Tackling the hard problems: Implementation experience and lessons learned in newborn health from the African Health Initiative

Hema Magge, Roma Chilengi, Elizabeth F. Jackson, Bradley H. Wagenaar, Almamy Malick Kante, Ahmed Hingora, Dominic Mboya, Amon Exavery, Kassimu Tani, Fatuma Manzi, Senga Pemba, James Phillips, Kate Ramsey, Colin Baynes, John Koku Awoonor-Williams, Ayaga Bawah, Belinda Afriyie Nimako, Nicholas Kanlisi, Mallory C. Sheff, Pearl KyeiPatrick O. Asuming, Adriana Biney, Helen Ayles, Moses Mwanza, Cindy Chirwa, Jeffrey Stringer, Mary Mulenga, Dennis Musatwe, Masoso Chisala, Michael Lemba, Wilbroad Mutale, Peter Drobac, Felix Cyamatare Rwabukwisi, Lisa R. Hirschhorn, Agnes Binagwaho, Neil Gupta, Fulgence Nkikabahizi, Anatole Manzi, Jeanine Condo, Didi Bertrand Farmer, Bethany Hedt-Gauthier, Kenneth Sherr, Fatima Cuembelo, Catherine Michel, Sarah Gimbel, Catherine Henley, Marina Kariaganis, João Luis Manuel, Manuel Napua, Alusio Pio

Research output: Contribution to journalArticle

Abstract

Background: The Doris Duke Charitable Foundation's African Health Initiative supported the implementation of Population Health Implementation and Training (PHIT) Partnership health system strengthening interventions in designated areas of five countries: Ghana, Mozambique, Rwanda, Tanzania, and Zambia. All PHIT programs included health system strengthening interventions with child health outcomes from the outset, but all increasingly recognized the need to increase focus to improve health and outcomes in the first month of life. This paper uses a case study approach to describe interventions implemented in newborn health, compare approaches, and identify lessons learned across the programs' collective implementation experience. Methods: Case studies were built using quantitative and qualitative methods, applying the World Health Organization Health Systems Strengthening Framework, and maternal, newborn and child health continuum of care framework. We identified the following five primary themes in health systems strengthening intervention strategies used to target improvement in newborn health, which were incorporated by all PHIT projects with varying results: health service delivery at the community level (Tanzania), combining community and health facility level interventions (Zambia), participatory information feedback and clinical training (Ghana), performance review and enhancement (Mozambique), and integrated clinical and system-level improvement (Rwanda), and used individual case studies to illustrate each of these themes. Results: Tanzania and Zambia included significant community-based components, including mobilization and sensitization for increased uptake of essential services, while Ghana, Mozambique, and Rwanda focused more efforts on improving the quality of services delivered once a patient enters a health facility. All countries included aspects that improved communication across levels of the health system, whether through district-wide data sharing and peer learning networks in Mozambique and Rwanda, or improved referral processes and systems in Tanzania, Zambia, and Ghana. Conclusion: Key lessons learned include the importance of focusing intervention components on addressing drivers of neonatal mortality across the maternal and newborn care continuum at all levels of the health system, matching efforts to improve service utilization with provision of high quality facility-based services, and the critical role of leadership to catalyze improvements in newborn health.

Original languageEnglish (US)
Article number829
JournalBMC Health Services Research
Volume17
DOIs
StatePublished - Dec 21 2017

Fingerprint

Rwanda
Mozambique
Zambia
Health
Ghana
Tanzania
Continuity of Patient Care
Health Facilities
Health Status
Population
Infant Health
Information Dissemination
Infant Mortality
Health Services
Referral and Consultation
Communication
Mothers
Learning
Newborn Infant
Delivery of Health Care

Keywords

  • Ghana
  • Health system strengthening
  • Maternal child health
  • Mozambique
  • Neonatal mortality
  • Newborn health
  • Quality of care
  • Rwanda
  • Tanzania
  • Zambia

