Community of Practice Health
Service Delivery
A model of knowledge management
at the district level
PHCPI, Global Stakeholders Workshop, Geneva, 6-8 April 2016 1
- More than 1400 experts
- From 78 countries
- Diversity : Universities, NGOs, governments,
civil societies, …
- Focus on the district level
2
Strategies
of the CoP HSD
• Dynamic horizontal
(peer-to-peer)
exchange
• Contribution to
address health
system issues
• Sharing of best
practices
3
The CoP HSD,
A knowledge management model
CoP HSD fosters exchange on health service
delivery at the district level
1. Brings different knowledge holders/profiles
together in one platform
2. Facilitates interaction and builds trust
3. Shares information and best practices
4. Develops a common knowledge agenda
4
1. An online discussion forum
https://hhacops.org/cop-hsd-pss-bilingual/discussions
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2. Newsletter in French
www.santemondiale.org
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3. A Blog
www.health4africa.net
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4. Face-to-face events
8
Dakar, November 2013
4. Face-to-face events
From Health Information System to collective Intelligence :
Refocusing the health district on population using ICT
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Cotonou, December 2015
5. Research and publications
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6. Collaborative projects
Mobilization 2.0
of District Health Management Teams (DHMTs)
against outbreaks
11
Dakar regional conference on Health
district (2013)
• Since Harare (1987): many changes in Africa
• Local health systems performance: still low
• The health district : remains a valid strategy, but needs
for a renewed vision to improve primary health care
– Health district: to be a learning system
– One of the 12 priorities for better performing health districts in
Africa was on health information system
ICT - The power of ICT to enhance governance and accountability, equity,
effectiveness and efficiency of local health systems
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Challenges of health information systems
Inputs
(Cotonou, 2015)
• HIS: designed for the purpose of the central level
• Decentralized level rarely involved in the design of HIS: what?
Why?
• Multiple and fragmented tools
Processes
• Central level: a data pulling system, Little feedback
• Decision-making not valued (focus on promptness and
completeness of data)
• Non-health actors disconnected (lack of collective intelligence)
Outcomes
• Poor data quality
• Poor performance of the district health systems
13
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Mobilization 2.0
Data and decision-making at the district level
A Quest for an effective theory of change
15
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Rationale
• Weak health systems with command and
control approach
• A bottom-up approach could, “must” be
complementary
• Critical role of PHC with Steward function of
District Teams
• How to empower them?
17
Key points of the program theory
• A flexible, context-relevant data collection,
analysis and visualization system improves the
motivation of DHMTs to use data for action
• A benchmarking of performance would improve
priority setting and decision-making
18
Key points of the program theory
• A national discussion forum empowers local actors
in taking action
• Mobilizing different categories of actors and
competencies leads to the improved health system
performance
19
Mobilisation 2.0:
4 key integrated components
1.
2.
3.
4.
District level preparedness against outbreaks
Sharing experience in outbreak response
Social medias
Action research
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Preparedness
• 2 Questions
– Is my district ready?
– What is needed more?
• Tools
– Online data collect and timely
vizualization platform
– Flexible content, adaptable to
emergent and bottom-up needs
• Objectives
– Self-evaluation
– Improve priority setting
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Optimizing improvement from data
• Key questions:
– How do peer deal with same challenges?
–How are top-down recommandations (not) adapted to local
contexts?
• District.team: An online discussion forum based on core CoP values
• Objectives
–Sharing practices and peer-to-peer support
–Improving collective intelligence
–Balancing power for district level decision-making
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Populations as collective and
individual decision-makers
• Do people have quality and up-to-date
information about diseases, outbreaks?
• Are they empowered to take evidence based
decisions and action accross social categories?
• Are they empowered to defend their right to
health and leverage an effective bottom-up
pressure?
23
Tools
• A Facebook Page (since January 2016) : more than 5000 likes
• A Facebook group
Objectives
• Inform & sensitize, kill rumors
• Collect population based data
• Build community leadership
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Action-research
• A core Question: How to mobilize DHMTs in
evaluating their own performance and improving
their response to health challenges?
• Tool: Action-research on the 3 other components
• Objectives
– Adapt strategies
– Draw and share the lessons
– Refine our program theory
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Implementation
• First phase: 2015-2016
– 2 countries: Benin and Guinea
– 3 research centres in Benin, Belgium and Guinea
– Support: UNICEF WCARO
• Second phase: 2017
– Inclusion of other countries
– Collaboration with other partners
– Focus on other health priorities (health district
performance indicators, maternal and child health, …)
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Conclusion
• Quality health information system require a new
vision to contribute as a core element of health
district performance
• The CoP HSD
– Focuses on the empowerment on local actors
including populations
– Has innovative tools including a fast learning by doing
approach
– Strong potential in contributing to improve PHC
performance
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Thank you
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Local Heath System
•
Collective understanding +
•
•
•
Collective objectives +
Collective decision making+
Collective action
= Collective Intelligence
PHCPI
Better
performance
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Inspired from Pierre Levy 1994, Gresselle 2008