Primary Health Care Delivery System Research Articles

Artabotrys brachypetalus Benth.: Evaluation of its traditional uses, phytochemistry, and pharmacological properties

Background: Artabotrys brachypetalus is best known for its edible fruits, but today, it is a well-known medicinal plant. However, there are several uses of the species, some of them known since prehistoric times.Aim: This study compiles the existing information of the traditional uses, phytochemistry and pharmacological properties, and future potential applications of A. brachypetalus.Setting: This review provides an overview of uses and ethnopharmacological properties of A. brachypetalus.Method: Multiple searches on existing literature were carried out on the traditional, medicinal, phytochemistry, and pharmacological properties of A. brachypetalus in online databases such as Scopus, PubMed, Google Scholar, JSTOR, and Science Direct as well as using pre-electronic literature sources obtained from the university library.Results: This study showed that A. brachypetalus is a multipurpose species used as a food plant, source of fibre, firewood, timber, and herbal medicine. Artabotrys brachypetalus serves as a medicinal plant in five countries to treat human and animal diseases, accounting for 55.6% of the countries where the species is naturally found. The phytochemical evaluation of the plant revealed that it contains alkaloids, cyclohexane carboxylic acid, dicarboxylic acid, fatty acids, flavonoids, phenolics, sesquiterpenes, and sugars. The pharmacological assessments showed that the phytochemical compounds isolated from the species and crude extracts demonstrated antifungal, antidiabetic, antiplasmodial, and larvicidal activities.Conclusion: Further research should focus on elucidation of pharmacological, phytochemical, toxicological, in vitro, in vivo and clinical research of the species.Contribution: This study contributes to the existing knowledge about A. brachypetalus that could be useful in bio-prospecting for new health-promoting products required in the primary healthcare delivery system.

IJCM_172A: Risk Scoring of Type 2 Diabetes Mellitus and Coverage of Screening Services through Primary Health Care System among Adults in a Block of Murshidabad District, West Bengal

Background: Type 2 diabetes is a major public health challenge. Indian Diabetes Risk Score (IDRS), a simple and cost-effective tool consisting of two modifiable (waist circumference, physical activity) and two non-modifiable risk factors (age, parental history) for diabetes, can be easily applied in mass screening programmes. Opportunistic screening for diabetes among individuals aged = 30 years is being done under the programme for Prevention and Control of Non-communicable Diseases. Objective: To assess the risk of type 2 diabetes mellitus using IDRS, coverage of screening services for diabetes through the primary health care delivery system and to identify their correlates. Methodology: : A descriptive, cross-sectional study was conducted in a block of Murshidabad district, West Bengal during September to November 2023 among permanent residents aged = 30 years on a calculated sample of 300 selected through multi-stage sampling. Required data were collected by interviewing the study subjects using pre-designed, pre-tested schedule including IDRS, reviewing medical records and measuring waist circumference. Analysis was done using SPSS-20. Results: Among 300 participants, 40.7% had high risk; 54% and 5.3% had moderate and low risk of diabetes respectively according to IDRS. In multivariable analysis, age =35 years (AOR 18.10, 95% CI 5.07-64.66), female gender (AOR 2.36, 95% CI 1.40-4.00) and being in joint family (AOR 3.53, 95% CI 1.77-7.04) were significant correlates for high-risk category according to IDRS. Only 67% were screened for diabetes within last six months, of which 89% were through primary health care delivery system. Screening status varied significantly by age group (OR 3.81, 95% CI 1.98-7.35) and IDRS risk categories (OR 1.72, 95% CI 1.06-2.80). Conclusion: Alarmingly substantial proportion of people in the area are at high/moderate risk of diabetes coupled with low opportunistic screening coverage, which highlights the need for intensive behaviour change communication and stronger service delivery.

Qualitative exploration for the under-foot fall in utilization of health services at Primary Health Center of Shahdol, Madhya Pradesh.

