By Basile Keugoung, Joël Arthur Kiendrébéogo, Jean-Paul Dossou, Cheickna Toure & Bruno Meessen
It is said that information is power. Decentralization in our health systems will only be effective when the health information systems really take into account the needs and constraints of decentralized actors. In this blog, we present the topic that will keep our Community of Practice Health Services Delivery busy in the coming months. This knowledge program will culminate in a workshop program to be held in Cotonou, Benin, 16-18 December 2015. We welcome your participation!
Since the Harare Declaration in 1987, the health district is the cornerstone of health systems in sub-Saharan Africa. Traditionally, the district office is at the heart of an information process which goes from top to bottom – from the central and regional levels to health facilities – and the other way round – from health facilities to the central level. Thus, the central level defines policies, products guidelines, sets goals and conveys them to the district level. The clinics provide health care and services to the people and collect related data which they then convey to the hierarchy. This model considers the central level as the ‘decision making level’ and the district as the ‘operational level’: the district that offers health care transmits data to the central level so that the latter can take informed decisions. In practice, however, in many countries this model fails to fully use health information within the district.
Health districts in the era of information and communications technology (ICT)
As mentioned during the Dakar conference, much has changed since Harare. New technological options have emerged for the collection, processing and transmission of health data. Let’s just mention here computers, smartphones, Internet and all digital applications and user-friendly interfaces. The time necessary for the management of health information has greatly shortened; the number of people with access to real-time information could be almost unlimited, in principle.
Yet many health districts still stick to a rigid administrative logic where the only health data that matters is the data required by the hierarchy. Too many district management teams are happy to just meet these administrative requirements and make very limited use of the data they gather. This contributes to the low participation of communities in the management of their health problems, poor quality of care and high preventable morbidity.
What we have emphasized at the Dakar conference
In November 2013, at the invitation of our Community of Practice, more than 170 experts from 20 national delegations met in Dakar to revisit the health district policy on the occasion of the 25th anniversary of the Harare Declaration. They reiterated the validity of the health district organizational model and the values underpinning it (equity, efficiency and autonomy). However, they also proposed a revamp of the strategy in view of the many contextual changes that occurred in sub-Saharan Africa over the past two decades and their implications. For example, district management teams should not be regarded as mere representatives of the Ministry of Health within the district, but become the central steward of health activities at local level.
Participants recommended that the Ministry of Health and its partners help districts to become ‘learning organizations’. This requires from district management teams to listen to the people, respect their autonomy, collect qualitative and quantitative information on their health needs, identify the interventions required to respond to them and assess the effectiveness of the latter. This also involves collecting data on the performance of the various components of the local health system and the determinants that affect this performance. All this information must be analyzed and shared in an easily interpretable way. The information should also be ‘actionable’ for all stakeholders: from the household, the obstetrician in charge of the maternity ward, via the mayor to the health committees.
Perspective: a workshop in Cotonou in December 2015
Our analysis is that ICT will strongly ‘shake the coconut tree’: thanks to these new technologies, it is now possible to transfer the management of quality information to the most decentralized actors and to empower’ them in their decision making. We also believe that all change will not (only) come from above. It is also up to the peripheral actors to organize themselves and steer this agenda.
In the coming weeks, we will invite you to reflect with us on these issues. We hope many of you will contribute. This process will culminate in a workshop in December 2015 in Cotonou. The theme of the workshop is: “From the health information system to collective intelligence, refocusing the health district on the population through ICT“.
This workshop will take stock of traditional health information systems to analyze why they have not succeeded in translating the values advocated by the Harare Declaration. Then we will review current innovative experiments applying ICT in Africa (are they really empowering local actors?). Finally, we will peer into the future to propose models for developing collective intelligence at the local health system.
A dozen experts have jointly prepared a draft concept note of this workshop. We encourage you to read the note carefully. It will serve as a compass for our activities in the coming months. Your reactions, criticisms and comments are most welcome. We are particularly interested to hear from the ones among you working on a daily basis at the decentralized level, particularly health district managers.
What should I do to participate in this process?
In the coming weeks, we will publish several blogs related to this knowledge program. We hope they will spark feedback and contributions from you. We also appeal to the ones among you who are directly involved in the implementation of original technology solutions to run health districts. You are the director of a hospital and have quite some experience with an ICT solution? You are part of a district team that makes extensive use of its health information system or ICT? You work for an NGO or a startup that has developed an innovative solution? Send us (to firstname.lastname@example.org) a PowerPoint presentation of up to 15 slides presenting your experience. An expert committee will review all of them and identify the ones deserving to be widely shared. Experts with the most interesting experiences will be invited to the Cotonou workshop.