Mobilizing health district management teams through digital tools: lessons from the District.team Initiative in Benin and Guinea using an action research methodology (Preprint)
BACKGROUND Improving capacities of health systems to quickly respond to emerging health issues, requires a health information system (HIS) that facilitates evidence-informed decision-making at the operational level. In many sub-Saharan African countries, HIS are mostly designed to feed decision-making purposes at the central level with limited feedbacks and capabilities to take action from data at the operational level. OBJECTIVE This paper presents the case of an e-health innovation designed to capacitate health district management teams (HDMTs) through participatory evidence production and peer-to-peer exchange. METHODS With an action-research design, we developed District.team, a web-based and facilitated platform targeting HDMTs. On District.team, knowledge sharing processes are organized in cycles. Each cycle has fundamentally five steps: i) identification of a health issue to investigate together; ii) development of the online questionnaire by the facilitation team; iii) completion of the questionnaire by the HDMTs; iv) data analysis, production and publication of results; and v) discussion of results on the online discussion forum. This initiative was tested in Benin and Guinea from January 2016 to September 2017. The action-research methodology allowed us to progressively improve the approach. The evaluation rests on mixed methods data collection techniques including data extraction from intermediary reports, web analytics, nine focus groups and 18 semi-structured interviews of key stakeholders. Besides the documentation of the level of participation on the platform, we have collected data on the barriers and enablers affecting the participation of the district medical teams. RESULTS Participation on the platform was good. District.team improved explicit (data) and tacit (experience and exchange) knowledge exchange among HDMT members in Benin and Guinea. Five groups of factors affect participation: characteristics of the digital tools, the facilitation effort, profile of participants, shared content and data and support by the leadership from health authorities. CONCLUSIONS District.team has shown that there is room for knowledge management platforms and processes valuing horizontal knowledge sharing among peers active at the decentralized levels of health systems in poor resource settings. We recommend health authorities to promote the integration of such initiatives in existing health information system platforms.