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Case studies

Systems transformation in practice.

Two engagements set out in full: what the system looked like, what was in the way, what was done, and what was left standing afterwards.

Both end the same way — by naming the structures around the technical work that decided whether it survived. That is the argument the Framework makes, arrived at from the field rather than asserted from the top.

01

Kenya

Building national biosafety governance and laboratory systems

National biosafety governance and laboratory systems strengthening

Technical leadership · Ministry of Health, Management Sciences for Health and development partners

Context

Kenya’s expanding laboratory network required stronger national systems for biosafety, biosecurity and laboratory quality management. While technical activities were taking place across institutions and facilities, sustainable improvement depended on stronger governance, national standards, coordinated oversight and a workforce able to translate policy into routine practice.

Challenge

Biosafety responsibilities were distributed across institutions and programmes, creating gaps in coordination, standardisation and accountability. Health facilities also required stronger systems to support compliance with biosafety requirements and internationally recognised laboratory quality and safety standards.

Approach

Doris provided technical leadership to strengthen biosafety and laboratory systems at national and facility levels, working with the Ministry of Health, national stakeholders, development partners and laboratory teams.

Selected results

  • Contributed to the establishment of a structured national biosafety governance mechanism and stronger institutional coordination.
  • Supported development and implementation of national biosafety policy and guidance.
  • Trained 1,044 laboratory professionals in biosafety and laboratory systems strengthening.
  • Reached 216 health facilities across 44 counties.
  • Supported 21 laboratories toward improved alignment with ISO 15189 and ISO 15190 requirements.
  • Built and directed a 48-person national trainer cadre, expanding national and subnational capacity and reducing dependence on centrally delivered training.
  • Strengthened institutional mechanisms connecting policy, workforce development, facility implementation and laboratory quality systems.

Link to the Integrated Health Systems Transformation Framework™

This work demonstrates that biosafety cannot be sustained through training alone. Long-term performance depends on the structures around the technical intervention: governance, national standards, institutional ownership, workforce capacity, quality systems, monitoring and accountability.

These lessons later became part of the thinking that informed the Integrated Health Systems Transformation Framework™, and provide an example of the systems approach the Framework now articulates — moving from isolated technical activities toward institutional capability and sustained national ownership.

How the Framework is structured

From technical capacity to institutional capability

The objective was not only to improve what individual laboratories did, but to strengthen the national structures that enabled biosafety and laboratory quality to be coordinated, standardised and sustained.

02

Multi-country

Integrating WASH and IPC into health systems

Global WASH and IPC technical assistance within a USD 277.6M USAID-funded programme

Senior Advisor, WASH & IPC · Save the Children US · 2022–2024 · USAID MOMENTUM Country and Global Leadership (MCGL)

Context

Under USAID’s flagship MOMENTUM Country and Global Leadership programme, WASH and Infection Prevention and Control needed to be embedded within maternal, newborn and broader health programming in ways that strengthened systems rather than creating parallel project structures.

Challenge

WASH and IPC interventions can achieve strong results during project implementation but remain vulnerable when they are not sufficiently connected to government priorities, health-system structures, planning processes, accountability mechanisms and routine monitoring.

Approach

Applied integrated programme design, MEAL systems strengthening, stakeholder coordination, and donor-aligned planning — including workplans, budgets and implementation frameworks — across multiple countries.

Achievement

  • Provided multi-country technical leadership for WASH and IPC within USAID MOMENTUM Country and Global Leadership.
  • Supported WASH and IPC integration within maternal and newborn health programming across diverse development and fragile settings.
  • Contributed to country-level WASH costing, landscape analysis, implementation planning and programme quality improvement.
  • Strengthened the use of monitoring, learning and accountability approaches to support programme performance and institutional ownership.
  • Led collaboration between global technical teams, country programmes, governments and implementing partners to strengthen the positioning of WASH and IPC within wider health-system priorities.

Impact

Improved health system resilience, strengthened infection prevention compliance, and transitioned IPC and WASH interventions into sustainable, government-led systems with enhanced accountability and performance tracking.

Link to the Integrated Health Systems Transformation Framework™

This work illustrates a central principle that now underpins the Integrated Health Systems Transformation Framework™. Sustainable change requires more than delivering technical interventions.

WASH and IPC need to be connected to governance, institutional ownership, financing, standards, workforce capacity, information systems and accountability.

How the Framework is structured

Next step

Bring this approach to your system.

Engagements begin wherever the system is — with a diagnostic, a time-bound transformation engagement, or embedded advisory support under The Integration Architecture™.

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