Implementing health system change: What are the lessons from the African Health Initiative?

Journal Article


Journal Title

BMC Health Services Research

Journal ISSN
Volume Title

BioMed Central Ltd


University of Cape Town

The five African Health Initiative Population Health Implementation and Training (PHIT) Partnerships represent a rich and important set of health system strengthening initiatives. All can be called whole system strengthening initiatives in two important respects. First, from a health system perspective, as explicitly discussed, all the PHIT Partnerships are multi-dimensional, seeking to achieve performance improvements by working across the building blocks and levels of the health system. All address resource needs (human, financial, and supplies) in some way. The common focus on strengthening information use in clinical and managerial decision-making, meanwhile, tackles what some regard as the key leverage point for health system improvement [1] and quality of care is another such point [2]. Considering the role of community health workers, moreover, emphasizes that the health system stretches beyond the doors of health facilities, and that health system development requires combined community and facility-based actions. Finally, several initiatives emphasize the importance of strengthening supervision and management coaching and mentoring. Importantly, the different activities within each partnership are intended to work synergistically together.