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Health System Strengthening for Equity: The Power and Potential of Mid-level Providers

Funded by Irish Aid and the Ministry of Foreign Affairs, Denmark.


HSSE Research Group Photo

The human resources for health crisis in Africa demands innovative and locally appropriate solutions that increase access to quality health care at a price affordable to governments. One such solution is the development and deployment of mid-level providers as seen in many countries throughout Africa over the past four decades. These mid-level providers typically perform critical functions conventionally associated with more highly trained and highly mobile health providers and, compared to doctors, are more likely to be present at district level health facilities especially in rural areas.

Yet, despite apparent broad use of mid-level providers in Africa, these health workers are virtually invisible in policy documents and government strategic plans; there are few efforts to expand their training; and little is known about their current use and practice or even about the factors at individual, organisational, and environmental levels that enable or block their performance. To address this need, a consortium of four research, advocacy and policy focused organizations have formed a strategic partnership to implement the proposed project, Health System Strengthening for Equity: The Power and Potential of Mid-level Providers (HSSE). This is a four year, multi-country project that builds on the growing policy momentum and global dialogue to address the human resource crisis and the need to support functioning, responsive health systems. The four partner organizations are Trinity College Dublin Centre for Global Health (CGH), Columbia University's Mailman School of Public Health Averting Maternal Mortality and Disability Program (AMDD), Realizing Rights: the Ethical Globalization Initiative (RR:EGI), and the Africa-based Regional Prevention of Maternal Mortality network (RPMM).

HSSE Project Goal and Objectives

The goal of the Health System Strengthening for Equity project was to support health system strengthening for equity in Africa by building an evidence base on the role of mid-level providers in maternal and neonatal health and promoting greater political leadership and critical policy action on this issue. The strategy that drives this Health Systems Strengthening for Equity (HSSE) project had multiple elements:

  • a) a unique and strategic collaborative partnership among research, policy and advocacy organizations, and among northern and southern institutions;
  • b) an approach to collaborative research that builds and supports capacity in countries and that respects the principle of country ownership of its data;
  • c) an approach to collaborative advocacy that builds capacity of both southern and northern institutions to use evidence for policy and to link global and national processes and debates in order to generate more realistic and sustainable solutions; and
  • d) a commitment to supporting (and not undermining) ongoing policymaking processes and to ensuring the development of policy-relevant evidence and analysis.

The HSSE project focused on the delivery of emergency obstetric and newborn health care (EmONC) by mid-level health workers as a key entry point to assessing the use and effectiveness of mid-level providers more broadly. A multi-country approach enabled in-country analyses and cross-country comparisons. The main focus countries were Malawi, Mozambique and Tanzania as each country has well established cadres of mid-level providers delivering the bulk of emergency obstetric care (including caesarean sections).

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Last updated 23 November 2016 School Web Administrator (Email).