Welcome from HRSA

Dear Global Health Colleagues:

The Health Resources and Services Administration’s (HRSA) HIV/AIDS Bureau is proud to share the Clinical Assessment for Systems Strengthening (ClASS) Framework and this toolkit.  These tools may assist you with activities associated with program monitoring, capacity building and other systems strengthening activities.

For the past 20 years, we have administered the Ryan White HIV/AIDS Program, the largest HIV-specific grant program in the United States. That history, as well as expertise from other Bureaus within HRSA, including the Bureau of Primary Health Care and the Bureau of Health Professions, continues to add value to global health efforts.  The ClASS Framework is based on the Primary Care Assessment Tool that we developed for use in monitoring the domestic Ryan White HIV/AIDS Program.

I have witnessed the evolution of the ClASS over the past years and have been gratified by its success as evidenced by a series of successful transitions of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR)-supported care and treatment programs and, more recently, by strengthening African medical schools and schools of nursing.  Though there are other approaches to accomplishing effective monitoring, country ownership, and sustainability, ClASS has a successful track record that we hope to continue to strengthen.

I hope that you will find this Toolkit helpful in your efforts to achieve our shared goals.

Laura Cheever, MD, ScM
Associate Administrator
Health Resource and Services Administration

Dear Global Health Colleagues:

Thank you for your interest in HRSA’s Clinical Assessment for System Strengthening (ClASS) Framework. 

The ClASS Toolkit provides information on the ClASS Framework and detailed information on the implementation process. .  The ClASS continues to evolve, and the Toolkit is regularly updated to reflect continuous improvements. 

The ClASS framework focuses on service systems to meet specific needs in many technical areas as well as administrative and financial management systems.

We are very proud of the success of the ClASS Framework in identifying technical assistance needs, and in working with International and Local Partners to strengthen and create sustainable systems, in clinical, educational, and training settings, clinical educational systems.

We welcome your feedback and inquiries and hope that you will find the information helpful in our shared work in Global Health.


Jose Rafael Morales, MD, FACOG

Director and Chief Medical Officer Global HIV/AIDS Program
HIV/AIDS Bureau (HAB) Health Resource and Services Administration (HRSA)