The HSSU is located within the field of health policy and systems research (HPSR) which “encompasses how societies plan, manage and finance health services as well as investigation of the role and interests of different actors in the health system”.  Over the last two decades, HPSR has emerged as a multi-disciplinary field, incorporating a number of different research orientations and epistemologies. Within this, the HSSU’s mandate has been to research, and build capacity to research, the contexts, mechanisms and processes through which initiatives to improve the accessibility, quality and equity of health services become integrated into the everyday practices of the routine institutional environment (“real-world” settings), on the one hand; and achieve sustainable coverage and impacts at scale, on the other hand.

The HSSU was established at UWC to generate evidence on health system strengthening in South Africa, whilst contributing to international knowledge and debates. Health systems are the vehicle through which effective interventions are delivered and made universally accessible. As clinical and programmatic researchers develop breakthroughs in diagnostic and treatment modalities and develop and test interventions targeting particular diseases, understanding the processes through which these interventions are adopted and implemented in an equitable fashion becomes particularly relevant.

District health systems and primary health care are the most decentralised building blocks of South Africa’s public health system. The functioning of these sub-systems (including their governance), the focus of the HSSU, is critical to the attainment of universal health coverage (UHC), and will be a key component of future reforms in South Africa, such as the impending National Health Insurance (NHI). How health systems address health inequities is also critical to ensure that marginalised groups are at the centre of health systems innovations and not further left behind. These foundational elements of health systems are also regaining attention globally as central to the achievement of the sustainable development goals (SDGs).

The research of the HSSU currently focuses on a number of themes related to the SAMRC strategic focus of Health System Strengthening. The first key theme of research is community health systems (CHS) and community health workers (CHWs); the second key theme of research in the HSSU is on health system governance, and the third key theme is district health system strengthening.

In 2019 the Director of the HSSU lead a SAMRC/National Department of Helath National Dialogue on UHC and the UHC research prioritisation exercise.