This document summarizes discussions from the first three days of a workshop on local health systems in Cotonou. It shows the various actors in a local health system and solutions reviewed to improve information flow and coordination. Two observations are that solutions scaled at the central level but lack inclusion of local actors, while point-of-care solutions grew through horizontal sharing but not scale. Key questions are how to better involve district management teams and increase connections between actors, and how to accelerate diffusion of solutions for both providers and users. An emerging framework emphasizes designing information solutions around a health system, people, context and technology to collect, analyze, share and improve data.

1. Day 3: What have we learned so far?
Cotonou, December 18 2015

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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 Clinic
Telemedicine
The solutions reviewed on days 1 & 2

8. 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

9. Central level
Local
government
Actors of
other sectors
Civil Society
Group
District
office
Hospital
Health Centre
Private
providers
Community
Health Workers
Verification
agent
Households
Djantoli
The solutions reviewed on days 1 & 2

10. Central level
Local
government
Actors of
other sectors
Civil Society
Group
District
office
Hospital
Health Centre
Private
providers
Community
Health Workers
Verification
agent
Households
mHealth India
The solutions reviewed on days 1 & 2

11. Central level
Local
government
Actors of
other sectors
Civil Society
Group
District
office
Hospital
Health Centre
Private
providers
Community
Health Workers
Verification
agent
Households
mHealth India
The solutions reviewed on days 1 & 2

12. 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)

13. Weak points
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

14. 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!

15. 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).

16. 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.

17. 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.

18. An effective information solution – an
emerging framework
• Health
System
• People
• Context
Design,
collect…
Organize,
analyse…
Decide,
act…
Share,
observe,
improve…
Technology