Abstract
Many health professionals and policymakers in Africa lack access to the information needed to make evidence-based decisions for effective health care. This study collected qualitative data from 75 key informants and members of two focus groups in Senegal on various aspects of health information needs, particularly in family planning and reproductive health, including information sources, strategies, and systems to transfer and share information; and barriers to accessing, sharing, and using health information. Respondents reported needing information on ways to motivate men's involvement in reproductive health and to address rumors and religious barriers to family planning. Results identified mobile phones as one scalable platform to improve health knowledge. Nevertheless, a nearly universal and persistent need for paper-based information exists, and many health personnel prefer interpersonal communication as a method for information sharing, knowledge synthesis, and learning. Hierarchy and social organization play a crucial role in the flow of communication and in knowledge exchange. The study also identified the importance of political support for a comprehensive knowledge management strategy for the health sector, including the need for strategies to empower and better support the knowledge role of health coordinators and supervisors.
Access to health information in developing countries is key not only for designing sound health programs at the national level but also for implementing quality services at the facility and health post level. Yet many health professionals and health policymakers in Africa lack access to the information needed to make evidence-based decisions and provide effective health care (Pakenham-Walsh & Bukachi, Citation2009). Despite increased Internet connectivity and the ubiquity of mobile phone subscriptions in sub-Saharan Africa, the region suffers from “information poverty” (Gebremichael & Jackson, Citation2006). Frontline health care providers cite poor availability of current health information that is context-specific and that supports patient care. At the district level, many providers lack reliable monitoring and supervision data. Provincial-level managers often cannot access current data for program planning and evaluation, and national-level policymakers lack timely, relevant data upon which to base decision making (Kols, Citation2009).
To inform its global activities, the Knowledge for Health (K4Health) project based at The Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (Citation2011) aimed to better understand information access and use at the national, sub-national, facility, and district levels. As part of the K4Health project, we were interested in learning more about health information needs and use in Senegal, a country with significant influence among other Francophone countries in the subregion.
To understand the information environment on family planning and reproductive health (FP/RH) and broader health issues in Senegal, we searched several databases (Library and Information Science Abstracts; Library Literature and Information Science; Association for Computing Machinery Digital Library; and PubMed) for literature published since 1990 on health information needs and use in Senegal—including use of information and communication technologies. The only relevant study we found that was specific to Senegal focused on health information officers at the Ministry of Health level (Allen, Ouedraogo, & McCullough, Citation2010).
To address this knowledge gap, we conducted a needs assessment among a broad range of health professionals and decision makers in urban and periurban areas of the country. The Senegal needs assessment, part of a multicountry research effort by the K4Health project (The Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, 2011), sought to document current systems and resources for managing and sharing health information; analyze the use of FP/RH information by health professionals, communicators, policymakers, and professional networks; identify obstacles to information sharing; and identify perceived needs and recommendations for strengthening knowledge management systems. The results from this study are intended to inform national efforts to strengthen access to and use of health information in Senegal.
Method
The research team included members of FHI 360, the Measure, Learning and Evaluation Project, and Centre de Formation et de Recherche en Santé de la Reproduction. We used a qualitative methodology consisting of individual key informant interviews and focus group discussions with health stakeholders in three regions of Senegal—Dakar, Kaolack, and St. Louis—that included urban and periurban areas.
The team determined the sample size and developed a list of potential respondents.
Study respondents included ministries and other governmental agencies involved in health, development partners, nongovernmental organizations, parliamentarians, public and private health service providers, community health workers, local elected officials, civil servants involved in territorial administration, news media (print and broadcast), traditional communicators, and professional networks and associations.
We selected the Dakar region because it encompasses three health districts (Pikine District, Mbao District, and North Dakar District) and because it is home to the decision-making centers of national and multinational state and nonstate entities. Two thirds of the interviews were conducted in the Dakar region. The Kaolack region (Kasnack District), located at a crossroads between northern and southern Senegal and between coastal and eastern parts of the country, features health facilities at different levels of the health system as well as training units for paramedical staff. The St. Louis region (St. Louis District) has health organizations at the municipal and regional level with different areas of focus, and they receive support from a wide variety of technical and financial partners, including the U.S. Agency for International Development and other development agencies.
