Research in Progress (RIP): "Advancing a Science for Sustaining Health: a New Platform in Madagascar"



Matthew Bonds, Harvard University

Date and Time

April 27, 2016 4:00 PM - 5:00 PM

FSI Contact

Nicole Feldman

Please note: All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.


The past two decades have witnessed an unprecedented expansion of investment in healthcare in developing countries with corresponding widespread improvement in health indicators, though there still remain a billion people without basic access to primary care. Though there is a growing emphasis on integrating international donor funds with broad-based health system strengthening (HSS) efforts, very little is known about the process in which healthcare systems improve at the point of service, and how that, in turn, impacts population health.   Unlike the role of randomized trials on individual interventions, there is no gold standard for health systems research.  As global health expands its scope to the new field of planetary health broadly associated with the SDGs, the gaps in knowledge and research grow even further. Here, we present a framework for adaptive district-level HSS in Madagascar.  The program simultaneously strengthens the WHO’s six building blocks of HSS at all levels of the health system within a government district, while pioneering a rigorous system for policy and implementation research that includes 1) strengthening the district’s health management information systems (HMIS); 2) a prospective longitudinal cohort demographic and health study of over 1500 households; and 3) selected qualitative and biomedical research projects.  The research platform allows for the evaluation of system output indicators as well as population-level impact indicators, such as mortality rates.  Moreover, it provides a platform for scientific research on socio-economic and environmental determinants of health that are fundamental to the new field of planetary health.