HEALTH SYSTEMS STRENGTHENING TO IMPROVE HEALTH OUTCOMES: APPLYING IMPLEMENTATION

说明(申请人提供)：尽管全球卫生投资大幅增加，低成本、有效的干预措施旨在减轻低收入和中等收入国家可预防疾病的负担，但将这些科学进步转化为有效的交付战略的过程缓慢、不均衡和不完整。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方面发挥着至关重要的作用，从而在人口层面改善健康结果。然而，卫生系统的复杂性继续挑战执行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。该研究项目由多丽丝·杜克慈善基金会的非洲健康倡议资助，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个区的卫生状况。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小组在卫生系统产出和成果方面的领导和管理能力。在具体目标2中，我们将评估一系列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小组的领导和管理能力对人口一级的卫生成果的影响。将采用准实验设计来响应具体目标，比较所选的产出、结果和影响措施的变化，以获取服务提供和健康结果的改善。这项执行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。 公共卫生相关性：这项研究与发展中国家的公共卫生高度相关，在这些国家，卫生进步的实施尚未以足够的速度和规模惠及人口。通过评估加强莫桑比克的卫生系统是否改善了卫生服务的提供和人口的健康，我们将建立证据，说明如何设计办法和直接供资，以便最大限度地大规模改善发展中国家的卫生状况。

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.