Data Collection Instruments
We adapted three qualitative data collection instruments developed by the K4Health project. The first was a key informant interview guide to interview various stakeholders involved in the management of health information. It focused on use of family planning by clients; the demand for information on topics related to family planning; use of health information for decision making, research, and information sharing; barriers to accessing, sharing, and using health information; professional networks; communication technologies and tools; and preferences for information dissemination channels and formats. We also used a network stakeholder guide to interview the heads of local professional networks active in health. It collected general information about networks and their activities, as well as information on communication and knowledge sharing within networks. To lead focus group discussions with community health workers, we used a third instrument, a focus group discussion guide comprising the same questions raised in the key informant interview guide.
Data Collection
Three qualitative research specialists were trained on the data collection instruments, which were pretested and validated. Data collection took place from February 11, 2010, to April 8, 2010. First, the entire team collected data in the Dakar region, where two-thirds of the potential respondents were located. One data collector subsequently traveled to the Kaolack region and another to the St. Louis region. The lead investigator also conducted a second phase of data collection in Dakar with stakeholders at the central level who had not been available initially. The data collectors took handwritten notes of the key informant interviews and focus group discussions, and tape-recorded most, but not all, of these sessions. They obtained written consent from all respondents to record interviews.
Data Analysis
The research team analyzed data from a literature review, interviews, and focus group discussions by theme. We conducted content analysis of the data manually, by sorting and organizing information according to thematic similarities and differences. Then, the lead investigator categorized and studied the information to understand relationships in the overall context of the research.
Data analysis took into account: the level of the health system in which the interviewees worked; sources of information; health information needs, especially related to FP/RH; information channels, including the strategies, systems, and technologies used to store, transfer, and share information; preferences for knowledge exchange approaches; the types and frequency of formal and informal communication between different levels of the health care system; barriers to accessing, sharing, and using health information; and examples of health information programs and services that had, or had not, worked well in the past.
Results
Table summarizes the number of individuals interviewed in each audience category and the number of focus group discussions conducted. In total, we conducted 75 of the planned 86 key informant interviews and two focus group discussions with community health workers.
Table 1. Number of interviews and focus groups conducted, by study site
Health Information Needs, Especially for Family Planning
The needs of different groups were quite varied, depending on the type of respondent (see Table ). Program managers required impact indicators, evidence-based information, and research results that would allow for better planning and programming. Best practices in management and prevention services (family planning, infant immunizations, prenatal care, prevention of mother-to-child transmission of HIV, and prevention of problem pregnancies) were in high demand. Managers particularly wanted service statistics to help them understand, compare, and address outcomes better at the facility level.
Table 2. Health information needs among different audience groups
It would be interesting to know what explains why some health facilities are better attended than others. Is this related to the health facility itself? Staff behavior? Maybe there are other apprehensions, other perceptions in the population, and we do not know.
—Health official, Ministry of Health and Prevention
Many groups expressed a need for technical information in different health areas (e.g., on the side effects of contraceptives), and at the district and community levels, information on the sociocultural determinants that affect men and women's perceptions of family planning and contraceptive continuation. All groups working in health—from the bilateral to the community level—cited the need for information that would help them address religious and cultural barriers to using family planning, including negative rumors, and to better motivate and involve men. Some also cited the need for practical information on the social and economic benefits of family planning.
Sources of Information
Respondents used multiple sources to access health information. Sources include generators of information (national health agencies, news agencies), physical collections of materials (libraries and resource centers), electronic channels that compile and distribute information (websites), and health professionals (supervisors, trainers, and colleagues).
While the Internet was most commonly cited by respondents as a key source of health information, all groups comprised of literate individuals (including community health workers) mentioned print documents as still essential. Syntheses or reviews were among the most popular print resources; others included manuals, checklists, updates, news alerts, conference reports, newsletters, fact sheets, and posters. Resource centers housing print copies of Senegal-specific materials were in high demand, although the existence of such centers was quite limited.
Many respondents within the health sector considered the National Health Information System as the primary source of health information, especially of service delivery data specific to Senegal. Health authorities, in particular, cited various governmental agencies as important sources that generate and distribute health-related information. Other respondents said that data were not always available from some of these agencies and that agency staff had limited qualifications in information management.
Many respondents at the district and health post level reported that Internet access was limited, and web searches rarely yielded information specific to Senegal. The national Ministry of Health and Prevention website, which provides information about its main activities, reference materials, various health programs, texts, and laws, was not perceived as a comprehensive archive of Senegal-specific strategies, research, or other health documents.
