What 15 Years of Research in Africa Reveals About Resilient and Responsive Health Systems
Partnerships and large-scale models of care that link research and workforce training directly to the delivery of integrated primary health care are essential to saving lives. Without a strong, resilient and responsive health system in place, disease-focused programs and other narrowly targeted health interventions are left with nothing to carry them and cannot succeed. This is the premise of the Doris Duke Charitable Foundation’s African Health Initiative (AHI), which launched in 2007 with the goal to strengthen health systems in sub-Saharan Africa.
In 2015, we shared a series of articles that documented program design, challenges to implementation, and preliminary outcomes from the initiative’s first phase. Now, more than 15 years since the initiative began, we are pleased to present the research findings from the second and final phase of this journey, featured in a supplement to the September 2022 issue of Global Health: Science and Practice.
In the African Health Initiative’s first phase, the foundation awarded four grants to pilot a variety of health systems strengthening interventions in Ghana, Mozambique, Rwanda, Tanzania and Zambia. Though not all activities had the desired impact, several resulted in measurable improvements to health system performance. The encouraging results prompted a follow-up phase, with the Doris Duke Charitable Foundation supporting partnerships in Ethiopia, Ghana and Mozambique to replicate and scale up measures that had proven successful in the earlier phase.
Central to both phases was the integration of “implementation research,” or the study of how stakeholders within health systems apply new knowledge and practices, into each project. Researchers were embedded within implementing teams and tasked with examining the barriers and facilitators to the interventions’ successes. Throughout the life cycle of each project, the researchers’ findings were used to assess the efficacy of the interventions and inform any necessary strategic pivots.
Their findings also formed the basis for the articles featured in the latest journal supplement. Three of these pieces analyze how effectively the African Health Initiative’s primary interventions—support for mainstreaming implementation research, strengthening data generation and analysis, and building or enhancing staff supervision and mentoring techniques—were incorporated into health care systems in phase 2 countries. The remaining articles explore the impact of those interventions on specific aspects of health care systems in each country.
Despite the varied content and geographic contexts covered, several common themes emerge across the articles. First, the integration of implementation research has a demonstrably positive impact on the resilience and responsiveness of health care systems. It provides a framework for all stakeholders to assess the performance of key functions, identify issues and devise solutions. Second, the generation and analysis of data—health information management—are critical to the optimal functioning of health systems. Accurate and timely data equips decision-makers with the information they need to create effective policies, ensures that resources are allocated where they are needed most, and enables administrators and health care workers to monitor key health programs in real time. Third, routinized mentorship and supervision is essential to maintaining fidelity to newly introduced practices. The benefits of one-off trainings wane over time, whereas frequent refreshers and supervisory check-ins help staff adhere to standards and practices. Finally, regular engagement among all stakeholders improves health system performance and the uptake of new practices. These frequent interactions build trust, broaden perspectives, and create opportunities for collaborative decision making.
Most of the work funded by the African Health Initiative will end in 2023, and the last project is set to conclude in 2024. Though the funding has come to an end, the work and partnerships established in each country will continue. As the initiative winds down after 15 years, the Doris Duke Charitable Foundation is proud to have helped build a foundation for responsive, resilient and sustainable health systems in communities across sub-Saharan Africa. It is our sincere hope that the lessons learned throughout, diligently captured in these articles, will inform subsequent efforts to further strengthen health systems in the region and beyond.
Direct links to each of the articles and a brief summary can be found below.
- Learning Health Systems to Bridge the Evidence-Policy-Practice Gap in Primary Health Care: Lessons From the African Health Initiative
Colin Baynes, Lola Adedokun, John Koku Awoonor-Williams, Lisa R. Hirschhorn
The authors provide a brief history of the African Health Initiative and introduce the articles of the Global Health: Science and Practice journal supplement, highlighting the importance of evidence-based interventions (EBI) in global health and summarizing key takeaways.
- Learning Health Systems to Bridge the Evidence-Policy-Practice Gap in Primary Health Care: Lessons From the African Health Initiative
Colin Baynes, Lola Adedokun, John Koku Awoonor-Williams, Lisa R. Hirschhorn
The authors provide a brief history of the African Health Initiative and introduce the articles of the Global Health: Science and Practice journal supplement, highlighting the importance of evidence-based interventions (EBI) in global health and summarizing key takeaways.
