Geneva Centre of Humanitarian Studies, University of Geneva, Graduate Institute, Geneva, Switzerland.
London School of Hygiene and Tropical Medicine, London, UK.
Int J Health Policy Manag. 2023;12:6073. doi: 10.34172/ijhpm.2022.6073. Epub 2023 Jan 1.
In 2014, Terre des Hommes (Tdh) together with the Ministry of Health (MoH) launched the Integrated electronic Diagnosis Approach (IeDA) intervention in two regions of Burkina Faso consisting of supplying every health centre with a digital algorithm. A realistic evaluation was conducted to understand the implementation process, the mechanisms by which the IeDA intervention lead to change.
Data collection took place between January 2016 and October 2017. Direct observation in health centres were conducted. In-depth interviews were conducted with 154 individuals including 92 healthcare workers (HCW) from health centres, 16 officers from district health authorities, 6 members of health centre management committees. In addition, 5 focus groups were organised with carers. The initial coding was based on a preliminary list of codes inspired by the middle-range theory (MRT).
Our results showed that the adoption of the electronic protocol depended on a multiplicity of management practices including role distribution, team work, problem solving approach, task monitoring, training, supervision, support and recognition. Such changes lead to reorganising the health team and redistributing roles before and during consultation, and positive atmosphere that included recognition of each team member, organisational commitment and sense of belonging. Conditions for such management changes to be effective included open dialog at all levels of the system, a minimum of resources to cover the support services and supervision and regular discussions focusing on solving problems faced by health centre teams.
This project reinforces the point that in a successful diffusion of IeDA, it is necessary to combine the introduction of technology with support and management mechanisms. It also important to highlight that managers' attitude plays a great place in the success of the intervention: open dialog and respect are crucial dimensions. This is aligned with the findings from other studies.
2014 年，Terre des Hommes（Tdh）与卫生部（MoH）合作，在布基纳法索的两个地区启动了综合电子诊断方法（IeDA）干预措施，为每个卫生中心提供一个数字算法。进行了现实评估，以了解实施过程，以及 IeDA 干预措施导致变革的机制。
数据收集于 2016 年 1 月至 2017 年 10 月进行。对卫生中心进行了直接观察。对来自卫生中心的 92 名卫生工作者（HCW）、16 名地区卫生当局官员、6 名卫生中心管理委员会成员等 154 人进行了深入访谈。此外，还组织了 5 次护理人员焦点小组。初始编码基于受中程理论（MRT）启发的初步代码列表。
我们的结果表明，电子协议的采用取决于多种管理实践，包括角色分配、团队合作、解决问题的方法、任务监测、培训、监督、支持和认可。这些变化导致重新组织卫生团队并在咨询前和咨询期间重新分配角色，以及包括认可每个团队成员、组织承诺和归属感在内的积极氛围。这种管理变革有效的条件包括在系统的各个层面进行开放对话、提供最少的资源来覆盖支持服务和监督以及定期讨论，重点解决卫生中心团队面临的问题。
该项目强调，要成功推广 IeDA，必须将技术引入与支持和管理机制相结合。还需要强调的是，管理者的态度在干预措施的成功中起着重要作用：开放对话和尊重是至关重要的维度。这与其他研究的结果一致。
