Research Section, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
Centre d'Excellence d'Afrique pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Conakry, Guinea.
BMJ Glob Health. 2023 Feb;8(2). doi: 10.1136/bmjgh-2022-010996.
Learning 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.
We 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.
The 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.
Our 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.
学习是弹性卫生系统的关键属性，因此是加强卫生系统的核心。本研究的主要目的是分析几内亚的卫生系统如何从 2014 年至 2021 年期间的疫情应对中吸取教训。
我们采用回顾性纵向单嵌入式案例研究设计，应用谢赫和阿比博拉为分析学习卫生系统而提出的框架。数据收集采用 2022 年 3 月进行的混合方法系统评价和 2022 年 4 月进行的在线调查。
证据综合中包含的 70 份报告涉及 2014-2016 年埃博拉病毒病（EVD）、麻疹、拉萨热、COVID-19、2021 年 EVD 和马尔堡病毒病。主要经验教训来自 2014 年至 2016 年 EVD，包括：早期在应对措施中让社区参与、社会动员、优先投资卫生人员、早期让人类学家参与、发展卫生基础设施和设备以及确保危机沟通。这些经验是通过信息（研究和专家意见）、行动/实践以及双重循环获得的，并通过审议、单循环、双重循环和三重循环学习逐步纳入对未来疫情的应对中。然而，先进的学习方面（通过行动、双重循环和三重循环学习）在卫生系统内受到限制。尽管如此，卫生系统还是成功控制了 COVID-19、2021 年 EVD 和马尔堡病毒病。调查受访者普遍报告，促进因素是国家卫生安全机构的建立和发展伙伴的支持。障碍包括文化和政治问题以及缺乏资金。共同建议包括在卫生部内设立一个知识管理单位，在区域和地区各级都有代表，投资于人力能力，并改善治理和管理系统。
本研究强调了学习的重要性。随着学习的发生，卫生系统表现良好，随着时间的推移，疫情应对取得了令人鼓舞和更好的结果。
