Brennan Elliot, Abimbola Seye
Sydney School of Public Health University of Sydney Sydney New South Wales Australia.
Learn Health Syst. 2024 Aug 29;8(4):e10447. doi: 10.1002/lrh2.10447. eCollection 2024 Oct.
Processes of self-reflection and the learning they allow are crucial before, during, and after acute emergencies, including infectious disease outbreaks. Tools-such as Action Reviews-offer World Health Organization (WHO) member states a platform to enhance learning. We sought to better understand the value of these tools and how they may be further refined and better used.
We searched the publicly available WHO Strategic Partnership for Health Security website for paired reports of Action Reviews, that is, reports with a comparable follow-up report. We complemented the paired action reviews, with a literature search, including the gray literature. The paired action reviews were analyzed using the "Learning Health Systems" framework.
We identified three paired action reviews: Lassa Fever After Action Reviews (AARs) in Nigeria (2017 and 2018), COVID-19 Intra-Action Reviews (IARs) in Botswana (2020 and 2021), and COVID-19 IARs in South Sudan (2020 and 2021). Action Reviews allowed for surfacing relevant knowledge and, by engaging the right (in different contexts) actors, asking "are we doing things right?" (single loop learning) was evident in all the reports. Single loop learning is often embedded within examples of double loop learning ("are we doing the right things?"), providing a more transformative basis for policy change. Triple loop learning ("are we learning right"?) was evident in AARs, and less in IARs. The range of participants involved, the level of concentrated focus on specific issues, the duration available for follow through, and the pressures on the health system to respond influenced the type (i.e., loop) and the effectiveness of learning.
Action Reviews, by design, surface knowledge. With favorable contextual conditions, this knowledge can then be applied and lead to corrective and innovative actions to improve health system performance, and in exceptional cases, continuous learning.
自我反思过程及其所带来的学习在急性紧急情况（包括传染病爆发）之前、期间和之后都至关重要。诸如行动回顾等工具为世界卫生组织（WHO）成员国提供了一个促进学习的平台。我们试图更好地理解这些工具的价值以及如何进一步完善和更好地使用它们。
我们在WHO卫生安全战略伙伴关系的公开网站上搜索了行动回顾的配对报告，即有可比后续报告的报告。我们通过文献检索（包括灰色文献）对配对行动回顾进行补充。使用“学习型卫生系统”框架对配对行动回顾进行分析。
我们确定了三项配对行动回顾：尼日利亚的拉沙热行动后回顾（AARs）（2017年和2018年）、博茨瓦纳的新冠疫情行动中回顾（IARs）（2020年和2021年）以及南苏丹的新冠疫情IARs（2020年和2021年）。行动回顾有助于揭示相关知识，并且通过让合适的（在不同背景下）行为者参与，“我们做事是否正确？”（单环学习）在所有报告中都很明显。单环学习通常嵌入在双环学习（“我们做的事情是否正确？”）的例子中，为政策变革提供了更具变革性的基础。三环学习（“我们学习是否正确？”）在AARs中很明显，在IARs中则较少。参与的人员范围、对特定问题的集中关注程度、后续跟进的可用时间以及卫生系统应对的压力影响了学习的类型（即环）和效果。
行动回顾从设计上就能揭示知识。在有利的背景条件下，这些知识随后可以得到应用，并导致纠正和创新行动，以提高卫生系统绩效，在特殊情况下还能实现持续学习。
