Strengthening Systems for Better Health (SSBH)

Save the Children is partnering with Abt Associates, Karnali Academy of Health Sciences (KAHS), and Management Support Services (MASS) to implement USAID's Strengthening Systems for Better Health Activity.  The five-year (Jan 2018 - Jan 2023) Cooperative Agreement supports the Ministry of Health and Population and Ministry of Federal Affairs and General Administration at federal level; Ministry of Social Development at provincial level; and Municipalities at local level to support the Government of Nepal in their efforts to improve health outcomes, particularly for the country’s most marginalized and disadvantaged groups.

Nepal has made notable improvements in overall health outcomes in recent decades, which have led to impressive reductions in under-five mortality and maternal mortality.  There is still room for significant improvement, however, in relation to maternal and newborn morbidity and mortality, and the health sector continues to face challenges in delivering quality services in an equitable manner. Many people continue to face financial, socio-cultural, geographical, and institutional barriers to accessing health services.  USAID, in collaboration with the Government of Nepal, designed the Strengthening Systems for Better Health Activity to advance Nepal’s health gains, while addressing critical barriers to sustainable, equitable delivery of quality services. The new activity will leverage the catalytic potential of federalism to improve health governance and health systems performance.

This will be achieved by improving access to and quality of maternal, newborn and child health and family planning (MNCH/FP) services, with special focus on newborn care. The Activity will also strengthen data driven planning and governance of the decentralized health system, which in turn will increase utilization of equitable, accountable, and quality health services.  Strengthening Systems for Better Health will be implemented throughout Karnali Province and in municipalities of Bardia, Banke and Dang of Province 5. The activity has three major outcomes: 

Outcome 1: Improved access to and utilization of equitable healthcare services

Outcome 2: Improved quality of health services at facility and community levels

Outcome 3: Improved health system governance, within the context of federalism 

Key Stakeholders

The primary target populations for the activity are women of reproductive age, expectant and postpartum mothers, under five children, newborns with the focus on disadvantaged populations and targeting men and youth for family planning.  Strengthening Systems for Better Health will directly support the Ministry of Health and Population (MoHP), the Department of Health Services, the Ministry of Federal Affairs and General Administration, and other relevant government institutions, or their equivalent in the new federal structure. At the subnational level, the team will collaborate actively with new provincial governments especially the Ministry of Social Development, rural and urban municipalities, subnational MoHP structures, health facilities and their respective management structures, and community institutions in support of strengthened delivery of quality health services.

Integrated systems Approach

Strengthening Systems for Better Health takes an integrated systems approach to the challenges of improving access to quality health services in the context of federalism. The project team will build sustainable capacity amongst provincial and municipal structures to plan, budget for and manage health service delivery in collaboration with local governments, MoHP officers and health service providers. In addition to enhancing quality and coverage of health services, the activity will work with municipal councils and Health Facility Operation and Management Committees (HFOMCs) to address social, economic, and geographic barriers to health faced by women and the most marginalized communities in the target geographic areas.  The  health systems strengthening and information systems officers will work to inculcate a culture of data-driven quality improvement and performance management within the health system, use technology to enhance delivery of program interventions and foster partnerships with the private sector to expand the reach and quality of critical public health services.


Over the life of the 5-year Activity, Strengthening Systems for Better Health will support the Government of Nepal to achieve:

  • Significant increase in the percent of health facilities in targeted geographic areas that offer a full range of high quality, client-centered health services, particularly MNCH/FP services;
  • Reduced financial and social barriers to accessing health care, including functional referral mechanisms to appropriate services in public and/or private facilities;
  • Expanded and improved community outreach to enhance coverage and reach of priority services;
  • Improved capacity of managers and providers to address quality challenges through institutionalized systems for evidence-driven quality improvement;
  • Engaged facility management teams that routinely incorporate community input on service availability and quality into planning and budget execution processes;
  • Empowered communities that demand quality services, and hold facilities, HFOMCs and municipalities accountable; and
  • A stronger, more resilient health system that addresses the root causes of underperformance and uses data to drive management decisions towards improved access to and use of MNCH/FP services.


For More Information:

Strengthening Systems for Better Health

2715 Narayan Gopal Marga, Maharajgunj, Kathmandu, Nepal

Telephone: +977 1 4720577, 4720365  Email:

Updated On April 2022