Learning is a means to progress and empowerment for health systems

Sheikh, Kabir; Peters, David H.; Agyepong, Irène Akua; Abimbola, Seye; Ghaffar, Abdul; Swaminathan, Soumya

doi:10.1136/bmjgh-2022-010572

Cited by 13 publications

(13 citation statements)

References 37 publications

(62 reference statements)

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“…Sheikh et al 24 argue that ‘learning is crucial for the performance of health systems and the achievement of broader health goals’ and that learning is more than information collecting and transfer. Action and deliberation are important—as is acknowledging what has gone wrong and correcting it.…”

Section: Discussionmentioning

confidence: 99%

Increased utilisation and quality: a focus on inequality and a learning health system approach—explaining Nepal’s success in reducing maternal and newborn mortality 2000–2020

Sharma,

Campbell,

Oswald

et al. 2024

BMJ Glob Health

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IntroductionMaternal mortality in Nepal dropped from 553 to 186 per 100 000 live births during 2000–2017 (66% decline). Neonatal mortality dropped from 40 to 21 per 1000 live births during 2000–2018 (48% decline). Stillbirths dropped from 28 to 18 per 1000 births during 2000–2019 (34% decline). Nepal outperformed other countries in these mortality improvements when adjusted for economic growth, making Nepal a ‘success’. Our study describes mechanisms which contributed to these achievements.MethodsA mixed-method case study was used to identify drivers of mortality decline. Methods used included a literature review, key-informant interviews, focus-group discussions, secondary analysis of datasets, and validation workshops.ResultsDespite geographical challenges and periods of political instability, Nepal massively increased the percentage of women delivering in health facilities with skilled birth attendance between 2000 and 2019. Although challenges remain, there was also evidence in improved quality and equity-of-access to antenatal care and childbirth services. The study found policymaking and implementation processes were adaptive, evidence-informed, made use of data and research, and involved participants inside and outside government. There was a consistent focus on reducing inequalities.ConclusionPolicies and programmes Nepal implemented between 2000 and 2020 to improve maternal and newborn health outcomes were not unique. In this paper, we argue that Nepal was able to move rapidly from stage 2 to stage 3 in the mortality transition framework not because of what they did, but how they did it. Despite its achievements, Nepal still faces many challenges in ensuring equal access to quality-care for all women and newborns.

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Section: Discussionmentioning

confidence: 99%

Increased utilisation and quality: a focus on inequality and a learning health system approach—explaining Nepal’s success in reducing maternal and newborn mortality 2000–2020

Sharma,

Campbell,

Oswald

et al. 2024

BMJ Glob Health

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“…An LHS can lead to more informed, critical and corrective practices and routines, resulting in improved performance of the health system’s functions, increased adaptivity and innovation and greater self-reliance. 10 20 The following examples illustrated some benefits of LHS connected with outbreak response—Several Asian countries, for example, South Korea, Singapore, Taiwan, Hong Kong, Saudi Arabia, Cambodia and Vietnam have speedily controlled COVID-19 based on learning from previous outbreaks of Middle East respiratory syndrome and/or severe acute respiratory syndrome 23–30 —In Barbados , a learning collaboration between the Ministry of Health (MoH) and researchers was instrumental in developing a climate-sensitive and epidemiology-sensitive warning system for future dengue outbreaks 31 —In Georgia , an evidence synthesis from the experiences of the earlier-mentioned Asian countries in the successful response to COVID-19 helped health authorities to identify a set of measures for an effective response (achievement of intended goals) to this outbreak. 32 In Nigeria , the establishment of vital new learning processes for outbreak control drawn on the experience from the response to Lassa fever enabled the health system to strengthen its capacity to produce the knowledge needed to tackle future outbreaks.…”

Section: Introductionmentioning

confidence: 99%

“…Referring to Garvin’s definition of a learning organisation,7 a learning health system (LHS) can be defined as a health system skilled at creating, acquiring, interpreting, transferring and retaining knowledge, and at purposefully modifying its behaviour to reflect new knowledge and insights. Over the past decade, there has been a growing interest in LHS 8–22. An LHS builds on the recognition that health systems are complex, adaptive and social institutions that dynamically respond and adapt to changing needs and contexts, and it also potentially has a long-term orientation towards change and transformation that goes beyond resilience 20.…”

