2025 Health and Social Protection Evaluation

Strengthening health systems – important but challenging for Swedish health aid

Björn Ekman, Olga Kaartinen, Joseph Kazibwe, Adam Lagerstedt, Jesper Sundewall, Jens Wilkens

Evaluation of Swedish support to health systems strengthening in Bangladesh and Uganda.

Ensuring that health aid strengthens countries’ health systems has long been a priority for Sweden. But how successful have we been in this regard? EBA has commissioned a study to assess the extent to which aid has contributed to long-term, sustainable improvements in health system functioning in partner countries.

The report evaluates Sweden’s bilateral health aid to six countries — Uganda, Bangladesh, Zambia, Somalia, Myanmar, and the Democratic Republic of the Congo — between 2014 and 2023, and includes case studies of Bangladesh and Uganda.

Main conclusions:

  • Strengthening health systems is a key ambition, but not a specific objective, of Sweden’s bilateral cooperation strategies.
  • Long-term commitment and coherence are vital for the strengthening of health systems.
  • Reduced cooperation with the governments of recipient countries hinders efforts to strengthen health systems.
  • Increased domestic funding is required to strengthen health systems.
  • Swedish government agencies need better capacity to be an active partner in the work to strengthen countries’ health systems.
  • Measuring and monitoring the strengthening of health systems within Sweden’s health aid needs to be developed.