Background The World Health Organization’s health systems guidance and the normative standards about health systems endorsed in World Health Assembly (WHA) have the potential to better support national and subnational health systems guidance and policy development processes by including information about the contextual factors that can shape decisions about health systems.

Objectives To assess the extent to which WHO health systems guidance and the WHA technical documents include information about how to address a health system problem and how the health system arrangements and political system features can influence decision-making.

Methods We reviewed all WHO guidance published since 2008 to 2012 and WHA resolutions published from 2005 to 2012 and included those with a focus on health systems. Two reviewers independently screened and applied the selection criteria to all the documents and extracted the information following pre-established data-extraction forms.

Results 13 out of 78 WHO guidance and 14 technical documents out of 207 WHA resolutions had a health system’s focus. Six WHO guidance and 12 WHA documents included information about how to address a health system problem. All WHO guidance included information about delivery arrangements but only three discussed financial arrangements. Two WHO guidance and five WHA documents discussed key features of political systems.

Discussions The inclusion of contextual factors, mainly financial arrangements of health systems and political systems features was infrequent among the reviewed documents.

Implications for Guideline Developers/Users It is necessary to understand better how to integrate these contextual factors in the process of global guidance development.