ASJC Scopus subject areas

  • Health Policy

Cite this

Tackling the hard problems : Implementation experience and lessons learned in newborn health from the African Health Initiative. / Magge, Hema; Chilengi, Roma; Jackson, Elizabeth F.; Wagenaar, Bradley H.; Kante, Almamy Malick; Hingora, Ahmed; Mboya, Dominic; Exavery, Amon; Tani, Kassimu; Manzi, Fatuma; Pemba, Senga; Phillips, James; Ramsey, Kate; Baynes, Colin; Awoonor-Williams, John Koku; Bawah, Ayaga; Nimako, Belinda Afriyie; Kanlisi, Nicholas; Sheff, Mallory C.; Kyei, Pearl; Asuming, Patrick O.; Biney, Adriana; Ayles, Helen; Mwanza, Moses; Chirwa, Cindy; Stringer, Jeffrey; Mulenga, Mary; Musatwe, Dennis; Chisala, Masoso; Lemba, Michael; Mutale, Wilbroad; Drobac, Peter; Rwabukwisi, Felix Cyamatare; Hirschhorn, Lisa R.; Binagwaho, Agnes; Gupta, Neil; Nkikabahizi, Fulgence; Manzi, Anatole; Condo, Jeanine; Farmer, Didi Bertrand; Hedt-Gauthier, Bethany; Sherr, Kenneth; Cuembelo, Fatima; Michel, Catherine; Gimbel, Sarah; Henley, Catherine; Kariaganis, Marina; Manuel, João Luis; Napua, Manuel; Pio, Alusio.

In: BMC Health Services Research, Vol. 17, 829, 21.12.2017.

Research output: Contribution to journalArticle

Magge, H, Chilengi, R, Jackson, EF, Wagenaar, BH, Kante, AM, Hingora, A, Mboya, D, Exavery, A, Tani, K, Manzi, F, Pemba, S, Phillips, J, Ramsey, K, Baynes, C, Awoonor-Williams, JK, Bawah, A, Nimako, BA, Kanlisi, N, Sheff, MC, Kyei, P, Asuming, PO, Biney, A, Ayles, H, Mwanza, M, Chirwa, C, Stringer, J, Mulenga, M, Musatwe, D, Chisala, M, Lemba, M, Mutale, W, Drobac, P, Rwabukwisi, FC, Hirschhorn, LR, Binagwaho, A, Gupta, N, Nkikabahizi, F, Manzi, A, Condo, J, Farmer, DB, Hedt-Gauthier, B, Sherr, K, Cuembelo, F, Michel, C, Gimbel, S, Henley, C, Kariaganis, M, Manuel, JL, Napua, M & Pio, A 2017, 'Tackling the hard problems: Implementation experience and lessons learned in newborn health from the African Health Initiative', BMC Health Services Research, vol. 17, 829. https://doi.org/10.1186/s12913-017-2659-4
Magge, Hema ; Chilengi, Roma ; Jackson, Elizabeth F. ; Wagenaar, Bradley H. ; Kante, Almamy Malick ; Hingora, Ahmed ; Mboya, Dominic ; Exavery, Amon ; Tani, Kassimu ; Manzi, Fatuma ; Pemba, Senga ; Phillips, James ; Ramsey, Kate ; Baynes, Colin ; Awoonor-Williams, John Koku ; Bawah, Ayaga ; Nimako, Belinda Afriyie ; Kanlisi, Nicholas ; Sheff, Mallory C. ; Kyei, Pearl ; Asuming, Patrick O. ; Biney, Adriana ; Ayles, Helen ; Mwanza, Moses ; Chirwa, Cindy ; Stringer, Jeffrey ; Mulenga, Mary ; Musatwe, Dennis ; Chisala, Masoso ; Lemba, Michael ; Mutale, Wilbroad ; Drobac, Peter ; Rwabukwisi, Felix Cyamatare ; Hirschhorn, Lisa R. ; Binagwaho, Agnes ; Gupta, Neil ; Nkikabahizi, Fulgence ; Manzi, Anatole ; Condo, Jeanine ; Farmer, Didi Bertrand ; Hedt-Gauthier, Bethany ; Sherr, Kenneth ; Cuembelo, Fatima ; Michel, Catherine ; Gimbel, Sarah ; Henley, Catherine ; Kariaganis, Marina ; Manuel, João Luis ; Napua, Manuel ; Pio, Alusio. / Tackling the hard problems : Implementation experience and lessons learned in newborn health from the African Health Initiative. In: BMC Health Services Research. 2017 ; Vol. 17.
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abstract = "Background: The Doris Duke Charitable Foundation's African Health Initiative supported the implementation of Population Health Implementation and Training (PHIT) Partnership health system strengthening interventions in designated areas of five countries: Ghana, Mozambique, Rwanda, Tanzania, and Zambia. All PHIT programs included health system strengthening interventions with child health outcomes from the outset, but all increasingly recognized the need to increase focus to improve health and outcomes in the first month of life. This paper uses a case study approach to describe interventions implemented in newborn health, compare approaches, and identify lessons learned across the programs' collective implementation experience. Methods: Case studies were built using quantitative and qualitative methods, applying the World Health Organization Health Systems Strengthening Framework, and maternal, newborn and child health continuum of care framework. We identified the following five primary themes in health systems strengthening intervention strategies used to target improvement in newborn health, which were incorporated by all PHIT projects with varying results: health service delivery at the community level (Tanzania), combining community and health facility level interventions (Zambia), participatory information feedback and clinical training (Ghana), performance review and enhancement (Mozambique), and integrated clinical and system-level improvement (Rwanda), and used individual case studies to illustrate each of these themes. Results: Tanzania and Zambia included significant community-based components, including mobilization and sensitization for increased uptake of essential services, while Ghana, Mozambique, and Rwanda focused more efforts on improving the quality of services delivered once a patient enters a health facility. All countries included aspects that improved communication across levels of the health system, whether through district-wide data sharing and peer learning networks in Mozambique and Rwanda, or improved referral processes and systems in Tanzania, Zambia, and Ghana. Conclusion: Key lessons learned include the importance of focusing intervention components on addressing drivers of neonatal mortality across the maternal and newborn care continuum at all levels of the health system, matching efforts to improve service utilization with provision of high quality facility-based services, and the critical role of leadership to catalyze improvements in newborn health.",
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TY - JOUR

