Highlights

Doctoral fellows and alumni of the CARTA program have recommended the following based on their research:

• To achieve universal and effective health coverage, African states must prioritize health system strengthening (HSS).    
• Increased investment in routine health information systems (RHIS) at all levels, safety nets for the poor, a mix of public and private funding mechanisms, service delivery that considers individual, community, and state-level factors, and sustainable service financing models, are critical.
• The implementation of the following measures may mitigate challenges faced by the workforce: strategic workload reduction, reward programs for busy clinic days, management training workshops, non-physician-centered staffing methods, and leadership styles that support health workers.    
• The use of new mHealth tools and methods may improve quality of care and fidelity to healthcare innovations.    
• While supporting and monitoring all threats, it is critical to prioritize diseases that continue to overwhelm Africa's health system.

Preamble

African countries face a host of public health concerns, including a high burden of infectious diseases, a rising prevalence of noncommunicable diseases, and diverse expressions of social determinants of health, such as a lack of access to healthcare. To address these challenges, African countries are focused on health system strengthening (HSS) initiatives, which among others involve developing new or improving existing policies, programs, and services that provide healthcare personnel with the knowledge and resources they need to provide universal quality care. Given the number of variables at play, success in HSS necessitates multidisciplinary approaches. The requisite human capability, however, is costly, and its deployment is not always feasible. Currently, research to improve Africa's healthcare systems in response to its challenges is either fragmented or insufficient.

A solution

Doctoral students and graduates can make a big contribution by studying new solutions to existing public health problems and proposing policies that address the requirements of diverse African communities. Through their research, PhD students can gain a comprehensive understanding of how to develop evidence-based strategies to enhance health systems in specific contexts, leading to improved public health outcomes throughout the continent.

CARTA fellows are individuals who have been chosen to participate in the Consortium for Advanced Research Training in Africa (CARTA) program as part of their PhD studies. The fellows come from various African countries and have backgrounds in science, health, education, engineering, economics, and other social sciences. The CARTA fellowship provides fellows with a one-of-a-kind opportunity to obtain advanced training in their particular professions while working on public and population health research topics. The CARTA fellowship program is designed to meet the specific needs of each fellow, giving them access to cutting-edge research, skills, and networks that will help them progress their careers. Fellows are able to develop creative ideas that can help their communities and countries as a result of this program. CARTA is assisting in the establishment of an environment in which African scholars may succeed and contribute to the resolution of some of the most serious issues confronting Africa today. In this short article, we highlight a few of the highly cited research publications authored by CARTA fellows, alumni and their colleagues to inform the health system’s building blocks to improve Africa's healthcare.

Governance

Jackline Sitienei and colleagues emphasize the need for inclusivity in the context of HSS governance. They argued that community (patients and general public) participation in health service governance is a critical component of health care decision-making and related activities. They emphasized that the health facility committees focus should include both special initiatives and the usual operation of the primary health care facility in order to achieve effective collaborative governance.

Information

According to the research conducted by Cheikh Faye and colleagues, there is a pressing need for low- and middle-income countries to prioritize the improvement of routine health information systems (RHIS) and to significantly enhance their use in health system planning and operations. In another study, they provide a roadmap for improving RHIS. Stephen Wandera and colleagues also make additional recommendations for enhanced RHIS in family planning services delivery.

Financing

According to Beatrice Maina and others, understanding the flow of resources to reproductive health at the national level is critical for effective financing of critical components of the health system. The importance of increasing budgets and expenditures to achieve both local and global health targets was emphasized. In this context, it is imperative to establish safety nets aimed at mitigating the financial burden of household expenditures experienced by low-income individuals. Furthermore, Henry Zakumumpa stated that the lessons learned from funding HIV programs show that a mix of funding mechanisms is recommended in the pursuit for universal health coverage in East African Community partner nations. The private sector's involvement is also critical and can be increased through specific initiatives aimed at achieving universal health coverage goals.

Service delivery

Sulaimon Adedokun reminds us that improving health outcomes can be accomplished through improved service delivery. Unfortunately, non-utilization of health services is influenced by factors at the individual, community, and state levels, and each should be appropriately considered in the design of effective solutions. On a global scale, Olujide Arije and colleagues observed that interruptions in donor support, such as funding cuts, have been linked to decreased quality of care, personnel shortages, and reliance on fee-based treatment for formerly free services. In summary, they recommend that sustainable models for funding services are desperately required.

Human resources

Human resources for health (HRH) limitations, according to Henry  Zakumumpa, are a key impediment to the sustainability of health programs to control HIV/AIDS  in Sub-Saharan Africa. He adds that health facility level strategies for responding to HRH constraints are feasible and can contribute to efforts to increase country ownership of programs in resource-limited settings. The identified strategies were classified into five themes: (1) providing monetary and non-monetary incentives to health workers on busy clinic days; (2) workload reduction through clinic appointment spacing; (3) using management training workshops as a motivation strategy for health workers; (4) using non-physician-centered staffing models; and (5) developing program leadership styles that increased health worker commitment.

Technology and medicines

Diana Menya and others advocate for greater use of technology in health care delivery for malaria diagnosis. They remark that the application of new mHealth tools for monitoring and quality control can ensure quality within a large-scale implementation of community level testing by lay health workers. Judith Mwansa-Kambafwile has repeatedly advocated that instant messaging can be utilized to increase TB treatment initiation, and perhaps reduce transmission, and improve treatment outcomes. Judith Mwansa-Kambafwile's use of technology is critical considering the high burden of tuberculosis on Africa's health system.      

Conclusion

In all, doctoral research studies can be a significant means of generating evidence to address the ongoing health system strengthening needs in Africa. The CARTA doctoral training program, in conjunction with its research and training information system, CARTA Evidence, offers a well-curated repository of research findings that can be utilized to guide decision-making in the fields of HSS and other domains of public health significance. In addition, the highly trained cohorts of current fellows and alumni within the CARTA program (as a model of doctoral training) provide an engaged, multi-disciplinary and accessible group that can facilitate impactful and sustained healthcare transformation through research and relevant stakeholder engagement.   

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Please visit CARTA Evidence policy brief for similar short articles