Early Lessons from the African Health Initiative
June 4, 2013
By Mary Travis Bassett, M.D., M.P.H., then program director for the African Health Initiative
As the African Health Initiative passes its midpoint, we are pleased to share with you, Improving primary health care to achieve population impact: the African Health Initiative, a special issue of BMC Health Services Research that documents the experience of five separate projects to strengthen health systems in sub-Saharan Africa.
The origins of the African Health Initiative track back to more than a decade ago when large increases in global health funding reinvigorated international solidarity to reduce the excess disease burden of low and middle income countries. The ambitious efforts that followed exposed the fragility of national health systems. The Doris Duke Charitable Foundation (DDCF), which at the time was making grants to support biomedical and operations research in Africa, saw stronger health systems as a prerequisite for sustainable country-owned efforts to improve population health. This observation led to the African Health Initiative, which was launched by the foundation in 2007.
In 2009, DDCF funded five partnership projects with lifespans of five to seven years to strengthen district health systems in Ghana, Mozambique, Rwanda, Tanzania and Zambia. Each project tackled health systems with approaches that were tailored to the needs of defined geographical areas that comprised no fewer than 250,000 people. The goal was to save lives, as reflected in measurably reduced mortality rates. Now, five years after DDCF's initial decision to invest in strengthening health systems, the need is more widely acknowledged and no less pressing. It is also clear that, while frameworks and approaches can be identified, there are no simple recipes for success. While we must await the projects' end to assess their impact on population mortality, the teams have already learned a great deal as they finalized their intervention plans and began to implement them.
This special journal supplement offers an early look at the design, challenges and progress of each project. As several strategies related to health service quality and the use of information for decision-making spanned across sites, cross-site learning is also shared. The task of adopting a shared evaluation framework and developing similar measures across five very different projects is also recounted. Last, several commentators, drawing on a range of expertise in global health systems, offer their individual perspectives on the ongoing critical necessity of a health systems approach. But why certain approaches are taken and how this work is accomplished will remain crucial to learning in the field. We salute the teams for sharing the process, not only the outcome, of their work!
You can find direct links to each of the articles below:
- Implementation Research to Catalyze Advances in Health Systems Strengthening in Sub-Saharan Africa: The African Health Initiative
- Introduction and organizing framework: An overview of the rationale for the African Health Initiative, site selection process, and introduction to the coordinating and collaboration structure
- The Ghana Essential Health Intervention Project: A plausibility trial of the impact of health systems strengthening on maternal & child survival
- Strengthening Integrated Primary Health Care in Sofala Province, Mozambique
- Strengthening and Studying Community-Based, Integrated Primary Health Care Systems in Rural Rwanda
- 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
- Protocol-driven primary care and community linkages to improve population health in rural Zambia: the Better Health Outcomes through Mentoring and Assessment (BHOMA) project
- Approaches to ensuring and improving quality in the context of health system strengthening: A cross-site analysis of the five African Health Initiative partnership programs
- Improving health information systems for decision making across five sub-Saharan African countries: Implementation strategies from the African Health Initiative
- A common evaluation framework for the African Health Initiative
The following are expert commentaries:
- Taking health systems research to the district level: A new approach to accelerate progress in global health by Agnes Binagwaho
- Public health information needs in districts by Ties Boerma
- Addressing health systems through a health equity lens by Mickey Chopra
- Implementing health system change: What are the lessons from the African Health Initiative? by Lucy Gilson
- African leadership for sustainable health policy and systems research by Cheikh Mbacke