Measuring health systems strength and its impact: experiences from the African Health Initiative View Full Text


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Article Info

DATE

2017-12

AUTHORS

Kenneth Sherr, Quinhas Fernandes, Almamy M. Kanté, Ayaga Bawah, Jeanine Condo, Wilbroad Mutale, the AHI PHIT Partnership Collaborative

ABSTRACT

BACKGROUND: Health systems are essential platforms for accessible, quality health services, and population health improvements. Global health initiatives have dramatically increased health resources; however, funding to strengthen health systems has not increased commensurately, partially due to concerns about health system complexity and evidence gaps demonstrating health outcome improvements. In 2009, the African Health Initiative of the Doris Duke Charitable Foundation began supporting Population Health Implementation and Training Partnership projects in five sub-Saharan African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) to catalyze significant advances in strengthening health systems. This manuscript reflects on the experience of establishing an evaluation framework to measure health systems strength, and associate measures with health outcomes, as part of this Initiative. METHODS: Using the World Health Organization's health systems building block framework, the Partnerships present novel approaches to measure health systems building blocks and summarize data across and within building blocks to facilitate analytic procedures. Three Partnerships developed summary measures spanning the building blocks using principal component analysis (Ghana and Tanzania) or the balanced scorecard (Zambia). Other Partnerships developed summary measures to simplify multiple indicators within individual building blocks, including health information systems (Mozambique), and service delivery (Rwanda). At the end of the project intervention period, one to two key informants from each Partnership's leadership team were asked to list - in rank order - the importance of the six building blocks in relation to their intervention. RESULTS: Though there were differences across Partnerships, service delivery and information systems were reported to be the most common focus of interventions, followed by health workforce and leadership and governance. Medical products, vaccines and technologies, and health financing, were the building blocks reported to be of lower focus. CONCLUSION: The African Health Initiative experience furthers the science of evaluation for health systems strengthening, highlighting areas for further methodological development - including the development of valid, feasible measures sensitive to interventions in multiple contexts (particularly in leadership and governance) and describing interactions across building blocks; in developing summary statistics to facilitate testing intervention effects on health systems and associations with health status; and designing appropriate analytic models for complex, multi-level open health systems. More... »

PAGES

827

References to SciGraph publications

  • 2013-05. A common evaluation framework for the African Health Initiative in BMC HEALTH SERVICES RESEARCH
  • 2015-06. Estimation of indices of health service readiness with a principal component analysis of the Tanzania Service Provision Assessment Survey in BMC HEALTH SERVICES RESEARCH
  • 2015-12. Effects of a health information system data quality intervention on concordance in Mozambique: time-series analyses from 2009–2012 in POPULATION HEALTH METRICS
  • 2011-12. An assessment of routine primary care health information system data quality in Sofala Province, Mozambique in POPULATION HEALTH METRICS
  • 2013-05. The Tanzania Connect Project: a cluster-randomized trial of the child survival impact of adding paid community health workers to an existing facility-focused health system in BMC HEALTH SERVICES RESEARCH
  • 2013-05. Protocol-driven primary care and community linkages to improve population health in rural Zambia: the Better Health Outcomes through Mentoring and Assessment (BHOMA) project in BMC HEALTH SERVICES RESEARCH
  • 2013-05. Strengthening integrated primary health care in Sofala, Mozambique in BMC HEALTH SERVICES RESEARCH
  • 2011-12. Health system determinants of infant, child and maternal mortality: A cross-sectional study of UN member countries in GLOBALIZATION AND HEALTH
  • 2013-05. The Ghana essential health interventions program: a plausibility trial of the impact of health systems strengthening on maternal & child survival in BMC HEALTH SERVICES RESEARCH
  • 2013-05. Comprehensive and integrated district health systems strengthening: the Rwanda Population Health Implementation and Training (PHIT) Partnership in BMC HEALTH SERVICES RESEARCH
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1186/s12913-017-2658-5

    DOI

    http://dx.doi.org/10.1186/s12913-017-2658-5

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1099743827

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/29297341


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