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.

Agency
National Institute of Health (NIH)
Type
Research Scientist Development Award - Research (K02)
Project #
5K02TW009207-04
Application #
8704776
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Jessup, Christine
Project Start
Project End
Budget Start
Budget End
Support Year
4
Fiscal Year
2014
Total Cost
Indirect Cost
Name
University of Washington
Department
Public Health & Prev Medicine
Type
Schools of Medicine
DUNS #
City
Seattle
State
WA
Country
United States
Zip Code
98195
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Gimbel, Sarah; Voss, Joachim; Rustagi, Alison et al. (2014) What does high and low have to do with it? Performance classification to identify health system factors associated with effective prevention of mother-to-child transmission of HIV delivery in Mozambique. J Int AIDS Soc 17:18828
Fernandes, Quinhas F; Wagenaar, Bradley H; Anselmi, Laura et al. (2014) Effects of health-system strengthening on under-5, infant, and neonatal mortality: 11-year provincial-level time-series analyses in Mozambique. Lancet Glob Health 2:e468-77
Gerdts, Sarah E; Wagenaar, Bradley H; Micek, Mark A et al. (2014) Linkage to HIV care and antiretroviral therapy by HIV testing service type in Central Mozambique: a retrospective cohort study. J Acquir Immune Defic Syndr 66:e37-44
Sherr, Kenneth; Gimbel, Sarah; Rustagi, Alison et al. (2014) Systems analysis and improvement to optimize pMTCT (SAIA): a cluster randomized trial. Implement Sci 9:55
Lambdin, Barrot H; Micek, Mark A; Sherr, Kenneth et al. (2013) Integration of HIV care and treatment in primary health care centers and patient retention in central Mozambique: a retrospective cohort study. J Acquir Immune Defic Syndr 62:e146-52
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Sherr, Kenneth; Cuembelo, Fatima; Michel, Cathy et al. (2013) Strengthening integrated primary health care in Sofala, Mozambique. BMC Health Serv Res 13 Suppl 2:S4
Hirschhorn, Lisa R; Baynes, Colin; Sherr, Kenneth et al. (2013) Approaches to ensuring and improving quality in the context of health system strengthening: a cross-site analysis of the five African Health Initiative Partnership programs. BMC Health Serv Res 13 Suppl 2:S8