Measuring health systems strength and its impact: experiences from the African Health Initiative
Abstract Background Health systems are essential platforms for accessible, quality health services, and population health improvements. Global health initiatives have dramatically increased health resources; however, funding to strengthen health systems has not increased commensurately, partially du...
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| Format: | Article |
| Language: | English |
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BMC
2017-12-01
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| Series: | BMC Health Services Research |
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| Online Access: | http://link.springer.com/article/10.1186/s12913-017-2658-5 |
| _version_ | 1831654812026929152 |
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| author | Kenneth Sherr Quinhas Fernandes Almamy M. Kanté Ayaga Bawah Jeanine Condo Wilbroad Mutale the AHI PHIT Partnership Collaborative |
| author_facet | Kenneth Sherr Quinhas Fernandes Almamy M. Kanté Ayaga Bawah Jeanine Condo Wilbroad Mutale the AHI PHIT Partnership Collaborative |
| author_sort | Kenneth Sherr |
| collection | DOAJ |
| description | Abstract Background Health systems are essential platforms for accessible, quality health services, and population health improvements. Global health initiatives have dramatically increased health resources; however, funding to strengthen health systems has not increased commensurately, partially due to concerns about health system complexity and evidence gaps demonstrating health outcome improvements. In 2009, the African Health Initiative of the Doris Duke Charitable Foundation began supporting Population Health Implementation and Training Partnership projects in five sub-Saharan African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) to catalyze significant advances in strengthening health systems. This manuscript reflects on the experience of establishing an evaluation framework to measure health systems strength, and associate measures with health outcomes, as part of this Initiative. Methods Using the World Health Organization’s health systems building block framework, the Partnerships present novel approaches to measure health systems building blocks and summarize data across and within building blocks to facilitate analytic procedures. Three Partnerships developed summary measures spanning the building blocks using principal component analysis (Ghana and Tanzania) or the balanced scorecard (Zambia). Other Partnerships developed summary measures to simplify multiple indicators within individual building blocks, including health information systems (Mozambique), and service delivery (Rwanda). At the end of the project intervention period, one to two key informants from each Partnership’s leadership team were asked to list – in rank order – the importance of the six building blocks in relation to their intervention. Results Though there were differences across Partnerships, service delivery and information systems were reported to be the most common focus of interventions, followed by health workforce and leadership and governance. Medical products, vaccines and technologies, and health financing, were the building blocks reported to be of lower focus. Conclusion The African Health Initiative experience furthers the science of evaluation for health systems strengthening, highlighting areas for further methodological development – including the development of valid, feasible measures sensitive to interventions in multiple contexts (particularly in leadership and governance) and describing interactions across building blocks; in developing summary statistics to facilitate testing intervention effects on health systems and associations with health status; and designing appropriate analytic models for complex, multi-level open health systems. |
| first_indexed | 2024-12-19T16:35:09Z |
| format | Article |
| id | doaj.art-cfa6bcb88d914a38b213c7cc7b1b68d4 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-19T16:35:09Z |
| publishDate | 2017-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-cfa6bcb88d914a38b213c7cc7b1b68d42022-12-21T20:13:59ZengBMCBMC Health Services Research1472-69632017-12-0117S3293810.1186/s12913-017-2658-5Measuring health systems strength and its impact: experiences from the African Health InitiativeKenneth Sherr0Quinhas Fernandes1Almamy M. Kanté2Ayaga Bawah3Jeanine Condo4Wilbroad Mutale5the AHI PHIT Partnership CollaborativeDepartment of Global Health, University of WashingtonMinistry of HealthBloomberg School of Public Health, Johns Hopkins UniversityRegional Institute for Population Studies, University of GhanaSchool of Public Health, University of RwandaDepartment of Public Health, University of Zambia School of MedicineAbstract Background Health systems are essential platforms for accessible, quality health services, and population health improvements. Global health initiatives have dramatically increased health resources; however, funding to strengthen health systems has not increased commensurately, partially due to concerns about health system complexity and evidence gaps demonstrating health outcome improvements. In 2009, the African Health Initiative of the Doris Duke Charitable Foundation began supporting Population Health Implementation and Training Partnership projects in five sub-Saharan African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) to catalyze significant advances in strengthening health systems. This manuscript reflects on the experience of establishing an evaluation framework to measure health systems strength, and associate measures with health outcomes, as part of this Initiative. Methods Using the World Health Organization’s health systems building block framework, the Partnerships present novel approaches to measure health systems building blocks and summarize data across and within building blocks to facilitate analytic procedures. Three Partnerships developed summary measures spanning the building blocks using principal component analysis (Ghana and Tanzania) or the balanced scorecard (Zambia). Other Partnerships developed summary measures to simplify multiple indicators within individual building blocks, including health information systems (Mozambique), and service delivery (Rwanda). At the end of the project intervention period, one to two key informants from each Partnership’s leadership team were asked to list – in rank order – the importance of the six building blocks in relation to their intervention. Results Though there were differences across Partnerships, service delivery and information systems were reported to be the most common focus of interventions, followed by health workforce and leadership and governance. Medical products, vaccines and technologies, and health financing, were the building blocks reported to be of lower focus. Conclusion The African Health Initiative experience furthers the science of evaluation for health systems strengthening, highlighting areas for further methodological development – including the development of valid, feasible measures sensitive to interventions in multiple contexts (particularly in leadership and governance) and describing interactions across building blocks; in developing summary statistics to facilitate testing intervention effects on health systems and associations with health status; and designing appropriate analytic models for complex, multi-level open health systems.http://link.springer.com/article/10.1186/s12913-017-2658-5Health system strengtheningMetricsAfrican Health InitiativeGhanaMozambiqueTanzania |
| spellingShingle | Kenneth Sherr Quinhas Fernandes Almamy M. Kanté Ayaga Bawah Jeanine Condo Wilbroad Mutale the AHI PHIT Partnership Collaborative Measuring health systems strength and its impact: experiences from the African Health Initiative BMC Health Services Research Health system strengthening Metrics African Health Initiative Ghana Mozambique Tanzania |
| title | Measuring health systems strength and its impact: experiences from the African Health Initiative |
| title_full | Measuring health systems strength and its impact: experiences from the African Health Initiative |
| title_fullStr | Measuring health systems strength and its impact: experiences from the African Health Initiative |
| title_full_unstemmed | Measuring health systems strength and its impact: experiences from the African Health Initiative |
| title_short | Measuring health systems strength and its impact: experiences from the African Health Initiative |
| title_sort | measuring health systems strength and its impact experiences from the african health initiative |
| topic | Health system strengthening Metrics African Health Initiative Ghana Mozambique Tanzania |
| url | http://link.springer.com/article/10.1186/s12913-017-2658-5 |
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