Lessons from the African Health Initiative: A Systematic Review Protocol

In many low- and middle-income countries, health systems are plagued with challenges, including weak service delivery systems, limited human resources, inequitable access to primary health care, fragmented financing, and poor health information systems (Masefield et al., 2020; Phelan et al., 2020; Preker et al., 2021; Siqueira et al., 2021). To address these challenges, health systems strengthening programs have been implemented (Bawah et al., 2019; Langlois et al., 2020; Opoku et al., 2022; Spasenoska et al., 2025). In sub-Saharan Africa (SSA), the African Health Initiative (AHI) program is implemented across multiple countries to design, implement, and study multifaceted interventions tailored to local contexts to strengthen systems and improve primary care (Ghaffar et al., 2022; Magge et al., 2020; Sherr et al., 2017). The AHI, supported by the Doris Duke Foundation (DDF), has been implemented in Ghana, Mozambique, Ethiopia, Rwanda, Tanzania and Zambia in three distinct phases (Phase 1 from 2009–2015, Phase 2 from 2016–2021) and Phase 3 from 2022–present) (Ghaffar et al., 2022). The initiative aimed to strengthen primary health care systems, improve district-level health management, and accelerate the adoption of evidence-based strategies to improve population health outcomes (Agula et al., 2024; Rwabukwisi et al., 2017). Since its launch, a considerable number of evaluations and publications of the program have emerged, highlighting various aspects of implementation and outcomes (Magge et al., 2017). Consequently, evidence on interventions implemented, lessons learned, best practices, and program impacts is scattered across internal project reports, evaluation documents, and peer-reviewed publications (Hirschhorn et al., 2017). This dispersion of evidence makes it difficult for policymakers and practitioners to obtain a coherent and comprehensive understanding of existing knowledge, identify evidence gaps, and determine what interventions are effective, under what circumstances, and why (Leary et al., 2017; Oliver et al., 2014)Consequently, there is fragmented evidence across internal project reports, evaluation documents, and peer-reviewed articles about lessons learned and best-bet practices from the program (Hirschhorn et al., 2017). Without consolidation, lessons remain scattered, reducing their usefulness for guiding effective health system strengthening. Against this background, there is a need for a consolidated resource report that captures what worked, what did not work, for whom, where, how, why, and under what conditions, so asto comprehensively to guide policymakers and practitioners in designing, implementing, and scaling up of evidence‑based, context‑appropriate, and sustainable PHC interventions.