A health system is the combination of resources, actors, organizations and management that is related to the improvement or maintenance of health. A well-functioning health system supports the ability of health actions to run effectively and efficiently. Since health system is a complex social-economic-political-cultural structure, strengthening the health system would not only improve health but also move us closer to a good place to live in in terms of social, economic, political, and cultural aspects-a dream world-.
However, the fact that the boundaries of the health system are very broad is a double-edged sword. Because strengthening health system is a really wide-ranging project requiring multilateral actions on many fronts, it doesn’t seem to be easy at all to make the dream world come true. The health system reform should encompass reducing political resistance, economic collapse, and ethical issues that have a negative influence on health system performance. How the health system reform should be done without the efforts being fragmented? What implementation options are available to enhance the health system performance effectively?
The truth is we don’t have enough knowledge to answer. The evidence-base on the health systems is weak. Because health system reform requires attentions to a wide range of issues, clarity and certainty on directions are pre-requisite for policies to keep focus on national health priorities. The need for health system research has been emphasized in the Ministerial Summit on Health Research in Mexico (2004), the High Level Task Force on Scaling up Research and Learning for Health Systems in Bamako, Mali (2008) and the first global symposium on health systems research in Montreux, Switzerland (2010).
Although attention and funding for health system research has been increased and some progress has been made since the summit in Mexico, total amount of funding for health system research is still very low. Moreover, there are substantial gap between high-income countries and low, middle-income countries in terms of funding, capacity for research and analysis. Because health systems are highly country and regional contextual, middle- and low-income countries have to invest for building the capacity to conduct the health system research and to apply evidence throughout the policy at the country level.
Investment in health system research is important for achieving the health-related Millennium Development Goals. Knowledge of how to strengthen health systems would help us to have a clear vision and direction to the dream world.
 World Bank. 2004. The Millennium Development Goals for Health: Rising to the challenges. Washington, DC: World Bank.