1. Advancing a Science for Sustaining Health: Establishing a Model Health District in Madagascar
- Author
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Tara Loyd, Benjamin Andriamihaja, Herrnstein Rm, Matthew H. Bonds, Megan Murray, Victor R Rabeza, Wright Pa, Thomas R. Gillespie, Andriamihaja Randrianambinina, Meg G. McCarty, Karen E Finnegan, Ann C. Miller, Djordje Gikic, Lara Hall, Herrnstein, Laura F Cordier, Josea Ratsirarson, Mohammed Ali Ouenzar, Michael Rich, Andres Garchitorena, and Paul Farmer
- Subjects
HRHIS ,Economic growth ,business.industry ,Environmental resource management ,1. No poverty ,International health ,Population health ,030204 cardiovascular system & hematology ,Health indicator ,3. Good health ,03 medical and health sciences ,0302 clinical medicine ,Health promotion ,Health care ,Global health ,030212 general & internal medicine ,Business ,Health policy - Abstract
ObjectiveWe demonstrate a replicable model health district for Madagascar. The governments of many low-income countries have adopted health policies that follow international standards, and yet there are four hundred million people without basic access to primary care. Closing this global health delivery gap is typically framed as an issue of scale-up, accomplished primarily through integrating international donor funds with broad-based health system strengthening (HSS) efforts. However, there is no established process by which healthcare systems measure improvements at the point of service and how those, in turn, impact population health. There is no gold standard, equivalent to randomized trials of individual-level interventions, for health systems research. Here, we present a framework for a model district in Madagascar where national policies are implemented along with additional health system interventions to allow for bottom-up adaptation.SettingThe intervention takes place in a government district in Madagascar, which includes 1 district hospital, 20 primary care health centers, and a network of community health workers.InterventionThe program simultaneously strengthens the WHO’s six building blocks of HSS at all levels of the health system within a government district and pioneers a data platform that includes 1) strengthening the district’s health management information systems; 2) monitoring and evaluation dashboards; and 3) a longitudinal cohort demographic and health study of over 1,500 households, with a true baseline in intervention and comparison groups.ConclusionThe integrated intervention and data platform allows for the evaluation of system output indicators as well as population-level impact indicators, such as mortality rates. It thus supports field-based implementation and policy research to fill the know-do gap, while providing the foundation for a new science of sustaining health.Data Sharing StatementData can be made available upon request by emailingresearch@pivotworks.org.
- Published
- 2017
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