From the ground up: strengthening health systems at district level

摘要: This supplement introduces the African Health Initiative (AHI), a research program comprised of five unique district health system-strengthening activities in Ghana, Mozambique, Rwanda, Tanzania, and Zambia that began 2009 (Figure ​(Figure1).1). should be interest to all engaged improving delivery primary care — whether ministries health, service providers, funders, or those who evaluate complex interventions. The AHI projects, known as Population Implementation Training (PHIT) Partnerships, are funded by Doris Duke Charitable Foundation (DDCF) with common goal: produce significant, measureable improvements defined geographic area over seven year grant period. With partnerships their fourth funding, it is now possible capture lessons learned project design implementation. Evaluation Initiative’s impact on population including mortality, however, must await conclusion period. Figure 1 Population implementation training partnership sites Why focus systems? The last two decades saw unprecedented growth level assistance available for developing countries. Although expenditure governments remains below Abuja Declaration target (15% government expenditure) [1], donor support more than tripled between 1990 2008 [2] , reaching $27 billion annual 2010 [3]. Much this directed at “big diseases”, notably HIV/AIDS, tuberculosis, malaria, often under auspices new global initiatives. These laudable, ambitious efforts major killers encountered already fragile, under-resourced systems limited capacity beneficiary countries absorb investments. there no simple, fast solutions strengthening systems, World Organization [4] others, Alliance Policy Systems Research, have been central promoting dialogue how address critical issue [5]. In 2006, funding was increasing, Board Trustees considering one initiatives, spurred desire both celebrate its upcoming 10th anniversary making surge returns endowment. Foundation’s Medical Research Program supported mainly domestic clinical research. Only small portion DDCF’s treatment AIDS patients Africa construction Institute Durban, South Africa. It these latter brought DDCF staff several sub-Saharan On an early visit, were struck presence HIV clinic stocked needed medicines supplies staffed proud worker –- while across street hospital —derelict, supplies, crumbling infrastructure, few staff, lying ground lack beds. Further visits confirmed that, rolled out, such contrasts throughout How could possibly make sense woman attend clinic, then contend non-functioning community pregnancy care, childhood immunizations, management malaria? Not only did seem logical clinics provide integrated entire family, but also part system deliver drugs time, train workers, and, when required, refer complicated cases. define, assess, measure continues pose challenges [6], real-world observations, consultation range experts, belief willing gaps even if they ‘hard high risk,’ propelled invest strengthening. Staff heartened findings Tanzanian Essential Interventions Project (TEHIP) [7] Navrongo Experiment northern Ghana [8], which suggested interventions indeed result meaningful gains relatively short period time.