Knowledge Management Plays a Critical Role in Fostering Country Ownership of Digital Health
By K4Health’s Digital Health team*
The Knowledge for Health (K4Health) Project’s Digital Health team has one goal: To bring together health program managers and service providers to use family planning and global health knowledge to build stronger health systems so that people can live healthier lives.
The K4Health Digital Health team implements cutting-edge digital health projects at the global and country level. As a driving member of the global digital health community, we contribute to vibrant conversations and listen to our colleagues’ experiences. We’ve learned a lot about what’s essential in country ownership of digital health programming, and we believe knowledge management is fundamental.
Knowledge Management makes program challenges easier to tackle.
No one is surprised when digital health projects take longer than expected. Funding delays, competing priorities, limited availability of stakeholders, and governance procedures regularly thwart time tables. These delays can take weeks or even months, and, as time passes, the risk of losing the project’s institutional knowledge grows. This is especially critical given the constant evolution of digital health projects as the field rapidly iterates, grows, and changes with technology enhancements.
K4Health recently worked on a project to improve knowledge-sharing and peer support among health care providers in Tanzania by connecting them to each other via mobile phones. The idea and buy-in for the project was all established through sensitization and relationship building among key stakeholders at the Ministry of Health, a local mobile network operator, and an international NGO. However, no one was documenting the discussions among these key partners or sharing the essential insights each partner brought to the table. Then, before the project had really gotten off the ground, the partners experienced unexpected staff turnover, and the project implementation team added new staff.
The challenges of bringing a new team up to speed shed light on the need for better documentation, organization, and sharing of information. The early conversations and decisions made among the key partners were crucial for the ongoing development of the program in Tanzania, yet that critical information vanished as key staff members turned over.
The project in Tanzania is doing well today. The team now uses Google Docs to record and share notes from all meetings and uses Facebook to share information with external stakeholders.
Knowledge management can foster country ownership — a critical ingredient for sustainable development.
InterAction, an alliance of global development organizations, defines country ownership as “the full and effective participation of a country’s population via legislative bodies, civil society, the private sector, and local, regional and national government in conceptualizing, implementing, monitoring and evaluating development policies, programs and processes.”
While country ownership applies broadly to national-level development, it is applicable across all sectors (health, education, agriculture). Country ownership is critical not only to macro-level economic development and poverty reduction, but also to the strengthening of health systems and related services. Digital health, using information and communication technology to strengthen those systems, can help countries achieve their public health goals.
However, full and effective participation for country ownership requires certain capacity, knowledge and skills, of key stakeholders.
Knowledge management can ensure that people have the ability — the knowledge and resources — to perform their jobs effectively.
In the context of country ownership, that “job” is participation in developing, implementing, tracking, and evaluating the country’s policies, programs, and processes. Knowledge management provides both formal and informal learning and sharing opportunities and ensures access to relevant information and tools.
Knowledge management can play a critical role in fostering country ownership of digital health in a number of ways:
- It can facilitate the development of robust and comprehensive national digital health strategies and related policies.
- It can support the building and strengthening of digital health knowledge and skills among the individuals and organizations involved in implementing strategic plans, from government staff to health program managers to frontline health workers to community members.
- It can ensure that digital health efforts are evaluated appropriately and that lessons learned are shared to guide investment and promote future successes.
These activities and the people carrying them out are the building blocks of country ownership of digital health.
Digital health, country ownership, and knowledge management intersect in Senegal.
When it comes to the use of digital technology in health, Senegal resembles other low- and middle-income countries around the world. Many different people are doing many cool things using technology without necessarily talking to each other, coordinating, or building on existing systems. So, while each initiative may see interesting results, the impact is often limited to a small number of people. Limited coordination or collaboration across initiatives means limited awareness of successes, even among government stakeholders.
In early 2015, K4Health began providing technical assistance and support to the Government of Senegal, specifically to the Ministry of Health and Social Action (MSAS), to develop their first National eHealth Strategy. The strategy will help the government better coordinate ongoing and future digital eHealth initiatives in the country and ensure that those initiatives are aligned to the country’s health goals and objectives. Knowledge management is essential to this process.
Three of our activities illustrate how knowledge management built country engagement and supported the development of the national eHealth strategy.
- The first activity was a desk review and landscape analysis that we conducted at the beginning of the process in Senegal. We opted to seek out, synthesize, and share knowledge from other countries about how they developed their own eHealth strategies and governance mechanisms. We reviewed strategies for similarities in content, and we interviewed individuals involved in developing those strategies about their challenges, successes, and lessons learned. We conducted interviews with a range of stakeholders in Senegal — from government, civil society, NGOs, private sector, and donors — to find out what challenges they face related to digital health, what they wanted to see in a national strategy, and what recommendations they had for ongoing coordination and knowledge sharing. These sources of information illuminated the next steps in the strategy development process.
- The second activity was the creation of a working group collectively charged with guiding and overseeing the process of developing the strategy. It sounds simple enough, but you would be surprised at how many national strategies are actually developed by one or two people sitting in a room in front of a computer. In this case, a group that oscillated in size from 6 to 25 people met regularly over five months to decide on the content of the strategy. They relied in large part on the information gleaned through the desk review and landscape analysis. The value of the working group for ongoing knowledge exchange and dialogue was clear; it formed the basis for the future governance structure.
- The last activity was the creation of a registry to collect and centralize basic information about existing eHealth initiatives in the country. K4Health interviewed individuals involved in implementing eHealth initiatives in Senegal and then filed the results into a simple Google Sheet. The spreadsheet includes information on the health area of the initiative, the technologies involved (smartphone, tablet, server), the type of application (health information/data collection, logistics management, workforce training/support), the geographic implementation area, the number of beneficiaries, and any available data or results. The registry offers the government not only an opportunity to keep tabs on what is going on in the country (including ongoing additions to the catalog via a Google form), but to make strategic decisions about how to combine initiatives, where to allocate resources, and what to scale.
With a strategy in-hand, a registry launched, and a working group at the ready, the Government of Senegal is well positioned to lead and guide digital health initiatives in the country.
The Digital Heath arena can be chaotic and loud — a cacophony of voices from many backgrounds and areas of expertise. Knowledge management methods and tools can provide the knowledge needed to design savvy digital health strategies, organize a vision and mission into actionable steps, clarify roles and responsibilities of the diverse community of key stakeholders, and ensure regular progress is made and desired outcomes are achieved. Knowledge management can create channels for every partner to contribute to a joint effort. When knowledge management is used effectively, stakeholders benefit, and initiatives thrive, from clearer communication, transparency, and trust.
*Written by K4Health’s Digital Health team, which includes James BonTempo, Heidi Good Boncana, Nandini Jayarajan, Amanda Puckett BenDor, Lisa Mwaikambo, Trinity Zan, Dave Potenziani, Willow Gerber, and Cassie Mickish Gross.
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The Exchange is a K4Health publication. The Knowledge for Health (K4Health) Project is supported by the United States Agency for International Development (USAID) Office of Population and Reproductive Health, Bureau for Global Health, under Cooperative Agreement #AID-OAA-A-13–00068 with the Johns Hopkins University.
The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the U.S. Government.