Following structural health sector reforms in the 1980s and 1990s and the pressure from the development of the AIDS pandemic, the health systems in many developing countries now suffer from several shortcomings: lack of personnel, intermittent supply of quality medicines, inefficient health information systems, variable quality services, lack of vision and public policies, etc.

This situation has caused various partners to mobilize and support for health systems now occupies a key position on the international health agenda, with a view to achieving the Millennium Development Goals (MDG) in this sector.

In 2007, the World Health Organization (WHO) put forward a definition of a functional health system based on six main pillars:
 The delivery of safe, quality health services;
 The appointment of adequate numbers of trained medical and paramedical personnel;
 A functional health information system that ensures the production, analysis, dissemination and use for decision making of reliable information on the health condition of the populations, health determinants and system performance;
 Access to quality medical products, vaccines and technologies;
 A health financing system including a considerable contribution from the public sector, pre-payment mechanisms for users and payment exemptions for the most vulnerable populations;
 Efficient governance of the health sector, led by the Ministry of Health, acting as a regulator and coordinator of the various players in the sector.

Taking into consideration the importance of this systemic approach, several specialized international funds (GAVI, Global Fund in the Fight against AIDS/HIV, Tuberculosis and Malaria) and international lenders are setting up health system support mechanisms for developing countries. In 2010, a platform for coordinating health system activities between the Global Fund, the GAVI and the World Bank is also being developed.

Improving health systems: a priority action for France

France considers that support for health systems complements the fight against the major pandemics (AIDS, malaria, tuberculosis). In view of the human resource crisis in the health sector that is affecting many developing countries, France has mobilized by participating actively in the Global Health Workforce Alliance.

Along with Germany, France also participated in creating an innovative health financing initiative, and, more particularly, protecting users against sickness risk. This latter, Providing for Health (P4H), currently brings together multilateral (WHO, World Bank, etc.) and bilateral (France, Germany) partners.

It supports about a dozen African and Asian countries in the development and implementation of sickness risk coverage mechanisms (Senegal, Rwanda, Kenya, Uganda, Tanzania, Cambodia, Nepal, Mongolia, Sri Lanka). France is contributing 2 million euros to this initiative (PSF 2009-23).

France is participating actively in the health information system (cf. Health security sheet) and is developing important actions for access to quality medicines. It supports the Cotonou Appeal.

^{Updated on 04.09.10}