1.4 Case examples of learning levels in practice
Individual and team learning – Benin and Guinea
- identification of a health issue or challenge to investigate;
- development of the tailored online tool of enquiry (survey questionnaire);
- completion of the questionnaire by HDMTs (Health District Management Teams);
- analysis, visualization and publication of the results on a custom-made web platform; and
- online discussion of results (on the same web platform) and synthesis of lessons learned.
By being able to see their data and also share examples with each other, individual managers were able to more quickly and easily see strengths and weaknesses in their own districts. Based on this understanding, it was then possible to focus on strategies to address the weaknesses and draw on experiences from their peers. Email, SMS, and phone calls all enabled managers to participate in each step and also sent reminders. The district managers felt that the engagement with peers was critical to improve their own practice.
District.Team was utilized not only at the district manager level, but also at national health systems levels. The dedicated online platform and facilitation team helps to support online engagement and user support.
To read more about this case example, see page 79 of the Learning Health Systems report.
Organization and cross-organizational learning – Burkina Faso
Burkina Faso has been working on cross-organizational learning to support their national Gratuité policy, which aims to provide free health care for children under five and women in public sector facilities since 2016. Similar initiatives had been tried previously but had been plagued by delays in payments sometimes of over a year. These previous challenges had hampered the work of these facilities, reduced the personal income of health workers, and therefore reduced quality of care.
The new structure was led by the government and international NGOs that established district health management teams and was carefully designed through getting input and deliberating with key stakeholders. This included many workshops with the technical and finance units of the Ministry of Health. NGOs participating in the meetings also undertook a pilot test of the model and provided regular updates on the experience. Former district health managers who now held policy-maker positions drew upon their own experience and discussed the reasons for previous challenges and potential ways to prevent them from happening again. Importantly, the government considered making up the financial shortfalls that clinics had been facing and to ensure that payments were received ahead of expenditure and adapted on a quarterly basis based on historical consumption of the facility. The Ministry of Finance was skeptical about this mechanism as it did not align with the current public financial management procedures. However, after several working sessions, an agreement was reached. The solution was based on prior experience and recognition by all stakeholders about how this model aimed to address historical challenges. The process of negotiating this plan helped institutionalize a process to deliberate and work to identify policy solutions to problems that could avoid previous mistakes and benefit the egalitarian agenda of user-fee removal.
To read more about this case example, see page 82 of the Learning Health Systems report.