Comprehensive and integrated district health systems strengthening: the Rwanda Population Health Implementation and Training (PHIT) Partnership

Drobac, Peter; Basinga, Paulin; Condo, Jeanine; Farmer, Paul; Finnegan, Karen; Hamon, Jessie K.; Amoroso, Cheryl; Hirschhorn, Lisa R.; Kakoma, Jean Baptiste; Lu, Chunling; Murangwa, Yusuf; Murray, Megan; Ngabo, Fidèle; Rich, Michael; Thomson, Dana R.; Binagwaho, Agnès

doi:10.1186/1472-6963-13-s2-s5

Cited by 59 publications

(68 citation statements)

References 14 publications

(15 reference statements)

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“…Brinkerhoff et al 23 indicated that responsiveness, leadership, customer voice, accountability, transparency, evidence-based practice, efficiency and effectiveness as governing outcome indicators in district health systems. Also, in some other countries, the World Health Organization's (WHO) building blocks were used to assess district health management and related interventions 24 . Whereas, it should be kept in mind that these frameworks weren't developed as specific tools to assess managerial performance at district levels.…”

Section: Discussionmentioning

confidence: 99%

A framework to assess management performance in district health systems: a qualitative and quantitative case study in Iran

et al. 2018

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Section: Discussionmentioning

confidence: 99%

A framework to assess management performance in district health systems: a qualitative and quantitative case study in Iran

et al. 2018

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“…Similarly, by examining the cycle of service delivery, research and documentation, and policy and program adjustments that feed back into care delivery, overall implementation and evaluation practices can be improved. A few examples from sub-Saharan Africa (and specifically Rwanda, where we work) of this cycle of implementation science, policy uptake, and quality improvement are provided for further reading [30–35]. Like the global burden of disease and our collective commitment to lightening the load on those who bear its heaviest weight, global health pedagogy must be dynamic and versatile, with a focus on systemic solutions to address health disparities wherever they occur.…”

Section: Discussionmentioning

confidence: 99%

The future of global health education: training for equity in global health

et al. 2016

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BackgroundAmong academic institutions in the United States, interest in global health has grown substantially: by the number of students seeking global health opportunities at all stages of training, and by the increase in institutional partnerships and newly established centers, institutes, and initiatives to house global health programs at undergraduate, public health and medical schools. Witnessing this remarkable growth should compel health educators to question whether the training and guidance that we provide to students today is appropriate, and whether it will be applicable in the next decade and beyond. Given that “global health” did not exist as an academic discipline in the United States 20 years ago, what can we expect it will look like 20 years from now and how can we prepare for that future?DiscussionMost clinicians and trainees today recognize the importance of true partnership and capacity building in both directions for successful international collaborations. The challenge is in the execution of these practices. There are projects around the world where this is occurring and equitable partnerships have been established. Based on our experience and observations of the current landscape of academic global health, we share a perspective on principles of engagement, highlighting instances where partnerships have thrived, and examples of where we, as a global community, have fallen short.ConclusionsAs the world moves beyond the charity model of global health (and its colonial roots), it is evident that the issue underlying ethical global health practice is partnership and the pursuit of health equity. Thus, achieving equity in global health education and practice ought to be central to our mission as educators and advisors when preparing trainees for careers in this field. Seeking to eliminate health inequities wherever they are ingrained will reveal the injustices around the globe and in our own cities and towns.

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“…Over the past 10 years, Partners In Health (PIH) and its Rwandan counterpart, Inshuti Mu Buzima (IMB), have worked in partnership with the Ministry of Health to bring health care to Kirehe, one of the poorest, rural districts in Rwanda (17). In 2013, PIH and Kirehe district leadership introduced ‘Race to the Top’ ( Inkera y'Imihigo ), a district-wide PBF scheme to reward health centers upon reaching district-identified targets that reflect district-level health priorities, supported with technical support in quality improvement (QI) and peer-to-peer learning.…”

Section: Introductionmentioning

confidence: 99%

Race to the Top: evaluation of a novel performance-based financing initiative to promote healthcare delivery in rural Rwanda

Nahimana

McBain

Manzi

et al. 2016

Global Health Action

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BackgroundPerformance-based financing (PBF) has demonstrated a range of successes and failures in improving health outcomes across low- and middle-income countries. Evidence indicates that the success of PBF depends, in large part, on the model selected, in relation to a variety of contextual factors.ObjectivePartners In Health∣Inshuti Mu Buzima aimed to evaluate health outcomes associated with a novel capacity-building model of PBF at health centers throughout Kirehe district, Rwanda.DesignThirteen health centers in Kirehe district, which provide healthcare to a population of over 300,000 people, agreed to participate in a PBF initiative scheme that integrated data feedback, quality improvement coaching, peer-to-peer learning, and district-level priority setting. Health centers’ progress toward collectively agreed upon site-specific health targets was assessed every 6 months for 18 months. Incentives were awarded only when health centers met goals on all three priorities health centers had collectively agreed upon: 90% coverage of community-based health insurance, 70% contraceptive prevalence rate, and zero acute severe malnutrition cases. Improvement across all four time points and facilities was measured using mixed-effects linear regression.FindingsAt 6-month follow-up, 4 of 13 health centers had met 1 target. At 12-month follow-up, 7 centers had met 1 target, and by 18-month follow-up, 6 centers had met 2 targets and 2 centers had met all 3. Average health center performance had improved significantly across the district for all three targets: mean insurance coverage increased from 68% at baseline to 93% (p<0.001); mean number of acute malnutrition cases in the previous 6 months declined from 24 to 5 per facility (p<0.001); and contraceptive prevalence increased from 42 to 59% (p<0.001). A number of innovative improvement initiatives were identified.ConclusionThe combining of PBF, district engagement/support, and peer-to-peer learning resulted in significant improvements despite resource constraints and is now being considered as a model for scale-up in other districts of Rwanda.

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Comprehensive and integrated district health systems strengthening: the Rwanda Population Health Implementation and Training (PHIT) Partnership

Cited by 59 publications

References 14 publications

A framework to assess management performance in district health systems: a qualitative and quantitative case study in Iran

A framework to assess management performance in district health systems: a qualitative and quantitative case study in Iran

The future of global health education: training for equity in global health

Race to the Top: evaluation of a novel performance-based financing initiative to promote healthcare delivery in rural Rwanda

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