Despite efforts to improve healthcare infrastructure and service delivery, significant disparities in healthcare utilization persist, leading to suboptimal health outcomes and hindering progress toward achieving universal health coverage. This research article aims to conduct a qualitative exploration of the under-foot fall in utilization of health services, shedding light on the barriers and challenges faced by individuals in accessing and utilizing health care to inform targeted interventions and improve health service utilization. This qualitative study employed free listing, pile sorting, and focus group discussions (FGDs) as data collection methods. Representatives from various stakeholders involved in the primary healthcare delivery system were selected based on their vocalness, knowledge, willingness to participate, and heterogeneity of responses. Subsequently, FGDs and key informant interviews (KIIs) were conducted to further explore the identified barriers. The collected transcripts underwent manual thematic analysis using coding rules and theme generation procedures. A total of 30 participants, including healthcare providers, community leaders, and individuals from the local community, took part in the qualitative exploration. The themes encompassed limited awareness and knowledge, geographical and infrastructural barriers, socioeconomic constraints, trust and perceptions of the healthcare system, and cultural and social factors. These findings provide valuable insights into the multifaceted barriers hindering healthcare utilization and can guide the development of targeted interventions and policies to improve healthcare access and delivery in the study area. The identified barriers, including limited awareness and knowledge, geographical and infrastructural challenges, socioeconomic constraints, trust and perceptions of the healthcare system, cultural and social factors, and gender disparities, are consistent with the existing literature.

Roles of African Traditional Medicine in Primary Healthcare Delivery System

One of the existing medicine in the world that receives so much criticism is traditional systems of healthcare delivery, almost to a point of extermination in some countries in the world. Although most of the issues raised to affirm the seemingly inadequate status of this system are debatable, but the effectiveness of traditional medicine has anull all those criticism if we carefully analyse the methods of health approach in TM. Part of the misconception derives from lumping Nigeria into one integrated and indivisible indigenous unit, notwithstanding differences in values, beliefs and practices among communities. Against this backdrop, this study invites a reassessment and possible integration of African traditional medicine with the introduced systems of Primary healthcare delivery. This will ensure not only a holistic approach to dealing with complex health issues among Africas, but also the continued relevance of indigenous medicine. Critical issues examined include forms and factors affecting traditional medicine, and conflicts between indigenous and introduced systems of healthcare delivery. Consequently, a framework for explaining traditional medicine in the context of Nigeria was designed through a triangulation of Rational Choice theory, Ethnomethodology and the Health Belief Model.

Using the Implementation Research Logic Model to design and implement community-based management of possible serious bacterial infection during COVID-19 pandemic in Ethiopia

BackgroundCommunity-based treatment of possible serious bacterial infection (PSBI) in young infants, when referral to a hospital is not possible, can result in high treatment coverage and low case fatality. However, in Ethiopia, the coverage of PSBI treatment remains low, worsened by COVID-19. To understand the challenges of delivery of PSBI treatment and design and test adaptative strategies to mitigate the impact of COVID-19 on neonatal mortality, we did implementation research (IR) employing Implementation Research Logic Model (IRLM). In this paper, we describe IRLM application experiences in designing, implementing, and evaluating strategies to improve community-based treatment of PSBI during the COVID-19 pandemic in Ethiopia.MethodsThis IR was conducted between November 2020-April 2022 at Dembecha and Lume woredas of Amhara and Oromia regions, respectively. We employed narrative reviews, formative assessment and facilitated stakeholder engagement to develop the PSBI treatment IRLM to identify barriers, understand the conceptual linkages among determinants, choose implementation strategies, elicit mechanisms, and link to implementation outcomes. In addition, we used the IRLM to structure the capture of emerging implementation challenges and resulting strategy adaptations throughout implementation.ResultsThis IR identified COVID-19 and multiple pre-existing contextual factors. We designed and implemented implementation strategies to address these challenges. These adaptive strategies were implemented with sufficient strength to maintain the delivery of PSBI services and improve mothers’ care-seeking behavior for their sick young infants.The IRLM offers us a clear process and path to prioritize implementation challenges, choose strategies informed by mechanisms of action, and where the adaptive implementation of community-based management of PSBI would lead to high-implementation fidelity and change in mother behavior to seek care for their sick young infants. The IRLM was also an effective tool for stakeholder engagement, easily explained and used to structure discussion and decision-making during co-design meetings.ConclusionsThe use of the IRLM helps us to specify the conceptual links between the implementation challenges, strategies, mechanisms of action, and outcomes to explore the complex community-based management of PSBI during complex contexts to improve high-fidelity implementation and integration of PSBI treatment in the primary healthcare delivery systems through active engagement of stakeholders.

