“Strengthening Integrated Primary Health Care in Sofala Province, Mozambique”
Grantee Institution:
Health Alliance International
Team Leaders:
- Kenneth Sherr, M.P.H., Ph.D.
Health Alliance International
- Maria de Fatima Cuembelo, M.D., M.P.H.
Eduardo Mondlane University, Mozambique
Project Summary:
Beginning in 2009, a consortium comprised of the Mozambique Ministry of Health, Health Alliance International (HAI) at the University of Washington, and the Eduardo Mondlane University School of Medicine received support from DDCF to improve and integrate Primary Health Care (PHC) service delivery at over 140 health facilities in Sofala Province, Mozambique (population 1.6 million). This seven-year project builds on 25 years of collaboration for PHC service delivery through the public sector in central Mozambique.
Current government reform in Mozambique focuses on decentralization of authority to the district and provincial levels, which has brought new challenges and opportunities to improve resource allocation and management for PHC delivery. To support this process in Sofala province, the project focuses on building the capacity of the 13 district management teams and provincial leadership to continually plan, monitor, and improve the health system as a means of increasing the quality and utilization of essential health services, and in turn lead to improved population health.
The first project objective is to strengthen integrated health systems management at district and provincial levels through in-service training and continuous mentoring by project staff, recognizing that training alone is inadequate to lead to sustainable capacity improvements. Building capacity to plan and manage the health system at the district level is important for ensuring that essential system resources are appropriately and efficiently distributed to health facilities.
The second project objective is to improve the quality of routine data and develop appropriate tools to facilitate decision-making for provincial and district managers. The PHIT project works to strengthen the quality of routine data systems through ongoing monitoring of data consistency and availability, reinforcing feedback loops, and annual data quality audits at the provincial, district and facility level. Recognizing the need to also improve the use of data, the PHIT project has developed tools for health system managers to identify problems and successes, and to guide resource allocation.
The third project objective is to build capacity to design and conduct innovative operations research in order to guide integration and system-strengthening efforts. Sources of service delivery bottlenecks and the key elements of potential solutions are often not fully understood or agreed upon by district and provincial managers. Building capacity for simple, applied research at the district and facility levels helps guide decision-making by better understanding modifiable service delivery barriers and testing potential innovations before scaling-up throughout the province. The PHIT project builds sustainable capacity for operations research through technical and financial support for the Ministry of Health’s Sofala-based Beira Operations Research Center (CIOB), master’s level public health training at the Eduardo Mondlane University, and applied thesis work for public health trainees.
In order to determine its impact on health system performance and the health of the population of Sofala province, a robust evaluation approach has been built into the project. Using routine, provincially-representative surveys, the evaluation approach compares population-level health service coverage, utilization and health status indicators between the intervention (Sofala) province and a neighboring control (Manica) province at multiple time points before and throughout the project timeframe. Supplemental data collection through ongoing health facility surveys, patient satisfaction surveys, time-in-motion studies, as well as through the routine health and financial information systems and ongoing project outputs, will allow for determining the effect of the PHIT project on health system functioning across its multiple building blocks.