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Health system modelling research: towards a whole-health-system perspective for identifying good value for money investments in health system strengthening
  1. Stéphane Verguet1,
  2. Isabelle Feldhaus1,
  3. Xiaoxiao Jiang Kwete1,
  4. Anwer Aqil2,
  5. Rifat Atun1,
  6. David Bishai3,
  7. Michele Cecchini4,
  8. Augusto Afonso Guerra Junior5,
  9. Mahlet Kifle Habtemariam1,6,
  10. Abdulrahman Jbaily1,
  11. Ozge Karanfil1,7,
  12. Margaret E Kruk1,
  13. Sebastien Haneuse8,
  14. Ole Frithjof Norheim1,9,
  15. Peter C Smith10,11,
  16. Mieraf Taddesse Tolla1,
  17. Solomon Zewdu12,
  18. Jesse Bump1
  1. 1Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  2. 2Office of Health Systems, USAID Bureau for Global Health, Arlington, Virginia, USA
  3. 3Department of Family and Population Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  4. 4OECD, Paris, France
  5. 5School of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  6. 6Federal Ministry of Health, Addis Ababa, Ethiopia
  7. 7College of Administrative Sciences and Economics, Koc Universitesi, Istanbul, Turkey
  8. 8Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  9. 9Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
  10. 10Imperial College Business School, London, UK
  11. 11Center for Health Economics, University of York, York, UK
  12. 12Bill and Melinda Gates Foundation, Global Development, Addis Ababa, Ethiopia
  1. Correspondence to Professor Stéphane Verguet; verguet{at}


Global health research has typically focused on single diseases, and most economic evaluation research to date has analysed technical health interventions to identify ‘best buys’. New approaches in the conduct of economic evaluations are needed to help policymakers in choosing what may be good value (ie, greater health, distribution of health, or financial risk protection) for money (ie, per budget expenditure) investments for health system strengthening (HSS) that tend to be programmatic. We posit that these economic evaluations of HSS interventions will require developing new analytic models of health systems which recognise the dynamic connections between the different components of the health system, characterise the type and interlinks of the system’s delivery platforms; and acknowledge the multiple constraints both within and outside the health sector which limit the system’s capacity to efficiently attain its objectives. We describe priority health system modelling research areas to conduct economic evaluation of HSS interventions and ultimately identify good value for money investments in HSS.

  • health system modelling
  • health system strengthening
  • economic evaluation

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  • Handling editor Seye Abimbola

  • Contributors SV conceived the paper and wrote the first draft of the manuscript with inputs from JB. All authors subsequently reviewed and edited the manuscript, and approved submission to publication.

  • Disclaimer The opinions expressed and arguments employed herein are solely those of the authors and do not necessarily reflect the official views of their organisational affiliations.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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