HEALTH SYSTEMS STRENGTHENING TO IMPROVE HEALTH OUTCOMES: APPLYING IMPLEMENTATION

描述（由申请人提供）：尽管全球卫生投资大幅增加，并且有了旨在减轻中低收入国家可预防疾病负担的低成本、有效的干预措施，但将这些科学进展转化为有效的提供战略的过程缓慢、不平衡和不完整。卫生系统在缩小我们的科学知识与以足够规模提供科学知识之间的差距，从而改善人口水平的健康结果方面发挥着根本作用。然而，卫生系统的复杂性继续对实施研究人员及其确定和克服卫生系统障碍并广泛应用这些经验教训的努力构成挑战。该研究项目由多丽丝·杜克慈善基金会的非洲卫生倡议资助，其目标是通过加强卫生系统和提供综合初级卫生保健，改善莫桑比克索法拉省13个地区的卫生成果。在具体目标1中，我们将评估卫生系统加强干预措施，包括改进数据系统，使用数据驱动的决策工具，以及加强地区卫生工作队对卫生系统产出和成果的领导和管理能力。在具体目标2中，我们将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，以及加强地区卫生工作队在人口层面卫生结果方面的领导和管理能力。将采用准实验设计来响应具体目标，比较产出、结果和影响措施的变化，以反映提供服务和改善保健结果的情况。这项实施研究的结果将产生具有全球意义的知识，以支持基于证据的卫生服务和卫生系统规划。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: This research is highly relevant to public health in developing countries, where implementation of health advancements has not reached populations with sufficient speed and scale. Through assessing whether strengthening health systems in Mozambique improves the delivery of health services and the health of populations, we will build evidence on how to design approaches and direct funding in order to maximally improve health at a large scale in developing countries.