Skip to main content
bioRxiv
  • Home
  • About
  • Submit
  • ALERTS / RSS
Advanced Search
New Results

Advancing a Science for Sustaining Health: Establishing a Model Health District in Madagascar

Matthew H. Bonds, View ORCID ProfileAndres Garchitorena, Laura Cordier, Ann C. Miller, Margaret McCarty, Benjamin Andriamihaja, Josea Ratsirarson, Andriamihaja Randrianambinina, Victor R. Rabeza, Karen Finnegan, Thomas Gillespie, Patricia A. Wright, Paul E. Farmer, Tara Loyd, Megan B. Murray, Robin M. Herrnstein, James R. Herrnstein, PIVOT Impact Team, Djordje Gikic, Mohammed A. Ouenzar, Lara Hall, Michael L. Rich
doi: https://doi.org/10.1101/141549
Matthew H. Bonds
1Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
2PIVOT, Ranomafana, Madagascar/ Boston, MA USA
3Department of Medicine, Stanford School of Medicine, Stanford CA USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: mhb9@hms.harvard.edu
Andres Garchitorena
1Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
2PIVOT, Ranomafana, Madagascar/ Boston, MA USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Andres Garchitorena
Laura Cordier
2PIVOT, Ranomafana, Madagascar/ Boston, MA USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ann C. Miller
1Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Margaret McCarty
2PIVOT, Ranomafana, Madagascar/ Boston, MA USA
5Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Benjamin Andriamihaja
2PIVOT, Ranomafana, Madagascar/ Boston, MA USA
6MICET, Antananarivo, Madagascar
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Josea Ratsirarson
4Ministry of Health, Madagascar
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Andriamihaja Randrianambinina
4Ministry of Health, Madagascar
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Victor R. Rabeza
7Madagascar National Institute of Statistics
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Karen Finnegan
11Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Thomas Gillespie
9Department of Environmental Studies, Emory University, Atlanta, GA USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Patricia A. Wright
8Department of Anthropology, Stony Brook University, Stony Brook, NY USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Paul E. Farmer
1Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
5Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Tara Loyd
2PIVOT, Ranomafana, Madagascar/ Boston, MA USA
5Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Megan B. Murray
1Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Robin M. Herrnstein
2PIVOT, Ranomafana, Madagascar/ Boston, MA USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
James R. Herrnstein
2PIVOT, Ranomafana, Madagascar/ Boston, MA USA
10Renaissance Technologies, Stony Brook, NY USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Djordje Gikic
2PIVOT, Ranomafana, Madagascar/ Boston, MA USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Mohammed A. Ouenzar
2PIVOT, Ranomafana, Madagascar/ Boston, MA USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lara Hall
2PIVOT, Ranomafana, Madagascar/ Boston, MA USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michael L. Rich
1Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
5Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Abstract
  • Full Text
  • Info/History
  • Metrics
  • Preview PDF
Loading

Abstract

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.

Copyright 
The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-ND 4.0 International license.
Back to top
PreviousNext
Posted May 30, 2017.
Download PDF
Email

Thank you for your interest in spreading the word about bioRxiv.

NOTE: Your email address is requested solely to identify you as the sender of this article.

Enter multiple addresses on separate lines or separate them with commas.
Advancing a Science for Sustaining Health: Establishing a Model Health District in Madagascar
(Your Name) has forwarded a page to you from bioRxiv
(Your Name) thought you would like to see this page from the bioRxiv website.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Share
Advancing a Science for Sustaining Health: Establishing a Model Health District in Madagascar
Matthew H. Bonds, Andres Garchitorena, Laura Cordier, Ann C. Miller, Margaret McCarty, Benjamin Andriamihaja, Josea Ratsirarson, Andriamihaja Randrianambinina, Victor R. Rabeza, Karen Finnegan, Thomas Gillespie, Patricia A. Wright, Paul E. Farmer, Tara Loyd, Megan B. Murray, Robin M. Herrnstein, James R. Herrnstein, PIVOT Impact Team, Djordje Gikic, Mohammed A. Ouenzar, Lara Hall, Michael L. Rich
bioRxiv 141549; doi: https://doi.org/10.1101/141549
Digg logo Reddit logo Twitter logo Facebook logo Google logo LinkedIn logo Mendeley logo
Citation Tools
Advancing a Science for Sustaining Health: Establishing a Model Health District in Madagascar
Matthew H. Bonds, Andres Garchitorena, Laura Cordier, Ann C. Miller, Margaret McCarty, Benjamin Andriamihaja, Josea Ratsirarson, Andriamihaja Randrianambinina, Victor R. Rabeza, Karen Finnegan, Thomas Gillespie, Patricia A. Wright, Paul E. Farmer, Tara Loyd, Megan B. Murray, Robin M. Herrnstein, James R. Herrnstein, PIVOT Impact Team, Djordje Gikic, Mohammed A. Ouenzar, Lara Hall, Michael L. Rich
bioRxiv 141549; doi: https://doi.org/10.1101/141549

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Subject Area

  • Epidemiology
Subject Areas
All Articles
  • Animal Behavior and Cognition (3689)
  • Biochemistry (7789)
  • Bioengineering (5674)
  • Bioinformatics (21282)
  • Biophysics (10576)
  • Cancer Biology (8173)
  • Cell Biology (11937)
  • Clinical Trials (138)
  • Developmental Biology (6762)
  • Ecology (10401)
  • Epidemiology (2065)
  • Evolutionary Biology (13863)
  • Genetics (9708)
  • Genomics (13070)
  • Immunology (8139)
  • Microbiology (19983)
  • Molecular Biology (7842)
  • Neuroscience (43053)
  • Paleontology (319)
  • Pathology (1279)
  • Pharmacology and Toxicology (2258)
  • Physiology (3351)
  • Plant Biology (7232)
  • Scientific Communication and Education (1312)
  • Synthetic Biology (2004)
  • Systems Biology (5537)
  • Zoology (1128)