Community of Practice Health Service Delivery A model of knowledge management at the district level PHCPI, Global Stakeholders Workshop, Geneva, 6-8 April

-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 5

6 2. Newsletter in French

3. A Blog 7

4. Face-to-face events Dakar, November

4. Face-to-face events From Health Information System to collective Intelligence : Refocusing the health district on population using ICT C otonou, December

5. Research and publications 10

11 Mobilization 2.0 of District Health Management Teams (DHMTs) against outbreaks 6. Collaborative projects

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 12

Challenges of health information systems (Cotonou, 2015) Inputs 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.District level preparedness against outbreaks 2.Sharing experience in outbreak response 3.Social medias 4.Action research 20

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 21

22 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 Optimizing improvement from data

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 Populations as collective and individual decision-makers

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 24

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 25

Implementation First phase: – 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, …) 26

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 27

Thank you 28

29 Local Heath System Better performance PHCPI Collective understanding + Collective objectives + Collective decision making+ Collective action = Collective Intelligence Inspired from Pierre Levy 1994, Gresselle 2008