Section: Introductionmentioning

confidence: 99%

How has Guinea learnt from the response to outbreaks? A learning health system analysis

et al. 2023

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IntroductionLearning is a key attribute of a resilient health system and, therefore, is central to health system strengthening. The main objective of this study was to analyse how Guinea’s health system has learnt from the response to outbreaks between 2014 and 2021.MethodsWe used a retrospective longitudinal single embedded case study design, applying the framework conceptualised by Sheikh and Abimbola for analysing learning health systems. Data were collected employing a mixed methods systematic review carried out in March 2022 and an online survey conducted in April 2022.ResultsThe 70 reports included in the evidence synthesis were about the 2014–2016 Ebola virus disease (EVD), Measles, Lassa Fever, COVID-19, 2021 EVD and Marburg virus disease. The main lessons were from 2014 to 2016 EVD and included: early community engagement in the response, social mobilisation, prioritising investment in health personnel, early involvement of anthropologists, developing health infrastructure and equipment and ensuring crisis communication. They were learnt through information (research and experts’ opinions), action/practice and double-loop and were progressively incorporated in the response to future outbreaks through deliberation, single-loop, double-loop and triple-loop learning. However, advanced learning aspects (learning through action, double-loop and triple-loop) were limited within the health system. Nevertheless, the health system successfully controlled COVID-19, the 2021 EVD and Marburg virus disease. Survey respondents’ commonly reported that enablers were the creation of the national agency for health security and support from development partners. Barriers included cultural and political issues and lack of funding. Common recommendations included establishing a knowledge management unit within the Ministry of Health with representatives at regional and district levels, investing in human capacities and improving the governance and management system.ConclusionOur study highlights the importance of learning. The health system performed well and achieved encouraging and better outbreak response outcomes over time with learning that occurred.

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“…In K2P, knowledge generated through evaluation is utilized to select areas for improvement, identify change indicators to be monitored, and specify appropriate actions to improve outcomes, and in P2D, the data harvesting and learning cycle begins anew. The essential function of evaluation within LHS is that it catalyzes the ability of health systems to learn from improvement efforts, supporting a trajectory of improvement (11,12).…”

Section: Introductionmentioning

confidence: 99%

Exploring the Impact of Evaluation on Learning and Health Innovation Sustainability: Protocol for a Realist Synthesis

Bird,

Côté-Boileau,

Wodchis

et al. 2023

Preprint

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Background Within the Learning Health System (LHS) model, learning routines, including evaluation, allow for continuous incremental change to take place. Within these learning routines, evaluation assists in problem identification, data collection, and data transformation into contextualized information, which is then re-applied to the LHS environment. Evaluation that catalyzes learning and improvement may also contribute to health innovation sustainability. However, there is little consensus as to why certain evaluations seem to support learning and sustainability, while others impede it. This realist synthesis seeks to understand the contextual factors and underlying mechanisms or drivers that best support health systems learning and sustainable innovation. Methods This synthesis will be guided by Pawson and colleagues’ 2005 and Emmel and colleagues’ 2018 guidelines for conducting realist syntheses. The review process will encompass five steps: 1. Scoping the Review, 2. Building Theories, 3. Identifying the Evidence, 4. Evidence Selection and Appraisal, and 5. Data Extraction and Synthesis. An Expert Committee comprised of leaders in evaluation, innovation, sustainability, and realist methodology will guide this synthesis. Review findings will be reported using the RAMESES guidelines. Discussion The use of a realist review will allow for exploration and theorizing about the contextual factors and underlying mechanisms that make evaluations ‘work’ (or ‘not work’) to support learning and sustainability. Depending on results, we will attempt to synthesize findings into a series of recommendations for evaluations with the intention to support health systems learning and sustainability. Finalized results will be presented at national and international conferences, as well as disseminated via a peer-reviewed publication. Systematic review registration : This realist synthesis protocol has been registered with PROSPERO (https://www.crd.york.ac.uk/prospero/ ID 382690)

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Learning is a means to progress and empowerment for health systems

Cited by 13 publications

References 37 publications

Increased utilisation and quality: a focus on inequality and a learning health system approach—explaining Nepal’s success in reducing maternal and newborn mortality 2000–2020

Increased utilisation and quality: a focus on inequality and a learning health system approach—explaining Nepal’s success in reducing maternal and newborn mortality 2000–2020

How has Guinea learnt from the response to outbreaks? A learning health system analysis

Exploring the Impact of Evaluation on Learning and Health Innovation Sustainability: Protocol for a Realist Synthesis

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