While specific disease and system priorities will vary by country, the implementation of the GHI will have four main components:
(1) Do more of what works: Rapidly scaling up the most relevant high impact interventions and, where possible, integrating across health programs through a common delivery platform. Priorities will vary by country, but will include such interventions as:
- Women's health, including appropriate integration of information and services to address the needs of women and the role of mothers, such as: early antenatal care and a basic package of preventive prenatal services, including prevention of mother-to-child HIV transmission (PMTCT); TB testing and treatment; insecticide-treated bednets and intermittent prophylactic treatment of pregnant women for malaria; voluntary family planning; micronutrient supplementation; HIV/AIDS testing and counseling; basic and emergency obstetric care; nutritional support; prevention and treatment of neglected tropical diseases; and safe water, sanitation and hygiene interventions;
- Information and services for adolescent girls, such as development of adolescent-friendly health services; behavior change messages promoting healthy reproductive behavior and delaying age of marriage; prevention of HIV and unintended pregnancy; and prevention and treatment of neglected tropical diseases;
- Newborn care, including breastfeeding and promotion of appropriate feeding of infants and children; prevention and treatment of neonatal infections; doses of vitamin A (in Asia); and diagnosis of HIV/AIDS;
- Child health, such as supporting expanded immunization that includes pneumococcal and rotavirus vaccines; young child feeding promotion; micronutrient supplementation, including vitamin A and zinc; food fortification; community management of acute under-nutrition; linkages to HIV diagnosis and treatment; safe water, sanitation and hygiene interventions; oral rehydration therapy (ORT) for diarrhea; antibiotic treatment of pneumonia; antimalaria treatment; and treatment for intestinal parasites, worms, and other neglected tropical diseases.
(2) Build on and expand existing platforms to foster stronger systems and sustainable results: Strengthening health systems through close coordination with governments, private sector and development partners, through measures such as:
- Identifying and implementing priority strategies to address health system bottlenecks that constrain improved health for women and children and their communities, including the following: drug supplies; stock-out of medications; availability of diagnostic laboratory services, vaccines and contraceptives; access to equipment; shortages of trained staff; restrictions on task-shifting for health workers; and the use of performance incentives at all levels in the health system;
- Strengthening existing data collection systems for monitoring health service provision and health outcomes and surveillance approaches for monitoring infectious diseases;
- Identifying and implementing changes required to re-focus the health platform to be results-oriented rather than input- or process-oriented, including increased focus on creating demand, applying quality improvement methods, and making governments and providers more accountable for results;
- Improving human resources for health by training additional health workers; deploying workers; motivating, mentoring and retaining trained workers;
- Increasing country capacity to manage, oversee, and operate national health systems, including the use of information and evidence for decision-making;
- Building on best practices and contributing to and leveraging efforts of multilateral partners and special global partnerships through joint assessments of national health programs, shared reviews of financing gaps and absorptive capacity, and refined auditing and reporting tools;
- Developing and communicating evidence on the links between health system strengthening, such as financial inputs, and health results; and
- Identifying and supporting policy and structural changes that improve health outcomes, including those outside the health sector.
(3) Innovate for results: Introducing, evaluating and, where appropriate, scaling up new interventions and approaches that have shown promise in small studies. For example:
- Integrated Community Case Management (ICCM) of child illness with Rapid Diagnostic Tests (RDTs) for malaria;
- Integrated prevention and treatment of diarrheal disease and pneumonia, including encouraging the use of breastfeeding, vitamin A and zinc supplementation, household sanitation and point-of-use water purification, oral rehydration therapy, effective treatment for pneumonia and neglected tropical diseases, and rotavirus and pneumococcal vaccine;
- School-based deworming and safe water, sanitation and hygiene interventions;
- Clinic-based handwashing and drinking water stations to prevent health-facility acquired infections and facilitate DOTS and other facility-based oral treatment administration;
- Results-based financing for provision of services, including introduction or expansion of selected fee-for-service and target-based incentives, while respecting voluntary family planning and informed choice;
- Financing innovations to reduce demand-side barriers that result in underutilization of services, including vouchers, incentives for screening and adherence to treatment, community mobilization, behavior change communications, and other demand-side approaches;
- Reaching Every District ("RED") strategy for key interventions integrated with immunization and HIV/AIDS services; and
- Community-based programs to engage communities in encouraging women and children to use health services, monitoring and demanding supply and quality of services, managing certain diseases, and increasing the participation of women and girls in decisions on health needs and interventions.
(4) Collaborate for impact: Implementing a new business model for the provision of U.S. funding and technical assistance to improve the efficiency, effectiveness and sustainability of improved health results for women, children, and their communities, to include:
- Supporting efforts to engage in true partnership with countries by enabling them to plan, coordinate, manage, and oversee their health systems;
- Scaling up operational research that identifies new health strategies and better ways to implement them, and integrating and coordinating health strategies across health programs;
- Integrating and coordinating technical support and policy dialogue across USG agencies;
- Promoting an evidence-based woman- and girl-centered approach to improve health;
- Promoting capacity building, learning and evidence-based decisions through more rigorous monitoring, evaluation and operations and implementation research;
- Supporting increased integration and coordination among country-level stakeholders, including partner country governments, other donors, and nongovernmental organizations;
- Coordinating more effectively among U.S. government agencies and other funders to reduce the burden of reporting by both establishing consistent reporting elements and reducing the number of reports; and
- Identifying and implementing linkages of health programs with other development areas including water and sanitation, food security, education, microenterprise, and governance/civil society programs.
