TY - JOUR
T1 - Tackling the hard problems
T2 - Implementation experience and lessons learned in newborn health from the African Health Initiative
AU - Magge, Hema
AU - Chilengi, Roma
AU - Jackson, Elizabeth F.
AU - Wagenaar, Bradley H.
AU - Kante, Almamy Malick
AU - Hingora, Ahmed
AU - Mboya, Dominic
AU - Exavery, Amon
AU - Tani, Kassimu
AU - Manzi, Fatuma
AU - Pemba, Senga
AU - Phillips, James
AU - Ramsey, Kate
AU - Baynes, Colin
AU - Awoonor-Williams, John Koku
AU - Bawah, Ayaga
AU - Nimako, Belinda Afriyie
AU - Kanlisi, Nicholas
AU - Sheff, Mallory C.
AU - Kyei, Pearl
AU - Asuming, Patrick O.
AU - Biney, Adriana
AU - Ayles, Helen
AU - Mwanza, Moses
AU - Chirwa, Cindy
AU - Stringer, Jeffrey
AU - Mulenga, Mary
AU - Musatwe, Dennis
AU - Chisala, Masoso
AU - Lemba, Michael
AU - Mutale, Wilbroad
AU - Drobac, Peter
AU - Rwabukwisi, Felix Cyamatare
AU - Hirschhorn, Lisa R.
AU - Binagwaho, Agnes
AU - Gupta, Neil
AU - Nkikabahizi, Fulgence
AU - Manzi, Anatole
AU - Condo, Jeanine
AU - Farmer, Didi Bertrand
AU - Hedt-Gauthier, Bethany
AU - Sherr, Kenneth
AU - Cuembelo, Fatima
AU - Michel, Catherine
AU - Gimbel, Sarah
AU - Henley, Catherine
AU - Kariaganis, Marina
AU - Manuel, João Luis
AU - Napua, Manuel
AU - Pio, Alusio
N1 - Funding Information:
We gratefully acknowledge the support of the Doris Duke Charitable Foundation’s African Health Initiative in Ghana (Grant # 2009058B), Mozambique (Grant # 2009059), Rwanda (Grant # 2009P001941), Tanzania (Grant # 2009058A EFJ), and Zambia (Grant # 2009060). Comic Relief provided additional support in Zambia (146781), Tanzania (112259), and Ghana (112475). We would also like to thank the members of the AHI PHIT Partnership Collaborative for their contributions to this manuscript. Members include: Ahmed Hingora, Dominic Mboya, Amon Exavery, Kassimu Tani, Fatuma Manzi, Senga Pemba, James Phillips, Almamy Malick Kante, Kate Ramsey, Colin Baynes, John Koku Awoonor-Williams, Ayaga Bawah, Belinda Afriyie Nimako, Nicholas Kanlisi, Elizabeth F. Jackson, Mallory C. Sheff, Pearl Kyei, Patrick O. Asuming, Adriana Biney, Roma Chilengi, Helen Ayles, Moses Mwanza, Cindy Chirwa, Jeffrey Stringer, Mary Mulenga, Dennis Musatwe, Masoso Chisala, Michael Lemba, Wilbroad Mutale, Peter Drobac, Felix Cyamatare Rwabukwisi, Lisa R. Hirschhorn, Agnes Binagwaho, Neil Gupta, Fulgence Nkikabahizi, Anatole Manzi, Jeanine Condo, Didi Bertrand Farmer, Bethany Hedt-Gauthier, Kenneth Sherr, Fatima Cuembelo, Catherine Michel, Sarah Gimbel, Bradley Wagenaar, Catherine Henley, Marina Kariaganis, João Luis Manuel, Manuel Napua, and Alusio Pio.
Funding Information:
The publication cost of this article was funded by the African Health Initiative of the Doris Duke Charitable Foundation.
