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Doris Duke Charitable Foundation African Health Initiative Population Health Implementation Training (PHIT) Planning Grant Team Project Summaries

Multi-Country Projects

Ghana, Tanzania

Grantee Institution: Trustees of Columbia University in the City of New York Team Leaders: Dr. James Phillips, Dr. John Koku Awooner-Williams, Dr. Godfrey Mbaruku Project Title: Accelerating Millennium Development Goal Progress by Exchanging Health System Innovations between Tanzania and Ghana

Tanzania is the first African country to be on target for achieving Millennium Development Goal (MDG) 4. This success followed the demonstration by the Tanzania Essential Health Interventions Project (TEHIP) that evidence-based healthcare resource allocation could enable district health system managers to prioritize services according to the pattern of the burden of disease. In Ghana, the Navrongo Experiment achieved equivalent success by mobilizing rural villages to develop systems for stationing community nursing in villages and sustaining their work. In response, the Ghana government launched the Community-based Health Planning and Services (CHPS) Initiative to scale up the approach. Despite these successes, a variety of service delivery, manpower, communication, logistics, resource management, and leadership bottlenecks have prevented these programs from realizing their full potential. A partnership between the two countries seeks to address these bottlenecks through exchanging innovations: Ghana’s CHPS strategies will be adapted for Tanzania, and Ghana will incorporate Tanzania’s systems for district-level planning into its district programming. Evaluation will assess the MDG impact of assembling a comprehensive package of proven interventions for strengthening health systems. This international collaboration will demonstrate a new paradigm for African countries to assist one another with achieving the health MDGs.

Rwanda, Lesotho, Malawi

Grantee Institution: Brigham and Women’s Hospital, Inc., Partners in Health Team Leaders: Dr. Michael Rich, Dr. Agnes Binagwaho Project Title: Strengthening and Studying Community-Based, Integrated Primary Health Care Systems in Rural Rwanda, Lesotho and Malawi

Brigham and Women’s Hospital, Partners In Health and Harvard Medical School, in collaboration with Rwandan partners, propose a PHIT Partnership in Rwanda, Lesotho and Malawi that will: 1) implement health care improvements and health systems strengthening in Rwanda, and 2) conduct research on the effect of these interventions in Rwanda and in Lesotho and Malawi, where the project proponents are implementing a similar intervention. Working closely with the government, the partnership will implement a primary health care program serving a population of 400,000 Rwandans that is integrated across three levels of care (community, health center and district hospital). The care delivery model includes developing a highly trained network of community health workers as a core element. Implementation Research in Rwanda, Lesotho and Malawi is directed toward two overlapping goals: an assessment of the efficacy of the overall program in improving health access and outcomes and the collection of data that will facilitate ongoing quality improvement and allow for mid-course corrections to enable the success of the intervention. Together, these efforts represent sufficient diversity in burden and type of disease, geography, ethnography and scale to offer significant opportunity for comparative learning and potential to improve health and research infrastructures.

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