Healthcare providers’ and policymakers’ experiences and perspectives on barriers and facilitators to chronic disease self-management for people living with hypertension and diabetes in Cameroon

BackgroundHypertension and diabetes are chronic noncommunicable diseases ranked among the leading causes of morbidity and mortality in resource-limited settings. Interventions based on patient empowerment (PE) have been shown to be effective in the management of these diseases by improving a variety of important health outcomes. This study aims to examine from the healthcare providers’ and policymakers’ experiences and perspectives, the facilitators and barriers in the management of hypertension and diabetes for patient empowerment to achieve better health outcomes in the context of the healthcare system in Cameroon.MethodsWe carried out a qualitative study involving three levels of embedded analysis in a public primary healthcare delivery system in Cameroon, through 22 semi-structural interviews with healthcare providers and policymakers and 36 observations of physicians’ consultations. We combined thematic and lexicometric analyses to identify robust patterns of differences and similarities in the experiences and perspectives of healthcare providers and policymakers about direct and indirect factors associated with patients’ self-management of disease.ResultsWe identified 89 barriers and 42 facilitators at the central, organizational, and individual levels; they were preponderant at the organizational level. Factors identified by healthcare providers mainly related to self-management of the disease at the organizational and individual levels, whereas policymakers reported factors chiefly at the central and organizational levels. Healthcare providers involved in the decision-making process for the delivery of healthcare tended to have a sense of ownership and responsibility over what they were doing to help patients develop self-management abilities to control their disease.ConclusionWhile interventions focused on improving patient-level factors are essential to PE, there is a need for interventions paying more attention to organizational and political barriers to PE than so far. Interventions targeting simultaneously these multilevel factors may be more effective than single-level interventions.

Horizontal Integration and Financing Reform of Rural Primary Care in China: A Model for Low-Resource and Remote Settings.

Primary health care (PHC) systems are compromised by under-resourcing and inadequate governance, and fail to provide high-quality health care services in most low- and middle-income countries (LMICs). As a response to solve the problems of underfunding and understaffing, Pengshui County, an impoverished area in rural Chongqing, China, implemented a profound reform of its PHC delivery system in 2009, focusing on horizontal integration and financing mechanisms. This paper aims to present new evidence from the Pengshui model, and to assess the relevant changes over the past 10 years (2009–2018). An inductive approach was adopted, based on analysis of national and local policy documents and administrative data. From 2009 to 2018, the proportion of outpatients who sought first-contact care in rural community or township health centers increased from 29% (522,700 of 1,817,600) in 2009, to 40% (849,900 of 2,147,800) in 2018 (the national average in 2018 was 23%). Our findings suggest that many positive results have been achieved through the reform, and that innovations in financial governance and incentive mechanisms are the main driving forces behind the improvement. Pengshui County’s experience has proven to be a successful experiment, particularly in rural and low-income areas.

Emergency Preparedness and Modish Practices among Primary Healthcare Delivery Systems Facilitated through Public-private Partnership Models in a South Indian Metropolitan City: A Descriptive Cross-sectional Study.

Access to health care is supposed to be a basic human right but the present scenario of the healthcare sector in India displays a large disparity in the healthcare services provided by the public and private sectors with wide variations in the infrastructure and services delivered by both sectors. Hence, public-private partnership (PPP) in healthcare delivery is an urgent and essential component that needs attention to ameliorate this gap. The aim of this study was to assess the current practices in healthcare services provided through PPPs in Bengaluru city. A cross-sectional questionnaire survey was conducted among primary healthcare centers (PHC) run under PPP in Bengaluru city, Karnataka, India. The pretested self-designed structured questionnaire consisted of 18 items regarding the current practices of PPP at the primary healthcare level. Descriptive statistics were used to describe the data. A total of 15 PPPs at the primary healthcare level were identified and included in the study. All of the participants provided basic healthcare services, some participants (33%) provided specialized services, and some (27%) mobile healthcare services. The overall impression of the medical officers in charge interviewed was that PPPs are better than individual endeavors by both public and private sectors. They also believed that it was important to have policies and guidelines in place to monitors aspects like the functioning of the setup, risk sharing, etc. The results indicated that all the participants were at the primary healthcare level and mostly involved in preventive practices. It is also important to look at venturing into services that provide curative services as well. Oral health, however, did not prominently feature at any point and is another area that requires attention. Mukherji I, Eshwar S, Srivastava BK, et al. Emergency Preparedness and Modish Practices among Primary Healthcare Delivery Systems Facilitated through Public-private Partnership Models in a South Indian Metropolitan City: A Descriptive Cross-sectional Study. Int J Clin Pediatr Dent 2022;15(2):153-158.

