Framework for Action”

The World Health Report 2000 – Health Systems: Improving Performance

Health Systems Assessment Approach: A How-To Manual

The Global Fund to Fight AIDS, Tuberculosis and Malaria: “The Global Fund’s approach to Health Systems Strengthening”

World Health Organization: “Integrated Health Systems Strengthening: An operational framework” 


'Time is costly': modelling the macroeconomic impact of scaling-up antiretroviral treatment in sub-Saharan Africa.
AIDS, January 2, 2008.
B. Ventelou, J-P. Moatti, Y. Videau, M. Kazatchkine

The cost effectiveness of antiretroviral treatment strategies in resource-limited settings.
AIDS, June 2007.
D. Bishai, A. Colchero, D. Durack

Scale-up of HIV care and treatment: can it transform healthcare services in resource-limited settings?
AIDS, October 2007.
W. M. El-Sadr, E. J. Abrams

Human resources in scaling up HIV/AIDS programmes: just a killer assumption or in need of new paradigms?
AIDS, October 21, 2004.
B. Marchal, G. Kegels, V. De Brouwere