More articles from ORIGINAL ARTICLE

The volume of literature on health systems in sub-Saharan Africa has been expanding since the 2000 MDG era. Focus has remained generally on categorical health themes rather than systems concepts. Topics such as scaling-up, organizational development, data use for decision making, logistics, and financial planning remain underrepresented. And quite surprisingly, implementation science remains something of a “black hole.” But bibliometric evidence suggests there is a shift in focus that may soon address these gaps.

Training public-sector providers to treat diarrhea in children with low-osmolarity oral rehydration salts and zinc appeared to be effective. Among private providers, drug-detailing visits by pharmaceutical representatives seemed less effective, particularly in improving knowledge of the correct dosage and duration of zinc treatment. Consistent supplies and sufficient attention to training all health care cadres, especially community health workers who may be new to diarrhea treatment and informal-sector providers who are typically excluded from formal training, are critical to improving knowledge and prescribing behaviors.

Using an analytical framework to design and implement voluntary medical male circumcision (VMMC) programs can lead to more effective interventions, especially when insights are incorporated from disciplines such as behavioral science and commercial market research. Promising VMMC behavior change practices: (1) address individual, interpersonal, and environmental barriers and facilitators; (2) tailor messages to men’s behavior change stage and focus on other benefits besides HIV prevention, such as hygiene and sexual pleasure; (3) include women as a key target audience; (4) engage traditional and religious leaders; (5) use media to promote positive social norms; and (6) deploy community mobilizers to address individual concerns.

Family planning social franchising has succeeded in countries with an active private sector serving low- and middle-income clients, with services provided mostly by mid-level providers, such as nurses and midwives. Key support for social franchising includes: clinical training and supportive supervision, help building sustainable businesses, marketing and demand creation, and mechanisms to make services affordable for clients. The forward agenda includes selectively introducing other priority health services, improving cost-effectiveness of the model, and promoting sustainability and health system integration.