Automated Primary Health Care Delivery System The Nigeria Context

Automated Primary Health Care Delivery System The Nigeria Context

Automated Primary Health Care Delivery System The Nigeria Context

Automated Primary Health Care Delivery System The Nigeria Context

Utilization of dental health-care services by accredited social health activist and anganwadi workers in lucknow district: A cross-sectional study

Background: Accredited Social Health Activists (ASHAs) and Anganwadi workers are grassroots-level health activists who are involved in health education and community mobilization and form a bond between the community and the primary health-care delivery system in India. The cross-sectional study was conducted to assess the dental health-care utilization and to estimate the dentition and periodontal status of ASHA and Anganwadi workers. Materials and Methods: The study was conducted at the primary health centers and subcenters of Lucknow District. ASHA and Anganwadi workers presented on the day of the examination were included in the study. The study pro forma was used to record demographic details and dental utilization. Dentition status and periodontal status were used to record dental caries and periodontal status using the World Health Organization Oral Health Assessment Form 2013. Data were analyzed using the SPSS version 21; descriptive statistics, Chi-square test, and regression analysis were used to assess factors related to health-care utilization and P < 0.005 was considered statistically significant. Results: The final study sample comprised 500 health-care workers (220 ASHA and 280 Anganwadi workers). Among the study population, 30% utilized dental services and was found to be statistically significant with age, occupation, and oral findings. However, 56.0% had both dental caries and periodontal diseases followed by dental caries‒32.0%, periodontal disease‒8.0%. There was a significant difference (P < 0.005) in the proportion of dental care utilization and oral diseases among participants. Conclusions: The dental care utilization was found to be short and is not comparative to the diseases among participants.

Development, validity and reliability of instrument to evaluate implementation fidelity of the Family Doctor Concept (FDC) programme in public primary care clinics in Malaysia.

The Family Doctor Concept (FDC) programme was introduced to public primary care clinics in late 2013 as part of the reform agenda in the primary healthcare delivery system. The study aimed to develop a validated and reliable instrument to evaluate the FDC implementation fidelity in primary care clinics. The instrument, which adapted the concept of patient-centred care (PCC), resulted from a series of expert discussions, a literature search, an FDC guideline, and a review of meeting minutes. A 2-step process was conducted with experts to achieve content and face validity. Consequently, the instrument was piloted in 5 public primary care clinics in Selangor involving 8 trained raters. Inter-rater reliability was estimated using intraclass correlation (ICC), while internal consistency was measured using Kuder-Richardson Formula 20 (KR-20). The final instrument comprises 3 sections (instructions, clinic's characteristics and assessment items), with Section 3 containing 15 items divided into four components - population registration, formation of a primary care team, integrated treatment, and monitoring and evaluation. The ICC for total score was excellent, 0.981, while the ICCs of the individual component scores were good to excellent (population registration: 0.937, formation of primary care team: 0.742, integrated treatment: 0.996, and monitoring and evaluation: 0.996). The value of KR-20 was 0.615, which was considered adequate. The instrument developed was found to be valid in terms of face and content validity and reliable in measuring the fidelity of FDC implementation with excellent inter-rater reliability.

Using immunisation caregiver journey interviews to understand and optimise vaccination uptake: lessons from Sierra Leone

Quantitative and qualitative assessments have revealed diverse factors that influence the uptake of childhood immunisation services and shed light on reasons for vaccination delays and refusals. UNICEF and partner organisations...

Repercussions of lockdown on primary health care in India during COVID 19.

