Despite significant increases in global health investment and the availability of low-cost, efficacious interventions designed to reduce the burden of preventable diseases in low and middle income countries, the translation of these scientific advances into effective delivery strategies has been slow, uneven and incomplete. Health systems play a fundamental role in closing this gap between our scientific knowledge and their delivery at sufficient scale to lead to population-level improvements in health outcomes. However, the complexity of health systems continues to challenge implementation researchers and their efforts to identify and overcome health system barriers, and broadly apply these lessons learned. This goal of this research project, funded through the Doris Duke Charitable Foundation's African Health Initiative, is to improve health outcomes in 13 districts in Sofala province, Mozambique, through strengthened health systems and delivery of integrated primary health care.
In specific aim 1, we will assess health systems strengthening interventions including improved data systems, use of data driven decision-making tools, and strengthened leadership and management capacity of district health teams on health system outputs and outcomes.
In specific aim 2 we will assess the impact of a package of health systems strengthening interventions including improved data systems, use of data driven decision-making tools, and strengthened leadership and management capacity of district health teams on population-level health outcomes. A quasi-experimental design will be employed to respond to the specific aims, comparing changes in output, outcome and impact measures selected to capture service delivery and health outcome improvements. The results of this implementation research will generate knowledge of global significance to support evidence-based health delivery and health systems planning.

Public Health Relevance

This research is highly relevant to public health in developing countries, where implementation of health advancements has not reached populations with sufficient speed and scale. Through assessing whether strengthening health systems in Mozambique improves the delivery of health services and the health of populations, we will build evidence on how to design approaches and direct funding in order to maximally improve health at a large scale in developing countries.

National Institute of Health (NIH)
Fogarty International Center (FIC)
Research Scientist Development Award - Research (K02)
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Special Emphasis Panel (ZRG1-AARR-H (55))
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Jessup, Christine
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University of Washington
Public Health & Prev Medicine
Schools of Medicine
United States
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Wagenaar, Bradley H; Gimbel, Sarah; Hoek, Roxanne et al. (2016) Wait and consult times for primary healthcare services in central Mozambique: a time-motion study. Glob Health Action 9:31980
Wagenaar, Bradley H; Sherr, Kenneth; Fernandes, Quinhas et al. (2016) Using routine health information systems for well-designed health evaluations in low- and middle-income countries. Health Policy Plan 31:129-35
Gimbel, Sarah; Rustagi, Alison S; Robinson, Julia et al. (2016) Evaluation of a Systems Analysis and Improvement Approach to Optimize Prevention of Mother-To-Child Transmission of HIV Using the Consolidated Framework for Implementation Research. J Acquir Immune Defic Syndr 72 Suppl 2:S108-16
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Wagenaar, Bradley H; Stergachis, Andy; Rao, Deepa et al. (2015) The availability of essential medicines for mental healthcare in Sofala, Mozambique. Glob Health Action 8:27942
Rustagi, Alison S; Manjate, Rosa Marlene; Gloyd, Stephen et al. (2015) Perspectives of key stakeholders regarding task shifting of care for HIV patients in Mozambique: a qualitative interview-based study with Ministry of Health leaders, clinicians, and donors. Hum Resour Health 13:18

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