BACKGROUND: In March 2009, the Task Force for Innovative International Financing for Health Systems
recommended “a health systems funding platform for the Global Fund, GAVI Alliance, the World Bank and others
to coordinate, mobilize, streamline and channel the flow of existing and new international resources to support
national health strategies.” Momentum to establish the Health Systems Funding Platform was swift, with the World
Bank convening a Technical Workshop on Health Systems Strengthening (HSS), and serial meetings organized to
progress the agenda. Despite its potential significance, there has been little comment in peer-reviewed literature,
though some disquiet in the international development community around the scope of the Platform and the
capacity of the partners, which appears disproportionate to the available information.
METHODS: This case study uses documentary analysis, participant observation and 24 in-depth interviews to
examine the processes of development and key issues raised by the Platform.
RESULTS: The findings show a fluid and volatile process, with debate over whether ongoing engagement in HSS by
Global Fund and GAVI represents a dilution of organizational focus, risking ongoing support, or a paradigm shift
that facilitates the achievement of targeted objectives, builds systems capacity, and will attract additional resources.
Uncertainty in the development of the Platform reflects the flexibility of the recently formed global health
initiatives, and the instability of donor commitments, particularly in the current financial climate. But implicit in the
conflict is tension between key global stakeholders over defining and ownership of the health systems agenda.
CONCLUSIONS: The tensions appear to have been resolved through a focus on national planning, applying
International Health Partnership principles, though the global financial crisis and key personnel changes may yet
alter outcomes. Despite its dynamic evolution, the Platform may offer an incremental path towards increasing
integration around health systems, that has not been previously possible.