T1 - Tackling the hard problems

T2 - Implementation experience and lessons learned in newborn health from the African Health Initiative

AU - Magge, Hema

AU - Chilengi, Roma

AU - Jackson, Elizabeth F.

AU - Wagenaar, Bradley H.

AU - Kante, Almamy Malick

AU - Hingora, Ahmed

AU - Mboya, Dominic

AU - Exavery, Amon

AU - Tani, Kassimu

AU - Manzi, Fatuma

AU - Pemba, Senga

AU - Phillips, James

AU - Ramsey, Kate

AU - Baynes, Colin

AU - Awoonor-Williams, John Koku

AU - Bawah, Ayaga

AU - Nimako, Belinda Afriyie

AU - Kanlisi, Nicholas

AU - Sheff, Mallory C.

AU - Kyei, Pearl

AU - Asuming, Patrick O.

AU - Biney, Adriana

AU - Ayles, Helen

AU - Mwanza, Moses

AU - Chirwa, Cindy

AU - Stringer, Jeffrey

AU - Mulenga, Mary

AU - Musatwe, Dennis

AU - Chisala, Masoso

AU - Lemba, Michael

AU - Mutale, Wilbroad

AU - Drobac, Peter

AU - Rwabukwisi, Felix Cyamatare

AU - Hirschhorn, Lisa R.