Primary health care is a comprehensive care with a wide range of essential services for people living in the rural and hard-to-reach areas. However, the primary healthcare delivery system in India is still in its initial stages and lacks human resources. With the COVID-19 pandemic around the corner, there has been a diversion of resources for controlling corona pandemic leading to undermining availability and accessibility of health services. This article highlights a few case scenarios and the multidimensional impact of lockdown on primary healthcare services. The article suggests certain appropriate measures that can be implemented as the lockdown simply cannot stop the transmission with no definite treatment and vaccine. There should be a multipronged strategy for breaking the chain of transmission and for future preparedness in case of such situations and to strengthen our primary healthcare system.

Battling against the twin pandemic of COVID-19 and HIV infection: World Health Organization

Human immunodeficiency virus (HIV) infection continues to remain one of the most significant public health concerns at the global level. The emergence of coronavirus disease-2019 (COVID-19) pandemic has significantly impacted the access to HIV testing, treatment and care facilities. There has been a gradual decline in the number of newly diagnosed people who are started on ART and some of them have also been forced to discontinue their ongoing treatment. It is the need of the hour to continue the delivery of the essential services and this calls for the need to strengthen primary health care and overall health care delivery system. In conclusion, it is the need of the hour to intensify our efforts and continue our battle against the twin pandemic of HIV and COVID-19 infection. This will essentially depend upon multi-sectoral and multi-faceted efforts and all of us have to work together for prolonged periods of time.

Patterns of antenatal care services utilization in rural Amroha, Uttar Pradesh: a community based cross sectional study

Background: Antenatal care (ANC) services are considered to be the crucial element in the primary health care delivery system of a country. World Health Organization (WHO) estimates suggested that almost all of the maternal deaths (99%) and child deaths (98%) occurred in developing countries. These maternal deaths could have been prevented if the pregnant women or adolescent girls had been able to access quality antenatal care. The objectives of the present study were conducted in rural parts of district Amroha, Uttar Pradesh for assessing the patterns of utilization of the ANC services and to ascertain the factors influencing utilization of ANC services.Methods: The present study was a cross sectional in nature. Recently delivered women were selected as study subject. A multi-stage stratified sampling design with random approaches had been used. Total 360 subjects included in the study.Results: Respondents age, education, occupation, socio economic status, family type and family size were the factors that influenced the utilization of the ANC services. With 100% ANC registration, sub centre was the most preferred place for registration. 76.9% of woman received more than 3 ANC visits. 315 (87.5%) and (71.9%) respondents received 2 doses to TT vaccine and more than 100 IFA tablets respectively.Conclusions: Utilization of ANC services are on rise in rural parts of Amroha, Uttar Pradesh. Still significant proportions of women are doesn’t return to health facility after the ANC registration. Intensification of efforts is needed to cater this left out group through improving community awareness and motivation.

Assessing receptiveness to change among primary healthcare providers by adopting the consolidated framework for implementation research (CFIR)

BackgroundAmid the current burden of non-communicable (NCD) diseases in Malaysia, there is a growing demand for more efficient service delivery of primary healthcare. A complex intervention is proposed to improve NCD management in Malaysia. This exploratory study aimed to assess primary healthcare providers’ receptiveness towards change prior to implementation of the proposed complex intervention.MethodThis study was conducted using an exploratory qualitative approach on purposely selected healthcare providers at primary healthcare clinics. Twenty focus group discussions and three in-depth interviews were conducted using a semi-structured interview guide. Consent was obtained prior to interviews and for audio-recordings. Interviews were transcribed verbatim and thematically analysed, guided by the Consolidated Framework for Implementation Research (CFIR), a framework comprised of five major domains promoting implementation theory development and verification across multiple contexts.ResultsThe study revealed via CFIR that most primary healthcare providers were receptive towards any proposed changes or intervention for the betterment of NCD care management. However, many challenges were outlined across four CFIR domains—intervention characteristics, outer setting, inner setting, and individual characteristics—that included perceived barriers to implementation. Perception of issues that triggered proposed changes reflected the current situation, including existing facilitating aspects that can support the implementation of any future intervention. The importance of strengthening the primary healthcare delivery system was also expressed.ConclusionUnderstanding existing situations faced at the primary healthcare setting is imperative prior to implementation of any intervention. Healthcare providers’ receptiveness to change was explored, and using CFIR framework, challenges or perceived barriers among healthcare providers were identified. CFIR was able to outline the clinics’ setting, individual behaviour and external agency factors that have direct impact to the organisation. These are important indicators in ensuring feasibility, effectiveness and sustainability of any intervention, as well as future scalability considerations.

