IFGH 2012: Health Systems Strengthening for Equity (HSSE): The Power and Potential of Mid-level Providers

January 30, 2012

Authors:McAuliffe E.1 and HSSE teams in organisations

Author Affiliations:1Centre for Global Health, University of Dublin, Trinity College; Averting Maternal Death and Disability Program (AMDD), Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, USA; Realizing Rights: the Ethical Globalization Initiative, USA; Regional Prevention of Maternal Mortality network, Accra, Ghana); Ifakara Health Institute, Mikocheni, Dar Es Salaam, Tanzania); University of Malawi, College of Medicine, Centre for Reproductive Health, Malawi; Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Mozambique

Option 1– Scientific / Empirical Research Findings Presented as – Oral Presentation


The HSSE project aimed 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 utilising the extensive experience and complementary strengths of the consortium partners, HSSE sought to expand the evidence base in support of effective use of mid-level health workers and increase recognition and effective use of mid-level health workers among national, regional, and global policymakers to address the human resource crisis in district health systems based on project evidence.


HSSE sought to change a dynamic where northern research projects engage with in-country partners to collect data, but then analyse that data in their home institutions. The consortium partners avoided an approach where skills-building is simply a means to meet project objectives. Instead, the project deliberately adopted a philosophy where capacity-building efforts explicitly added to the bank of research expertise in partner countries.


Feedback from the data collectors demonstrated that teams felt part of a bigger process, where they gained skills and confidence, shared expertise and made new connections. A number of important lessons for future projects emerged including the need to:

  • Undertake a full skills assessment of the existing platform of each partner’s research resources and gaps prior to study commencement
  • Engage in capacity building to enhance accountability and responsibility of in-country partners thus contributing to in-country partners’ ability to lead research teams
  • Improve data management processes

Discussion/conclusions/ implications:

The project demonstrated the need to engage in capacity building that is a lasting and sustainable investment in the work of all partners. The commitment to research capacity building exposed a number of issues that could be considered for future work, both at institutional level and more broadly within health systems research.



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