HEALTH SYSTEMS STRENGTHENING TO IMPROVE HEALTH OUTCOMES: APPLYING IMPLEMENTATION

摘要 尽管全球卫生投资大幅增加， 旨在减轻中低收入国家可预防疾病负担的干预措施， 将这些科学进步转化为有效的交付战略的工作进展缓慢、不平衡， 不完整卫生系统在缩小我们的科学知识与 以足够的规模提供这些服务，以改善人口一级的健康成果。但 卫生系统的复杂性继续挑战实施研究人员和他们的努力， 克服卫生系统的障碍，并广泛应用这些经验教训。这项研究的目的是 一个由多丽丝杜克慈善基金会的非洲健康倡议资助的项目旨在改善健康状况 通过加强保健系统和提供保健服务，在莫桑比克索法拉省13个县取得成果 综合初级保健。在具体目标1中，我们将评估加强干预措施的卫生系统 包括改进数据系统，使用数据驱动的决策工具，加强领导， 地区卫生队对卫生系统产出和成果的管理能力。在具体目标2中， 评估一揽子卫生系统加强干预措施的影响，包括改进数据 系统，使用数据驱动的决策工具，并加强领导和管理能力， 地区卫生队对人口一级的卫生成果的评价。将采用准实验设计， 对具体目标作出反应，比较产出、成果和选定的影响措施的变化， 提供服务和改善保健成果。这项研究的结果将产生 具有全球意义的知识，以支持循证卫生服务和卫生系统规划。

ABSTRACT 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.