The Health System Assessment Approach: A How-To Manual was first published in 2007 and made possible through support provided by the U.S. Agency for International Development (USAID) in cooperation with Health Systems 20/20, the Quality Assurance Project, and RPM Plus/Management Sciences for Health. In 2012, the HSAA manual was updated to reflect lessons learned through its application in more than 20 countries.

Version 3.0 was published in 2017 by the Health Finance and Governance (HFG) project, working with USAID’s Office of Health Systems. This latest version of the manual includes updates in three major areas –

  1. Technical updates from subject experts from the USAID health systems projects (see below) and WHO;
  2. Guidance on assessing the health system’s ability to effectively undertake core functions to achieve universal health coverage; and
  3. Guidance and techniques to reinforce ‘Systems Thinking’

The following core health system functions modules were revised by experts working as part of several USAID health systems projects:

The team is grateful to the World Health Organization for providing technical review and feedback on the six health system function modules.

The HFG project (2012-2018) is funded by the U.S. Agency for International Development (USAID) and is led by Abt Associates under USAID cooperative agreement AID-OAA-A-12-00080. To learn more, go to

USAID_HFG co-branding

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