AU - Binagwaho, Agnes

AU - Gupta, Neil

AU - Nkikabahizi, Fulgence

AU - Manzi, Anatole

AU - Condo, Jeanine

AU - Farmer, Didi Bertrand

AU - Hedt-Gauthier, Bethany

AU - Sherr, Kenneth

AU - Cuembelo, Fatima

AU - Michel, Catherine

AU - Gimbel, Sarah

AU - Henley, Catherine

AU - Kariaganis, Marina

AU - Manuel, João Luis

AU - Napua, Manuel

AU - Pio, Alusio

PY - 2017/12/21

Y1 - 2017/12/21

N2 - Background: The Doris Duke Charitable Foundation's African Health Initiative supported the implementation of Population Health Implementation and Training (PHIT) Partnership health system strengthening interventions in designated areas of five countries: Ghana, Mozambique, Rwanda, Tanzania, and Zambia. All PHIT programs included health system strengthening interventions with child health outcomes from the outset, but all increasingly recognized the need to increase focus to improve health and outcomes in the first month of life. This paper uses a case study approach to describe interventions implemented in newborn health, compare approaches, and identify lessons learned across the programs' collective implementation experience. Methods: Case studies were built using quantitative and qualitative methods, applying the World Health Organization Health Systems Strengthening Framework, and maternal, newborn and child health continuum of care framework. We identified the following five primary themes in health systems strengthening intervention strategies used to target improvement in newborn health, which were incorporated by all PHIT projects with varying results: health service delivery at the community level (Tanzania), combining community and health facility level interventions (Zambia), participatory information feedback and clinical training (Ghana), performance review and enhancement (Mozambique), and integrated clinical and system-level improvement (Rwanda), and used individual case studies to illustrate each of these themes. Results: Tanzania and Zambia included significant community-based components, including mobilization and sensitization for increased uptake of essential services, while Ghana, Mozambique, and Rwanda focused more efforts on improving the quality of services delivered once a patient enters a health facility. All countries included aspects that improved communication across levels of the health system, whether through district-wide data sharing and peer learning networks in Mozambique and Rwanda, or improved referral processes and systems in Tanzania, Zambia, and Ghana. Conclusion: Key lessons learned include the importance of focusing intervention components on addressing drivers of neonatal mortality across the maternal and newborn care continuum at all levels of the health system, matching efforts to improve service utilization with provision of high quality facility-based services, and the critical role of leadership to catalyze improvements in newborn health.

AB - Background: The Doris Duke Charitable Foundation's African Health Initiative supported the implementation of Population Health Implementation and Training (PHIT) Partnership health system strengthening interventions in designated areas of five countries: Ghana, Mozambique, Rwanda, Tanzania, and Zambia. All PHIT programs included health system strengthening interventions with child health outcomes from the outset, but all increasingly recognized the need to increase focus to improve health and outcomes in the first month of life. This paper uses a case study approach to describe interventions implemented in newborn health, compare approaches, and identify lessons learned across the programs' collective implementation experience. Methods: Case studies were built using quantitative and qualitative methods, applying the World Health Organization Health Systems Strengthening Framework, and maternal, newborn and child health continuum of care framework. We identified the following five primary themes in health systems strengthening intervention strategies used to target improvement in newborn health, which were incorporated by all PHIT projects with varying results: health service delivery at the community level (Tanzania), combining community and health facility level interventions (Zambia), participatory information feedback and clinical training (Ghana), performance review and enhancement (Mozambique), and integrated clinical and system-level improvement (Rwanda), and used individual case studies to illustrate each of these themes. Results: Tanzania and Zambia included significant community-based components, including mobilization and sensitization for increased uptake of essential services, while Ghana, Mozambique, and Rwanda focused more efforts on improving the quality of services delivered once a patient enters a health facility. All countries included aspects that improved communication across levels of the health system, whether through district-wide data sharing and peer learning networks in Mozambique and Rwanda, or improved referral processes and systems in Tanzania, Zambia, and Ghana. Conclusion: Key lessons learned include the importance of focusing intervention components on addressing drivers of neonatal mortality across the maternal and newborn care continuum at all levels of the health system, matching efforts to improve service utilization with provision of high quality facility-based services, and the critical role of leadership to catalyze improvements in newborn health.

KW - Ghana

KW - Health system strengthening

KW - Maternal child health

KW - Mozambique

KW - Neonatal mortality

KW - Newborn health

KW - Quality of care

KW - Rwanda

KW - Tanzania

KW - Zambia

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