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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Rustagi, Alison S; Gimbel, Sarah; Nduati, Ruth et al. (2017) Health facility factors and quality of services to prevent mother-to-child HIV transmission in Côte d'Ivoire, Kenya, and Mozambique. Int J STD AIDS 28:788-799
Sherr, Kenneth; Fernandes, Quinhas; Kanté, Almamy M et al. (2017) Measuring health systems strength and its impact: experiences from the African Health Initiative. BMC Health Serv Res 17:827
Monroe-Wise, Aliza; Reisner, Elizabeth; Sherr, Kenneth et al. (2017) Using lean manufacturing principles to evaluate wait times for HIV-positive patients in an urban clinic in Kenya. Int J STD AIDS 28:1410-1418
Gimbel, Sarah; Mwanza, Moses; Nisingizwe, Marie Paul et al. (2017) Improving data quality across 3 sub-Saharan African countries using the Consolidated Framework for Implementation Research (CFIR): results from the African Health Initiative. BMC Health Serv Res 17:828
Manzi, Anatole; Hirschhorn, Lisa R; Sherr, Kenneth et al. (2017) Mentorship and coaching to support strengthening healthcare systems: lessons learned across the five Population Health Implementation and Training partnership projects in sub-Saharan Africa. BMC Health Serv Res 17:831
Wagner, Anjuli D; Wachira, Cyrus M; Njuguna, Irene N et al. (2016) Active referral of children of HIV-positive adults reveals high prevalence of undiagnosed HIV. J Acquir Immune Defic Syndr :
Wagner, Anjuli D; Mugo, Cyrus; Njuguna, Irene N et al. (2016) Implementation and Operational Research: Active Referral of Children of HIV-Positive Adults Reveals High Prevalence of Undiagnosed HIV. J Acquir Immune Defic Syndr 73:e83-e89
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
Wagenaar, Bradley H; Cumbe, Vasco; Raunig-Berhó, Manuela et al. (2016) Outpatient Mental Health Services in Mozambique: Use and Treatments. Psychiatr Serv 67:588-90
Wagenaar, Bradley H; Raunig-Berhó, Manuela; Cumbe, Vasco et al. (2016) Suicide Attempts and Deaths in Sofala, Mozambique, From 2011 to 2014. Crisis 37:445-453

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