Day 3: What have we learned so far?

Cotonou, December 18 2015

Local health system: the dominant view

Central level

Local government

Actors of other sectors

Civil Society Group

District office

Hospital

Health Centre

Private providers

Community Health Workers

Verification agent

Households

What it is actually Central

level

Local government

Actors of other sectors

Civil Society Group

District office

Hospital

Health Centre

Private providers

Community Health

Workers

Verification agent

Households Community groups

Collectively intelligent local health system

Central level

Local government

Actors of other sectors

Civil Society Group

District office

Hospital

Health Centre

Private providers

Community Health

Workers

Verification agent

Households Community groups

The solutions reviewed on days 1 & 2

Central level

Local government

Actors of other sectors

Civil Society Group

District office

Hospital

Health Centre

Private providers

Community Health Workers

Verification agent

Households

DHIS2

The solutions reviewed on days 1 & 2

Central level

Local government

Actors of other sectors

Civil Society Group

District office

Hospital

Health Centre

Private providers

Community Health

Workers

Verification agent

Households Community groups

Open RBF

Central level

Local government

Actors of other sectors

Civil Society Group

District office

Hospital

Health Centre

Private providers

Community Health Workers

Verification agent

Households

Open ClinicTelemedicine

The solutions reviewed on days 1 & 2

Central level

Local government

Actors of other sectors

Civil Society Group

District office

Hospital

Health Centre

Private providers

Community Health Workers

Verification agent

Households

DataSanté

The solutions reviewed on days 1 & 2

Central level

Local governmentActors of other

sectors Civil Society Group

District officeHospital

Health Centre

Private providersCommunity Health

Workers

Verification agent

Households

Djantoli

The solutions reviewed on days 1 & 2

Central level

Local governmentActors of other

sectors Civil Society Group

District officeHospital

Health Centre

Private providersCommunity Health

Workers

Verification agent

Households

mHealth India

The solutions reviewed on days 1 & 2

Central level

Local governmentActors of other

sectors Civil Society Group

District officeHospital

Health Centre

Private providersCommunity Health

Workers

Verification agent

Households

mHealth India

The solutions reviewed on days 1 & 2

Collectively intelligent LHS: 3 principles?

1. Information and processes should empower LHS actors in their specific role

2. Information and processes enhances connections between actors, both within the LHS and with key actors outside the LHS

3. Information and processes empower actors in charge of the coordination of the LHS (including in the management of tensions and conflicts)

Weak points

Central level

Local governmentActors of other

sectors Civil Society Group

District officeHospital

Health Centre

Private providersCommunity Health

Workers

Verification agent

Households Community groups

The empty hamburger

A lot of attention at the top

Growing attention at the bottom

Not enough attention to the middle and the many ingredients that make the system effective!

Two emerging observations on ICT solutions

1. Solutions going to scale are those developed first for the needs of the central level. Main limit: They are not inclusive enough for LHS actors.

2. Solutions empowering health providers are those first developed for their specific needs. Main limit: none has scaled up (not inclusive enough of the central and district levels?). Yet, some are growing by horizontal diffusion (ex. Open Clinic).

An observation on actors

• Those in local coordination position (mainly DMT, local governments) are under-using data.– Too many district teams are still under-achieving

their 1987 mission (coordinate public & assimilated health facilities).

– Even fewer are using data to steer other providers (2013 pluralistic vision).

– Local governments are out-of-the info loop.

Key questions

• How to involve DMT (dashboards and beyond) and increase connections between LHS actors?

• How to accelerate the diffusion / the scale up of solutions for: health providers (‘point of care’) and users.

An effective information solution – an emerging framework

• Context

• Health System• People

Design, collect…

Organize, analyse…

Decide, act…Share,

observe, improve…

Technology