Abstract
BackgroundAchieving the United Nations Sustainable Development Goals in sub-Saharan Africa will require substantial improvements in the coverage and performance of primary health care delivery systems. Projects supported by the Doris Duke Charitable Foundation’s (DDCF) African Health Initiative (AHI) created public-private-academic and community partnerships in five African countries to implement and evaluate district-level health system strengthening interventions. In this study, we captured common implementation experiences and lessons learned to understand core elements of successful health systems interventions.MethodsWe used qualitative data from key informant interviews and annual progress reports from the five Population Health Implementation and Training (PHIT) partnership projects funded through AHI in Ghana, Mozambique, Rwanda, Tanzania, and Zambia.ResultsFour major overarching lessons were highlighted. First, variety and inclusiveness of concerned key players (public, academic and private) are necessary to address complex health system issues at all levels. Second, a learning culture that promotes evidence creation and ability to efficiently adapt were key in order to meet changing contextual needs. Third, inclusion of strong implementation science tools and strategies allowed informed and measured learning processes and efficient dissemination of best practices. Fourth, five to seven years was the minimum time frame necessary to effectively implement complex health system strengthening interventions and generate the evidence base needed to advocate for sustainable change for the PHIT partnership projects.ConclusionThe AHI experience has raised remaining, if not overlooked, challenges and potential solutions to address complex health systems strengthening intervention designs and implementation issues, while aiming to measurably accomplish sustainable positive change in dynamic, learning, and varied contexts.
Highlights
Achieving the United Nations Sustainable Development Goals in sub-Saharan Africa will require substantial improvements in the coverage and performance of primary health care delivery systems
Building on knowledge of key stakeholders and need to broaden engagement, Population Health Implementation and Training (PHIT) project leaders each identified a number of shared core activities during the planning stage that were used to inform intervention design and implementation
These were focused on ensuring input and buy-in from key leaders and implementing partners (PHIT partnership members, national and local Ministry of Health leaders, local researchers, and district-level leaders) and sustaining and strengthening trust and acceptance from the community and intervention beneficiaries
Summary
Achieving the United Nations Sustainable Development Goals in sub-Saharan Africa will require substantial improvements in the coverage and performance of primary health care delivery systems. There has been increasing recognition that disease-specific interventions will be more effective and sustainable when linked to improvements in the broader health system, including a strong focus on primary health care [5, 6] Reflecting these lessons learned, broader health systems strengthening and primary health care are seen as core to achieving Universal Health Coverage (UHC) and critical to meeting the new healthrelated United Nations Sustainable Development Goals (SDGs) [7, 8]. Extracting the key learnings from this work is important to be able to inform current and future efforts to more effectively strengthen the care delivery and supporting systems needed to improve population health Reflecting this complexity, there has been a growing use of a systems thinking approach in the design, implementation and evaluation of complex, multiple-level interventions, including HSS interventions in sub-Saharan Africa. The emergence of implementation science as a discipline has resulted in new frameworks and models to inform decision-makers on how to best design, implement, and adapt interventions to the changing environments in which they are working and produce new knowledge for more effective strategies and implementation [11, 12]
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