Sub-Saharan Africa and the health MDGs: the need to move beyond the “quick impact” model

What is the impact of multi-professional emergency obstetric and neonatal care training?

“…Donor agencies tend to fund short-term, fast-tracked interventions with a "quick impact" that often run parallel to a country's health system [84].…”

Systems Thinking in Short-term Health Missions: A Conceptual Introduction and Consideration of Implications for Practice

“…5,8,20 In this approach, interest groups and planners from HICs (high-income countries) drive the agenda, while communities and households in LICs are treated like recipients 8 as opposed to collaborators. Planners, providers, and managers learn and communicate what works within the context of narrow, often disease-specific, initiatives so that interest groups will continue to provide necessary funding.…”

“…When targeting a welldefined problem, some of these programs have been effective in reaching focused goals, but sustainability has remained elusive due to the complex adaptive nature of health systems. 5,14,20 STHMs are often planned and executed in the same way, from the top down. 3,[6][7][17][18]27 …”

“…Negative effects may not be so obvious, as participants may be unaware of local cultural context, the multifactorial causes of disease, and the complex interactions between diverse stakeholders that make up a health system, leading to some of the unintended consequences that we discuss in this paper. 4 Health systems are inherently complex and under some approaches to STHMs (as well as many other global health interventions) 5 -that are not always designed to address complexity by engaging local stakeholders in long-term collaboration and shared learning -impact may be limited and sustainability is sometimes lacking. 2,[5][6][7][8][9] This paper describes health systems as CASs, discusses why some STHM practices might lead to unintended consequences, and proposes a way forward that could lead to increased local innovation and long-term capacity in health.…”

“…4 Health systems are inherently complex and under some approaches to STHMs (as well as many other global health interventions) 5 -that are not always designed to address complexity by engaging local stakeholders in long-term collaboration and shared learning -impact may be limited and sustainability is sometimes lacking. 2,[5][6][7][8][9] This paper describes health systems as CASs, discusses why some STHM practices might lead to unintended consequences, and proposes a way forward that could lead to increased local innovation and long-term capacity in health. While the concepts outlined in this paper could (and many argue should [10][11][12][13][14] ) be applied by larger global health organizations and initiatives, in this paper we focus on their specific application to STHMs.…”