HEALTH SYSTEMS STRENGTHENING AS A PATHWAY TO GLOBAL HEALTH EQUITY: FRAMEWORKS, FAILURES, AND FUTURES

Abstract

Global health equity — the aspiration that every person, regardless of where they are born or the resources they command, should attain the highest achievable standard of health — remains a distant aspiration for billions. Health systems, defined as the totality of organisations, institutions, resources, and actions whose primary purpose is to promote, restore, or maintain health, constitute the foundational infrastructure through which equity is either advanced or denied. This chapter examines health systems strengthening (HSS) as a strategic and moral imperative for closing persistent health gaps between and within nations. Drawing on the World Health Organization's six building-block framework, the chapter critically reviews prevailing conceptual models, documents systemic failures that have undermined equitable outcomes, and identifies promising pathways drawn from documented evidence across low- and middle-income countries. Three illustrative tables organise empirical evidence on the building blocks, comparative country experiences, and forward-looking policy recommendations. The chapter argues that genuine equity-oriented HSS requires more than technical investment; it demands political will, transformative governance, community participation, and a reorientation of global health financing architectures. The conclusion advances a research and policy agenda for the post-2030 era.