African Health Initiative

Why Put Health Systems First?

Improving human health across a large population cannot be achieved by taking isolated approaches focused solely on combatting particular diseases. A country without a well-functioning primary health care system will always struggle to meet the challenges of any epidemic or health crisis. Further, many of the medical issues affecting the largest numbers of people do not fall under the umbrella of any particular disease area. Putting health systems first—strengthening the entire foundational health system with an integrated network of learning, approaches and solutions—is essential to saving lives.

It is with this understanding that the Doris Duke Charitable Foundation crafted the strategy for the African Health Initiative. There are three components we see as critical to the success of any effort by a funder to strengthen a health system: 1) supporting countries in owning the solutions that address weaknesses in their systems, 2) enabling the creation of learning systems by buoying the timely collection and application of data to resolve issues, and 3) building partnerships between the key stakeholders that play distinct and interconnected roles in strengthening public health. Learn more below about how we execute these elements in our work in places such as Ghana, Mozambique and other sub-Saharan countries.


Supporting Local Ownership of Solutions

No one better understands the challenges to a community or the context necessary to address them than the people who live there. They play a pivotal role in making ideas applicable and improvements sustainable.

That is why local voices take center stage in each of the programs the African Health Initiative funds. Supported as the primary owners of the solutions, government leaders at the national, regional and community level take the lead in these programs and their outcomes so that improvements to the general system result in effects that long outlast our funding. These leaders directly engage the communities they serve to localize efforts to improve health, using approaches built with the context of the specific places and people in mind.

To see what this looks like in powerful practice, view our video about the Community Health-Based Planning and Services project (CHPS+) in Ghana, an effort in concert with Columbia University Mailman School of Public Health and Ghana Ministry of Health.

Enabling Learning Systems

When lives are at stake, research often needs to be applied in real time. A system that is always learning from and refining itself in a timely way is more able to respond quickly to both expected and unexpected population health issues. Therefore, the African Health Initiative’s second phase is intended to support health system leaders to be as responsive as possible to obstacles within their health systems by equipping them with the data and research needed to help them to problem-solve ways to improve service delivery. African Health Initiative grantees also regularly convene to share and discuss their successes and challenges. Through this exchange, they not only learn from one another and improve their own programs, but collaborate to share collective lessons with the field of public health—contributing to greater progress across the continent and beyond.

Learn more in the video at right about how we are working with Health Alliance International, University of Washington and Mozambique Ministry of Health to make research central to service delivery and about the ways data is driving important decision making in Mozambique.

Building Partnership-Based Philanthropy

Every African Health Initiative grantee program is built on a three-pronged partnership between national African government health ministries, U.S. and African universities, and global funding organizations. Each partner plays a special and complementary role in this equation to improve their health system. This collaborative approach allows the players to elevate the effectiveness of each other’s work toward the same end goals.

Local governments are the experts on their country’s own norms and cultural practices and are best positioned to carry the leadership of local service delivery as their population evolves; university and research institutions are critical for testing existing and new methods of implementing health care solutions; and global funders play a key role in supporting health systems in their earliest stages of development as they continue to grow more efficient and efficacious.

Often, globally funded health projects slip into leadership arrangements that are only “partnerships” in name but not in practice. In contrast, the African Health Initiative aims in its second phase to ensure that each country’s health system gains from the critical vantage points of each partner, and that partnerships of trust and commitment sustain the system over the long term. Watch this video to hear Lola Adedokun, Director of DDCF's African Health Iniative, along with our colleagues at the USAID Office of Maternal and Child Health and Nutrition, Korea International Cooperation Agency, and the World Bank Global Financing Facility for Women, Children and Adolescents talk about their partnership together to accelerate the impact of each other’s work.

The Case for Building Partnership-Based Philanthropy: Featured Research