African Health Initiative

Phase 1: Zambia PHIT Partnership

The African Health Initiative (AHI) 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. This page summarizes one of five Population Health Implementation and Training (PHIT) Partnership projects that are being supported through the AHI.

Better Health Outcomes Through Mentorship and Assessment (BHOMA)

Grantee Institution:

The University of North Carolina at Chapel Hill

Team Leaders:

  • Jeffrey S.A. Stringer, M.D.
    Centre for Infectious Disease Research in Zambia
  • Roma Chilengi, MBChB, DTM&H, MSc
    Centre for Infectious Disease Research in Zambia

Project Summary:

The Zambia PHIT partnership, comprised of the Center for Infectious Disease Research in Zambia (CIDRZ), the University of North Carolina at Chapel Hill and the Zambia Ministry of Health, focuses on a health research intervention in three rural districts in the nation's Lusaka Province: Chongwe, Kafue and Luangwa (population over 300,000). The foundation of the Zambia partnership's approach begins with a simple fact: Good health outcomes are largely the result of good clinical care. A successful HIV/AIDS program orchestrated by CIDRZ has already transformed Zambia's expectations for improving the quality of clinical care through clinical mentoring, data collection and monitoring. The model used by CIDRZ, when applied to the delivery of integrated primary care, will reverse the patterns of the past 20 years in the three intervention districts and produce measurable improvements in Millennium Development Goal health indicators. [1] The seven-year project has both a clinic-based and community-based implementation strategy.

The clinic intervention is composed of five key components: 1) Introduction of practical tools, protocols and forms by the PHIT project to establish clear clinical care standards; 2) Intensive clinic implementation that clearly communicates required clinical standards; 3) Supportive mentoring of clinicians that reinforces standards and changes practice through District Quality Improvement Teams; 4) Provision of essential resources and tools to enable standards to be met; and 5) A data feedback system that provides feedback on whether standards are met by health care providers. The community intervention consists of patient follow-up and household assessments by community health workers using automated mobile phone technology that is linked directly to patient information transcribed by clinicians and entered by data technicians into a data capture system. Through this automated system, health workers are able to follow up with the sickest and most at-risk patents in the community in order to intervene where possible and document outcomes. Clinic and community health workers have clear protocols and receive ongoing mentoring, measuring and performance reviews by supervisors.

The intervention will be evaluated through a series of community, household and facility surveys. The Zambia PHIT Partnership's primary focus for these surveys is determining age-standardized mortality in persons less than 60 years old.

For more information, please visit the CIDRZ website.



[1] The United Nations Millennium Declaration, signed in September 2000, commits world leaders to try to achieve the eight Millennium Development Goals by 2015: 1) to eradicate extreme poverty and hunger, 2) to achieve universal primary education, 3) to promote gender equality and empower women, 4) to reduce child mortality, 5) to improve maternal health, 6) to combat HIV/AIDS, malaria and other diseases, 7) to ensure environmental sustainability; and 8) to develop a global partnership for development.