Abstract
World Health Organization devoted World Health Report of 2000 to health systems performance. Since then, many international development partners and national governments have been funding health systems strengthening (HSS) interventions. Interventions that are included in this review are those that were carried out in single or multiple African countries. Among other criteria, such interventions had to directly target at least one of six HSs building blocks. Eighteen relevant evaluations were critically appraised for quality from 200 potentially relevant evaluations. No intervention concurrently strengthened all the six HSs building blocks and none improved all four overall outcomes of HSS. HSS intervention in Africa deserves more attention by policy makers, global health funders, and public health professionals in Africa. This systematic review reveals shortcomings of HSS interventions in Africa and makes four evidence-based recommendations to guide and improve future HSS interventions in Africa to enable them have impacts on all intermediate and overall HSS outcomes indicators.
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