Realistic Evaluation of the Integrated Electronic Diagnosis Approach (IeDA) for the Management of Childhood Illnesses at Primary Health Facilities in Burkina Faso

Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.

Facilitators and barriers in the use of the electronic consultation register for Integrated Management of Childhood Illness in the health district of Toma, Burkina Faso: Perspectives of health care providers

“…Indeed, the results generally prove that ECR allows for appropriate diagnosis and proper management of patients. It is necessary to combine the introduction of technology with support and management mechanisms (Blanchet, Sanon, Sarrassat, & Satouro Somé, 2023). This finding aligns with and reinforces the findings of Divall et al (2013).…”

“…For the latter, “Overall, healthcare professionals described using portable electronic devices, or personal digital assistants (PDAs) as a positive experience.” The added value of using PDAs is that they offer easy and quick access to health workers compared to paper-based devices, which are heavy and not easy to use. It is also important to highlight that managers’ attitudes play a great role in the success of the intervention: open dialogue and respect are crucial dimensions (Blanchet et al, 2023). Thus, the fact that health workers go through pages of paper protocols to obtain information, use several tables and guidelines and search for correct treatment doses made compliance with care protocols more complex.…”

“…IeDA is a telehealth solution for reducing child mortality through digitalizing medical protocols, improving quality, enhancing data use, and continuously training agents. It also relies on the Electronic Consultation Record (ECR) (Blanchet, Sanon, Sarrassat, & Somé, 2022). This software guides health professionals throughout the consultation process based on the IMCI by recording achievements and rating the adherence of healthcare providers (HCPs).…”

“…It was then deployed in the health district of Toma in 2020 to be used by healthcare providers (HCPs) in the Health and Social Promotion Centers (HSPCs). After a few years of implementing the IeDA, a realistic evaluation was conducted to describe the project effects and users’ perceptions and analyze factors that influenced the implementation (Blanchet et al, 2022). However, no study has explored the barriers and facilitators that HCPs encounter in adopting and using this new tool.…”

Perceived Benefits and Disadvantages Associated with the Use of the Electronic Consultation Register by Health Providers in the Health District of Toma, Burkina Faso

“…This project was implemented in 2014 and aimed to reduce morbidity and mortality in children under five by digitalizing the integrated management of childhood illness (IMCI) protocol. [ 13 ] In part of this project, TDH and the MoH have developed applications that include an ECR for maternity. This ECR is a decision support tool for maternal and neonatal care that consists of an application for collecting data during consultations of children over five years of age and stock management for the health facility drug depot.…”