Health systems are complex and extend beyond health care services, including multiple functions that provide mutual support for each other and adapt in response to their environment. Learning is essential for health systems performance. It occurs at all levels of health systems and involves the generation and acquisition, sharing of knowledge and changing behaviours based on new findings.
The Alliance for Health Policy and Systems Research drew attention to the importance of this approach with the publication of its flagship report “Learning health systems: pathways to progress” in September 2021. Now, a new special issue of BMJ Global Health on learning health systems builds on the momentum from the report and deepens understanding of how to create learning health systems in practice.
In an editorial introducing the special issue, Kabir Sheikh, Policy Advisor at the Alliance, and colleagues suggest that the learning process is more than information transfer. Dialogue, debate and reflection are necessary to contextualize problems, anticipate, prevent and solve them collectively. Action and deliberation are important in the learning process, they write.
“Learning is a route to progress and empowerment for health systems—particularly those in LMICs—by developing the inbuilt ability to generate and use the knowledge and skills they need for their constant improvement and performance.”
Indeed, in an article from Sophie Wittier from the Institute of Global Health and Development & ReBUILD Consortium at the University of Queen Margaret Edinburgh and colleagues, they suggest that: “Health systems are knowledge producers, but learning is not automatic. It needs to be valued and facilitated.” In this study, researchers conducted a literature review and interviews with key health systems actors and found that learning health systems in LMICs are enabled by eight domains: leadership, organizational culture, organizational design, resources and incentives, external linkages, health information systems and data use, competencies and mind-sets and institutional processes. Addressing these domains is key to learning health systems. These eight domains mutually intersect, reinforce and require favourable contextual conditions for their sustainability and development.
This supplement includes three practice articles so far. The first one covers deliberations organized by the China Health Development Research Center to improve neonatal care in the country, bringing together national and subnational managers. The second article draws on Nigeria’s learning experience from Lassa fever and COVID-19 outbreaks, highlighting the key roles that commitment and investment play in learning and adapting public health responses. Finally, the third article shares Barbados’ learning experience during the co-creation of a dengue early warning system, discussing barriers to its implementation and the need for a multidisciplinary and collaborative work between the climate and health sectors.
Editorial:
Original research:
In practice:
- Deliberation-based learning: strengthening neonatal care in China
- Adapting public health response through lessons learnt: Nigeria’s experience from Lassa fever and COVID-19
- Co-learning during the co-creation of a dengue early warning system for the health sector in Barbados