Those with access to training workshops, including journalists, considered them good sources of health information and updates.
Public-sector health providers reported that they tend to seek information from interpersonal sources, including primary health care supervisors and reproductive health coordinators, who centralize all district-level data and sometimes share information on health practices. Providers in the private sector conducted Internet searches, subscribed to journals, or enrolled in continuing education (including online courses) to access needed information.
Health care workers at the community level identified television and radio as important sources of information, given their remoteness and limited opportunities to attend meetings. News media, elected officials, and health care providers also considered broadcast media to be an important source. Other important information sources and gatekeepers were religious leaders.
Use of Health Information for Decision-Making, Research, and Information Sharing
Health managers at several levels mentioned that normative guidance generated at the international and national level was useful to inform strategic and programmatic decisions. Development partners—bilateral and multilateral technical and financial partners—and nongovernmental organizations reported adapting and using strategies based on successful experiences (e.g., from neighboring countries). A number also reported the use of research and strategies defined by global authorities, such as the World Health Organization, to guide decisions and support ongoing programs.
Some respondents applied information on policies and practices shared during in-person coordination meetings in ways that appeared to improve service quality:
After each monthly review of data, I summon all midwives to share all the information collected and provide solutions to … problematic deliveries and to follow up with women who had to be referred to hospitals. These facilities send us feedback and I share it with the midwives. Sometimes we organize regional medical meetings to share information on policies, standards and procedures with other districts—or do that during quarterly formative supervision meetings at the regional level.”
—Reproductive health coordinator, Dakar
Health care providers indicated group discussions with colleagues were a common venue for determining how to handle difficult medical cases. Some also reported using the Internet to do so. The Internet was also used for information-gathering by journalists and others.
Barriers to Accessing, Sharing, and Using Health Information
Barriers to knowledge management (accessing, sharing, and using health information) exist at all levels of the health pyramid, and among public and private sector providers alike. The majority of groups mentioned the paucity of units or personnel adequately trained and responsible for collecting, organizing, and making accessible information for their respective constituencies—a reality described as reflecting insufficient human and financial resources.
We lose the possibility of capitalizing on experience and information because there is not a good system for accessing information, for storing it, for sharing it, or for letting people know it exists in a way that can be exploited … You often have to search high and low to pull together useful information on a specific topic.
—Nongovernmental organization director
Another common barrier related to problems in the flow and usefulness of information shared, including delays in receipt of information; problems with the completeness or reliability of information; low relevancy of information available (technical level, quantity, and a reliance on written material even for illiterate communicators such as traditional griots); and challenges with access.
Barriers more common among service delivery providers and community health workers included logistical and capacity issues, such as lack of Internet access; electrical outages and connectivity problems; poor access to training in use of information and communication technologies; high cost of mobile phone minutes; and inadequate time to seek professional updates. Service delivery providers and journalists also mentioned challenges with understanding technical language.
Some respondents said mobile phones offer many opportunities that could be useful for sharing and transferring information. However, many preferred not to use phones for these purposes because of the expense.
The mobile phone becomes the umbilical cord between the health post and the hospital to correctly handle complications. However, the communication costs are assumed by the head nurses at health posts.
—Development partner
Professional Networks
Numerous respondents indicated that networks play a crucial role in knowledge exchange, including that of sharing information between groups and individuals that otherwise might not collaborate, such as public and private sector providers.
It gives us additional resources which we can access. It gives us access to people that we could not have access to otherwise. It's much easier to do something for someone when we know each other, and the network is used to weave this kind of knowledge.
—Development partner
Information Channels Used to Store, Transfer, and Share Information
As Table shows, respondents reported various levels of use of information and communication technologies to store, transfer, and share information. They also reported using traditional and innovative strategies to share information. Some strategies rely on interpersonal channels; others on hybrid approaches that blend use of information and communication technologies and conventional forms of knowledge exchange.
Table 3. Systems and technologies used by different groups to transfer and share information
Internet Access
Respondents described the Internet and e-mail, the two most widely used technologies in all three regions, as widespread and indispensable in the transfer and rapid sharing of health information, although access is still limited in some areas. A number of respondents stored or accessed documents on CD-ROMs and flash drives. At the health district level, most health centers and a few health posts have computers with Internet connections. Some health centers even have Wi-Fi.
