This presentation follows up a commentary on the need to address broader health systems in the original Saving Mothers Giving life district maternal and family planning project in Zambia in 2015 The original comment drew attention to the need to address broader health system elements in a project approach that focused on strengthening district health systems. While the focus on district health systems was appropriate there have been lessons learnt over the last five years in regard to strengthening health systems. It is now recognized that health systems approaches need to address broader elements of the systems, including financing, and integrating across systems. (2) Other lessons include the need to integrate with emerging new health system challenges, notably NCDs, and (3) to recognize issues of relative power differential that can hamper or enable participation and contribution from communities and women in the organization and provision of maternal health care. (4) This links with a move beyond the formal / government system to consider social and informal systems and their involvement / engagement (5) Continued focus on knowledge and understanding, noting that this is rooted in the people, not just in researchers. (6) The ongoing challenge of integrating within and across systems – health does not stand in isolation but relates to education, employment opportunities, investment.

Krishna Hort is a honorary senior fellow at the Melbourne School of Population and Global Health, with a particular interest in health systems in low and middle income countries and in maternal and child care. He has over 20 years’ experience in development assistance programs in health in the Asia Pacific region, including in country residence in Bangladesh (7 years), Indonesia (3 years) and Philippines (2.5 years); and over 11 years’ experience in the assessment and provision of technical and policy advice to health policy makers of countries in the Asia Pacific,. Experience in the design, conduct and analysis of research in the health field, both in developing countries (Philippines and Indonesia) and in Australia, with a particular interest in health system governance, regulation, and strategies to improve quality of care. Experienced at engaging at a policy level and has in-depth understanding of the potential of research-policy linkages, in Bangladesh, Indonesia, Vietnam and East Timor, including evidence based analysis of policy options and development of policy briefs in areas of regulation of dual practice, engaging the private sector, and quality of care.