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It provides an overview of the method and describes the 11 steps that cover the diagnosis and planning processes. The diagnosis aims at creating a common vision, and identifying the weaknesses and strengths of the health system, and the planning phase builds synergy between actors, by defining solutions and activities to be implemented to strengthen the health system, and enhance its resilience.

Action Against hunger has reconsidered its approach in the last 10 years and shifted from a vertical approach focused on nutrition interventions to a horizontal and health system strengthening approach.

This manual describes a step by step approach to carry out health systems assessment, and planning at the District level. The objective of this bottom-up assessment is to bring together all the key stakeholders of the health system and have them work together to get a snapshot of the health system structure and understand its strengths and weaknesses (diagnosis phase), in order to determine the priority actions required for the development of a health system strengthening strategy (planning phase). Ultimately, this approach aims not only at strengthening health system, but also at contributing to build its resilience by allowing the system to prepare, absorb, adapt and transform from stresses/shocks.

The diagnosis phase intends to provide detailed information on strengths and weaknesses of the health system based on the WHO six building blocks of the health system namely: Governance, financing, service delivery, health workforce, supply, and health information systems.

The planning phase intends to support the development of comprehensive strategies and activities over several years to reinforce the health system and improve its resilience based on the initial diagnosis, the needs of the population and the various exceptional and seasonal shocks to which the health system is exposed.

Guidance and tools are provided for each of the 11 steps. Global explanations regarding the approach are described, as well as practical guidance or tips, to facilitate the implementation of the approach.

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