In contrast, access to these technologies is virtually nonexistent at the community level. Computer printers and photocopy machines are not widely available or in good repair in some places, including health posts and some media outlets. Nevertheless, a number of respondents made photocopies of documents to distribute to health personnel—in one case, delivering them to remote health posts by ambulance.
Internet [e-mail] is for me the best for transferring and sharing [information] because … at least there is a record of what was done.
—Nongovernmental organization director, Dakar
Respondents explained that lack of access to technologies and tools sometimes results from insufficient technical skills. For example, traditional communicators (e.g., griots) typically are illiterate and do not have computer skills.
Mobile Phones
Mobile phones are possibly the most ubiquitous communication tool across all levels of the health system. Health professionals use SMS text messaging occasionally to send brief information, but most considered it restrictive because of space limitations. Aside from some rare cases where mobile phones are used to supplement information or help train health care providers, the phones are mostly used for coordination purposes or in case of emergency.
Respondents also reported fax machines as an important tool for updating health information; reports are often sent by fax because of the speed of transmission.
Traditional Approaches to Store, Share, and Transfer Information
Print materials remain an important communication channel, especially in areas where access to information and communication technologies is problematic, according to respondents in all groups except traditional communicators and community health workers.
Respondents indicated that coordination meetings planned by nongovernmental organizations with their technical and financial partners were an excellent source for sharing and using information. At the central level, a combination of e-mail and meetings are used to communicate with colleagues in remote areas and share tacit knowledge and experience:
With colleagues who are in remote areas, we share information via email or at meetings called Post-Graduate Education. This may be information about our own experiences, i.e., what we do in practice, or information and news from meetings and conferences that we participated in.
—Specialized health care provider, Dakar
Information Flow Between Different Levels of the Health Care System
The communication of standard policies, protocols, and other information from the central and regional levels to public sector providers travels a well-established circuit through the health system. Information moves from the Ministry of Health and Prevention to the health post through the medical region and the health district through coordination meetings, workshop updates, mail, or service notes (notice of administrative acts taken by authorities at all levels). On occasion, this information is disseminated by phone, fax, or e-mail.
The Ministry of Health and Prevention system for information sharing from the decentralized level to the center is similarly linear and is pegged to certain time intervals. The peripheral level (the health post) submits a report each month to the primary health care supervisor describing all activities undertaken during that period. The primary health care supervisor, in turn, produces a quarterly report to the medical region by integrating data from the health centers. The medical region consolidates data from all districts twice a year. At the national level, an annual report is prepared based on the data submitted by the medical regions and by priority programs.
Much of the information collected is fed back up hierarchically... The activity reports are validated by the person responsible at each health facility who then sends it up to his supervisor, all the way to the [National Health Information System]: house – health post – district – medical region and national level. Now, the information is fed up the hierarchy via email.
—Ministry of Health and Prevention program manager
District and regional teams are the main information managers at the local level—the key gatekeepers involved in information exchange and knowledge processing—with links to the decentralized and central levels of the health system. They participate in various coordination meetings and training sessions, and they receive information about the operation and implementation of programs in the form of memos or ministerial decrees. They are responsible for the collection, analysis, storage, and dissemination of information to higher levels. These gatekeepers often use e-mail to inform teams quickly about new information and rely heavily on meetings to discuss how to apply knowledge.
…we have coordination meetings to determine the positive and negative points [on programs], and what needs improvement.
—Supervisor, nongovernmental organization, Dakar
With the exception of the National Health Information System, which serves agencies and providers nationally, programs tended to have their own information channels and structures.
Preferences for Knowledge Exchange Approaches
Information Management at the Regional and District Levels
Respondents commonly use coordination meetings to transfer and share information, and most described such meetings as the preferred forum. Many said the best communication channels by far were interpersonal ones, especially face-to-face interactions. Interpersonal approaches were considered much richer than other channels because they let participants obtain references, ask questions, and get immediate explanations.
I really like the face to face; the dynamic there is in exchanging, and the opportunity to ask questions and compare ideas.
—Nongovernmental organization development partner
Respondents mentioned meetings between medical region staff and district managers (formative supervision meetings) were critical venues for sharing information that focuses on improving service delivery and facility management. At the regional level, respondents described supervisory visits as a good channel to communicate and discuss information relevant to program implementation: an activity essential for the monitoring of operational plans from the district or the medical region.