PY - 2017/12/21
Y1 - 2017/12/21
N2 - Background: The Doris Duke Charitable Foundation's African Health Initiative supported the implementation of Population Health Implementation and Training (PHIT) Partnership health system strengthening interventions in designated areas of five countries: Ghana, Mozambique, Rwanda, Tanzania, and Zambia. All PHIT programs included health system strengthening interventions with child health outcomes from the outset, but all increasingly recognized the need to increase focus to improve health and outcomes in the first month of life. This paper uses a case study approach to describe interventions implemented in newborn health, compare approaches, and identify lessons learned across the programs' collective implementation experience. Methods: Case studies were built using quantitative and qualitative methods, applying the World Health Organization Health Systems Strengthening Framework, and maternal, newborn and child health continuum of care framework. We identified the following five primary themes in health systems strengthening intervention strategies used to target improvement in newborn health, which were incorporated by all PHIT projects with varying results: health service delivery at the community level (Tanzania), combining community and health facility level interventions (Zambia), participatory information feedback and clinical training (Ghana), performance review and enhancement (Mozambique), and integrated clinical and system-level improvement (Rwanda), and used individual case studies to illustrate each of these themes. Results: Tanzania and Zambia included significant community-based components, including mobilization and sensitization for increased uptake of essential services, while Ghana, Mozambique, and Rwanda focused more efforts on improving the quality of services delivered once a patient enters a health facility. All countries included aspects that improved communication across levels of the health system, whether through district-wide data sharing and peer learning networks in Mozambique and Rwanda, or improved referral processes and systems in Tanzania, Zambia, and Ghana. Conclusion: Key lessons learned include the importance of focusing intervention components on addressing drivers of neonatal mortality across the maternal and newborn care continuum at all levels of the health system, matching efforts to improve service utilization with provision of high quality facility-based services, and the critical role of leadership to catalyze improvements in newborn health.
AB - Background: The Doris Duke Charitable Foundation's African Health Initiative supported the implementation of Population Health Implementation and Training (PHIT) Partnership health system strengthening interventions in designated areas of five countries: Ghana, Mozambique, Rwanda, Tanzania, and Zambia. All PHIT programs included health system strengthening interventions with child health outcomes from the outset, but all increasingly recognized the need to increase focus to improve health and outcomes in the first month of life. This paper uses a case study approach to describe interventions implemented in newborn health, compare approaches, and identify lessons learned across the programs' collective implementation experience. Methods: Case studies were built using quantitative and qualitative methods, applying the World Health Organization Health Systems Strengthening Framework, and maternal, newborn and child health continuum of care framework. We identified the following five primary themes in health systems strengthening intervention strategies used to target improvement in newborn health, which were incorporated by all PHIT projects with varying results: health service delivery at the community level (Tanzania), combining community and health facility level interventions (Zambia), participatory information feedback and clinical training (Ghana), performance review and enhancement (Mozambique), and integrated clinical and system-level improvement (Rwanda), and used individual case studies to illustrate each of these themes. Results: Tanzania and Zambia included significant community-based components, including mobilization and sensitization for increased uptake of essential services, while Ghana, Mozambique, and Rwanda focused more efforts on improving the quality of services delivered once a patient enters a health facility. All countries included aspects that improved communication across levels of the health system, whether through district-wide data sharing and peer learning networks in Mozambique and Rwanda, or improved referral processes and systems in Tanzania, Zambia, and Ghana. Conclusion: Key lessons learned include the importance of focusing intervention components on addressing drivers of neonatal mortality across the maternal and newborn care continuum at all levels of the health system, matching efforts to improve service utilization with provision of high quality facility-based services, and the critical role of leadership to catalyze improvements in newborn health.
KW - Ghana
KW - Health system strengthening
KW - Maternal child health
KW - Mozambique
KW - Neonatal mortality
KW - Newborn health
KW - Quality of care
KW - Rwanda
KW - Tanzania
KW - Zambia
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UR - http://www.scopus.com/inward/citedby.url?scp=85039039001&partnerID=8YFLogxK
U2 - 10.1186/s12913-017-2659-4
DO - 10.1186/s12913-017-2659-4
M3 - Article
C2 - 29297352
AN - SCOPUS:85039039001
VL - 17
JO - BMC Health Services Research
JF - BMC Health Services Research
SN - 1472-6963
M1 - 829
ER -