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"Towards a learning system : the District.Team experience" - Kéfilath Bello

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Workshop "Learning for UHC"

Publié dans : Santé
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"Towards a learning system : the District.Team experience" - Kéfilath Bello

  1. 1. Setting a learning organization Lessons learnt from District.Team Bénin Kéfilath Bello, Basile Keugoung, Jean-Paul Dossou, Bruno Meessen
  2. 2. Health Districts Management Teams (HDMTs) Several challenges HDMTs need to quickly adapt and respond 2 Becoming a learning organization ? (Dakar conference, 2013)
  3. 3. However… 3
  4. 4. 4
  5. 5. Proposition of District.Team 5 • Mobilize DHMTs for better response • Facilitate problem identification • Foster experience sharing • Support for collective formulation of contextually adapted solutions • Pilot phase: January 2016 to July 2017
  6. 6. A cycle with five steps • Health district characteristics • Human resources • Performance based financing • Epidemiologic surveillance • Maternal deaths Surveillance and response 6 Facilitation
  7. 7. 7
  8. 8. Various levels of participation of HDMTs 8
  9. 9. Action research • Routine data collection • Check-lists • Dashboards • Informal discussions with stakeholders • Final evaluation • In-depth interviews • Focus group discussion • Analysis • Automatic analysis + Excel (quantitative) • Content analysis (qualitative) • Triangulation 9
  10. 10. Mainly District Medical officers 10 District Medical Officers 23 Technical assistants (PBF) 8 Others members HDMTs 6 Participants for regional Directorates 3 Other participants 3 Total number of participants 43
  11. 11. Added value for individuals 11 Improved knowledge and skills « ... The opinion of the experts helped us. And the opinion of others on something you posted (on District.Team) allows you to know if what you are saying is correct » « The questionnaire on epidemiological surveillance made us realized the weaknesses of our preparedness so that we could adress them District Medical officers
  12. 12. Added value for organizations 12 « ... The cycle on Maternal Death Surveillance and Response raised my attention and push me to attend the maternal death reviews myself » « District.Team permit to compare ourselves to other health districts…It is a crucible to make our health District well known» District Medical officers Alert Visibility and benchmarking
  13. 13. Added value for organizations 13 Improved interaction and knowledge sharing « ... District.Team improved our communication with our colleagues from the neighbourhood districts » « District.Team facilitated exchanges including offline. For instance, a colleague shared an experience regarding the repartition of PBF subsidies. I called him to know better on his initiative. » District Medical officers
  14. 14. Lessons learnt: five key elements for success 14 Digital tools Facilitation Participants Content & data management Leadership from legitimate authorities
  15. 15. Digitalization of interactions • Saved time • Little absenteism • reduced costs • Improved transparency But • Need to build trust (face to face…) • Digital can be non accessible (passeword !) 15
  16. 16. Facilitation is key for learning • Various approaches for mobilization • Enough time to interact with participants • Facilitation skills • Experts contributions • Regular synthesis needed 16
  17. 17. Participants • Involve participants in the choice of topicsInterest • Internet, computer • Knowledge of the topic Capacities • Align activities with their routine work Perceived usefulness • Shouldn’t put additional workload for themAvailability 17
  18. 18. Content & data management • Starts with data (routinely or actively collected) • Powerful and meaningful visualizations • Benchmarking • Collective identification of gaps and potential solutions • Clear and practical output needed for impact • Cycle 1, 2 and 4: no output • Cycle 3 (PBF): recommendations at national level • Cycle 5: contribution to the national plan on MDSR 18
  19. 19. Leadership Power dynamics and hierarchical culture were overlooked Very little effect on the health system 19 • Bottom-up approach and peer-support privileged • But hierarchical lines strongly felt • Little support from national level regarding • Non integration in routine management District.Team was not a priority • Reticence to make change • All stakeholders not properly engaged
  20. 20. 20 «What was lacking was the participation of the central level; if my hierarchy is not interested in this project, why should I do? » «I am on the platform, but I’ve never participated to the discussions because I saw that there were only DMO that talk there. It is bosses’ discussions «We use our free time to participate to District.team » Medical doctor, member of HDMT District Medical Officer District Medical Officer
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