Likewise, reproductive health reviews—organized meetings between the medical regions and central services of the Ministry of Health and Prevention—also provide an excellent discussion platform for certain providers. For example, the Division of Reproductive Health at the Ministry of Health and Prevention organizes a meeting each semester with technical teams from the regions. The regions present the status of their programs, indicator levels, and challenges faced while implementing activities.
Many respondents valued the Internet because it facilitates knowledge acquisition, storage, adaptation, and transfer; one physician noted the utility of the Internet's sound and video capabilities for gynecology.
Best Practices and Strategies for Sharing Health Information
Respondents from many levels in the health system expressed the need for a system that would allow better storage and use of information and experiences to develop practical guidelines, identify sustainable strategies, and improve the design and implementation of programs. Many indicated that health professionals would benefit from having clearer channels of inquiry to find information to solve specific problems.
Some suggested connecting different resource centers or linking resources to make searching for information easier, especially for research results. One called for greater attention by the health sector to synthesize and disseminate information in local languages and recommended strengthening national agencies, especially the National Health Information System, that have information sharing and communication roles.
We must above all communicate in all languages and involve more men. We must also have multi-sectoral interventions... [and] strengthen health education services … and medical regions to enable them to play their role.
—Ministry of Health and Prevention program manager
Even though most health organizations already have their own websites, respondents were generally excited by the idea of a national FP/RH website that would permit them to read articles, participate in forums, download documents, link to databases (such as HINARI and Cochrane Reviews), and access the perspectives and voices of program beneficiaries. Respondents wanted case studies on political aspects of the management of health issues; country successes and failures organizing health systems; information on current health indicators, services, and issues in Senegal (including constraints, problems, and possible solutions); new methods, policies, and guidelines at the international level; online training courses and notices of trainings and conferences; and global best practices. Desired information on family planning included advantages of family planning, contraceptive side effects, where to access services, cost information, information on prevention of mother-to-child transmission of HIV, and risk factors in pregnancy, immunization, and malaria during pregnancy. Respondents recommended that the Ministry of Health and Prevention create an online information hub to ensure consensus and sustainability.
Simpler electronic technologies that participants found useful included organizational e-newsletters alerting recipients to new materials and personal listservs, where an individual alerts colleagues to or passes along interesting new health information.
A few respondents recommended greater use of mobile phones to communicate health issues, with one recommending the extension of the message alert system on mobile phones used by parliamentarians to reach other actors. Respondents also recommended using YouTube to upload simple videos showing program progress and engaging a broader group of stakeholders to communicate about FP/RH, such as training journalists to report effectively on health.
Discussion
This study confirms results from previous studies in other countries showing that access to current, relevant information by health professionals and decision makers in Senegal at many levels in the health sector is problematic. It also demonstrated significant problems with the currency and completeness of data in the national health information system and therefore the National Health Information System's utility to many health stakeholders, a common issue in Africa (MEASURE Evaluation, Citation2011a).
At the same time, respondents in our study reported that the Senegalese system of holding regular meetings that cascade new information up and down the health pyramid functions well to share certain types of information. In this hierarchical chain, information flows from the central level to medical regions to district managers and supervisors, then further down to the health post level and back up, most typically during face-to-face coordination meetings. Some information is transmitted by e-mail, and urgent information (e.g., on disease outbreaks) is sent through mobile phones.
The most important “boundary spanners” (Aldrich & Herker, Citation1977), or intermediaries that communicate family planning information with the lower and higher levels in the health pyramid, are reproductive health coordinators and supervisors. Knowledge exchange at this intersection is carried out during supervisory visits. Also, managers at the district level often receive new information or directives through e-mail and then discuss the content verbally with lower level health providers and social mobilizers. These providers, in turn, simplify and translate the information into local languages for community stakeholders.
These findings are consistent with prior research on recirculation of electronic information (Edejar, Citation2000), as well as with a large qualitative study of health information use in developing countries, which demonstrated that health professionals often access, process, understand, and adopt information through interpersonal interactions in physical gatherings such as meetings (Lanham, Robinson, & Burke, Citation2008). Strategies to empower and better support the knowledge management role of coordinators and supervisors and that take into account the positive aspects of a well-defined hierarchical information flow and the important role of interpersonal communication should be implemented and tested.