English

The use of plants for medicine has constituted an important aspect of primary healthcare delivery system of people throughout the world for many centuries. Nonetheless, information on medicinal plants and their conservation are still lacking in some areas, including the Togo Plateau Forest Reserve in Ghana. This paper investigates the ethnobotany of the Togo Plateau Forest Reserve, Ghana, to document the traditional knowledge, uses and conservation of medicinal plants. Information on these plants was sought through a structured questionnaire administered to 384 registered members of the Ghana Federation of Traditional Medicine Practitioners’ Association including certified traditional healers, traditional birth attendants (TBAs), vendors of herbal remedies, managers of herbal medicine centers, and local plant collectors from six communities within the catchment area of the Togo Plateau Forest Reserve. The study recorded 114 medicinal plant species, including 14 herbs, 6 lianas, 21 shrubs and 74 trees that are mostly collected from the wild. The most commonly cited medicinal plant species were Azadirachta indica, Alstonia boonei, Morinda lucidaand Nauclea latifolia, mostly used to treat human conditions such as malaria, jaundice, rheumatism, andcough. Mostof the herbal medicines were prepared as decoctions and administered by drinking. Majority of the informants (75%) were within the age bracket of 41-60 years, with males (39%) out numbering the females (36%). Barks, roots and leaves were the most commonly used plant parts, and these were mostly collected by destructive methods. The unregulated collection of plant parts and harvesting methods may reduce plant species richness and abundance in the area, requiring sustained conservation efforts in order to benefit from them medicinally. Key words: Medicinal plants, Togo Plateau forest reserve, plant diversity.

Enablers and Barriers of Follow-Up Care: An Experience From an HPV DNA Detection–Based Cervical Cancer Screening Program in Rural India

Background: Success of a cervical cancer screening program is intrinsically linked with appropriate management of women detected positive on screening tests. While routine screening can be done in any setting, the follow-up care of screen positive women is linked with settings that are equipped with diagnostic and treatment facilities, and trained medical providers. In low resource settings, the major obstacles to deliver follow-up care are lack of adequate healthcare infrastructure and trained service providers at district or subdistrict levels. Aim: To assess feasibility of implementing community based interventions to increase uptake of follow-up care of screen positive women in a HPV detection based screening program conducted by Chittaranjan National Cancer Institute (CNCI), Kolkata. Strategy: A network of key stakeholders including government authorities and civil society organizations was developed to deliver continuum of care at the doorsteps of screen positive women. The infrastructure of government's primary health care delivery system was used to set up temporary clinics at district and subdistrict levels. The clinics were organized on prescheduled dates and times that were convenient to the women. Community health workers (CHWs) were trained in community mobilization strategies to increase uptake of follow-up services. All instruments, equipment and consumables required for providing follow-up services were carried to the clinics in a vehicle. Program: The CHWs played a key role in counseling and recalling the screen positive women. The temporary clinics were arranged in the government primary health centers. A team of trained doctors and paramedics provided the diagnostic and treatment services. Colposcopy was performed on all screen positive women using portable colposcopes and guided biopsies were taken as indicated. Women who were eligible for ablative treatment were counseled and treated in the same sitting. All women were advised yearly follow-up. Outcomes: A total of 43,325 women were screened by HC2 test during July 2010 to March 2015, and 2045 (4.7%) women were detected to be high-risk HPV positive. Compliance to first recall was good with 78.6% (1608/2045) of women undergoing diagnostic evaluation at field clinics. But overall compliance to at least one follow-up visit after 1 year was poor (23.2%). Follow-up compliance rate was higher in women who were diagnosed with CIN1 as compared with those with normal diagnosis ( P &lt; 0.001). What was learned: Diagnostic and treatment services could be effectively organized in the community in convergence with existing healthcare delivery system. High compliance to initial diagnostic evaluation and treatment was achieved by making the services available close to the doorsteps of the women. The reasons for low compliance to yearly follow-up were lack of understanding of future cancer risk, unwilling to undergo speculum examination again, and lack of cooperation of spouse/family.

Health system strengthening: a qualitative evaluation of implementation experience and lessons learned across five African countries

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.