Purpose
The African Health Initiative seeks to catalyze significant advances in strengthening health systems by supporting partnerships that will design, implement and evaluate large-scale models of care that link implementation research and workforce training directly to the delivery of integrated primary healthcare in sub-Saharan Africa.
Activities
Central to the initiative is the establishment of large-scale Population Health Implementation & Training (PHIT) Partnerships that will link implementation research and training directly to health care delivery. In 2009, DDCF awarded four grants ranging from $8 million to $15 million each to support PHIT Partnerships working in Ghana, Mozambique, Rwanda, Tanzania and Zambia.
Over a period of 5 to 7 years, each PHIT Partnership will:
- Provide integrated primary healthcare and achieve significant, measurable health improvements for underserved communities of between 300,000 and 1.6 million people;
- Strengthen health systems in a manner that enables local and national governments to sustain improvements beyond the grant period;
- Increase the knowledge available for evidence-based health systems planning through rigorous operations and implementation research.
PHIT Data Collaborative
Research conducted by each PHIT partnership will measure the impact of their interventions on reducing child mortality and other health outcomes, in addition to analyzing indicators of health systems performance. The partnerships will participate in a data collaborative to share information and will be convened annually starting in the fall of 2009. The foundation is also committed to ensuring that relevant data and information collected by the partnerships be made available to the public.
In order to facilitate this, a PHIT Data Collaborative will be created, which will be led by a central coordinating body referred to as the Data Coordinator. The Data Coordinator will serve as a resource to the teams to ensure that each of the PHIT Partnerships collects a set of common measures, or “core metrics”, which are standardized and of high quality. It will also facilitate the public access to data in a timely manner; help identify lessons learned across partnerships; promote the communication of research findings to the wider community; and when appropriate, coordinate PHIT Partnership data collection and analysis with efforts supported by other organizations.
A team at the Institute for International Programs (IIP), Bloomberg School of Public Health, Johns Hopkins University will serve as the Data Coordinator, led by Robert Black and Jennifer Bryce. The IIP team has a strong track record in external program evaluation and is well-linked to other complementary efforts at health systems strengthening. For more information about IIP, please visit their website.
DDCF may also support a portfolio of smaller projects that complement and advance PHIT Partnership activities, such as focused training programs, the development of shared tools, and activities that foster collaboration among developing countries on health systems improvement.
Implementation Research Framework
One of the main goals of the African Health Initiative is to improve health systems planning by providing strong evidence to the global health community on what works and what doesn’t in implementing large-scale, integrated primary healthcare.
With that goal in mind, DDCF asked the Institute of Health Metrics and Evaluation to develop an Implementation Research Framework for the PHIT Partnerships. While this framework will need to be adapted to suit the context and specific activities of each PHIT Partnership, it has helped guide the grantees in developing rigorous implementation research plans to document outcomes and impact, and foster innovation and continuous process improvements.
PHIT Partnership Selection Process
The PHIT Partnerships were selected using a three-stage competitive review process. The foundation first issued an open call for letters of interest from teams working in nine target countries. Following an expert review of the 137 letters of interest received, the foundation invited 29 teams to submit proposals for planning grants of up to $150,000 each. Eleven teams received planning grants following a second expert review process.
During the third and final stage, members of the African Health Initiative’s Advisory Council and other experts in epidemiology, health economics and statistics reviewed each planning grant team’s proposal on the following criteria: 1) potential to significantly strengthen the local health system and improve health; 2) strength and quality of the team; 3) presence of local leadership; 4) alignment with local and national activities; 5) ability to build on existing programs; and 6) innovation and potential for replication. Based on the recommendations of the expert reviewers and availability of DDCF funds, the foundation selected four teams to receive grants ranging from $8 million to $15 million each over five to seven years.
Background & Rationale
As the DDCF approached its tenth anniversary, the foundation's board challenged the staff to identify a compelling and urgent need that fit the mandate of Doris Duke’s will, and for which a well-timed and large infusion of the foundation’s resources (above and beyond its normal grant-making activities) had the potential to make a significant positive impact on society.
Seeing the board’s challenge as an opportunity to build upon and expand beyond the foundation’s support for AIDS research in Africa, the Medical Research Program sought to identify opportunities for DDCF to help address health disparities in Africa more broadly.
Extensive research and interviews with dozens of experts revealed that despite the recent growth of health investments in Africa, efforts to improve access to essential medical care remain seriously hindered by fragile health systems, health worker shortages and a lack of focus on integrated care.
In response to these challenges, DDCF launched the multi-million dollar African Health Initiative in the fall of 2007.