RT Journal Article
SR Electronic
T1 Advancing a Science for Sustaining Health: Establishing a Model Health District in Madagascar
JF bioRxiv
FD Cold Spring Harbor Laboratory
SP 141549
DO 10.1101/141549
A1 Matthew H. Bonds
A1 Andres Garchitorena
A1 Laura Cordier
A1 Ann C. Miller
A1 Margaret McCarty
A1 Benjamin Andriamihaja
A1 Josea Ratsirarson
A1 Andriamihaja Randrianambinina
A1 Victor R. Rabeza
A1 Karen Finnegan
A1 Thomas Gillespie
A1 Patricia A. Wright
A1 Paul E. Farmer
A1 Tara Loyd
A1 Megan B. Murray
A1 Robin M. Herrnstein
A1 James R. Herrnstein
A1 PIVOT Impact Team
A1 Djordje Gikic
A1 Mohammed A. Ouenzar
A1 Lara Hall
A1 Michael L. Rich
YR 2017
UL http://biorxiv.org/content/early/2017/05/30/141549.abstract
AB Objective We 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.Setting The 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.Intervention The 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.Conclusion The 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 Statement Data can be made available upon request by emailing research{at}pivotworks.org.