Consonant with other research (Hara & Hew, Citation2006), we found that professional networks were important forums for knowledge generation and exchange of social capital. These networks should be better supported, as they promote regular exchange, and sharing of knowledge and diverse perspectives; facilitate the establishment of relationships; allow for a more contextualized analysis of a given issue; and help harmonize processes, such as the tools and procedures used during capacity-building activities.
It is interesting that, consistent with some of the gender barriers to health reported in the 2005 Demographic and Health Survey for Senegal (Ndiaye & Ayad, 2006), our study showed nearly universally held needs throughout the health sector for information on ways to motivate men's involvement in FP/RH. The second most often cited need was to address rumors and religious barriers to family planning, pointing to religious leaders as important traditional gatekeepers and thought leaders. Other needs and preferences for information sources varied somewhat by level in the health system, but were mostly similar to those documented in a comprehensive review by Kols (Citation2009) and others (Sheba, Citation1997). A new finding in our study was that managers at most levels of the health pyramid cited the importance of literature reviews that synthesize evidence.
At the regional and district levels, respondents recommended that personnel receive more training in use of information technologies and that managers strengthen their capacity to use information for program management. Health personnel at the community level also reportedly need greater access to practical information and training in its use. These findings are consistent with other evidence on data use to improve health service delivery (MEASURE Evaluation, Citation2011b), although further research is needed to identify the cost-effectiveness of investments in information and communication technologies at various levels in the health sector.
Limitations
Although conducted in urban and periurban locations and among a diverse group of health stakeholders, our study did not include a component to verify basic claims made by respondents (e.g., that national health databases were current). In addition, the data collectors lacked mastery of new digital recording equipment, and thus, some detail typical to qualitative data was diminished when information from interviews was lost. Data collectors returned to some respondents to fill in gaps, but some data were limited to written notes taken during interviews.
In addition, upon data analysis, we determined that religious leaders were important sources of information on FP/RH at the community level. Future studies should probe ways in which they could be integrated further into a comprehensive knowledge management approach.
Conclusion
Despite challenges related to inconsistent availability of reliable health information and resources (including time constraints), our study indicates that health professionals actively seek information to improve practices and programs. Further, the study suggests an important opportunity to leverage existing information and communication technology infrastructures for information sharing, especially mobile phones and SMS text messaging. Nevertheless, there exists a nearly universal, persistent need among health personnel in Senegal for French-language, paper-based information and a strong preference for interpersonal communication as a method for information sharing, knowledge synthesis, and learning.
Our results indicate the crucial role that hierarchy and social organization play in the flow of communication and in knowledge exchange. Depending on where a given provider or manager is in the organizational, social, or community structure, he or she may be a central lynchpin in information sharing, may have access to information, or conversely may have little access to information. Systematic efforts to change and incentivize information-sharing behavior should be part of an overall knowledge management strategy.
Development of a national website containing Senegal-specific information addressing the needs identified at all levels would improve access to existing local materials, as identified by the respondents. Subsequent to this study, the K4Health project developed a website with the Ministry of Health and Prevention.
Last, political support for a comprehensive knowledge management strategy for the health sector—supported by appropriately trained personnel and including concrete steps to strengthen the National Health Information System—should be a priority.
We conclude that Senegal is still confronting issues related to the three main determinants of use of health information: the technical aspects of data processes and tools; the behavior of individuals who provide and/or use data; and the system or organizational context that supports data collection, availability, and use (LaFond, Fields, & Lippeveld, Citation2005).
Acknowledgment
The Knowledge for Health (K4Health) project provided financial and technical support to this needs assessment. Tara Sullivan and Vanessa Mitchell from The Johns Hopkins Center for Communication Programs provided the overall leadership for the multicountry needs assessment. Social scientists at FHI 360 and Management Sciences for Health provided technical input on study design, including development of the topic guides used in the needs assessment. Beverly Tucker and Ilene Speizer of the Measurement, Learning & Evaluation Project for Urban Reproductive Health Initiative implemented by the Carolina Population Center at the University of North Carolina in partnership with the African Population and Health Research Center and the International Center for Research on Women participated in the design of the questionnaire and the selection of interviewees to obtain data on information needs in Senegal for use by the Bill & Melinda Gates Foundation–funded Measurement, Learning & Evaluation Project. Amadou Hassane Sylla (former Centre de Formation et de Recherche en Santé de la Reproduction coordinator), conducted the data collection and analysis, and wrote a report used as the basis for this article. Co-author Karim Seck (FHI 360, Senegal) managed the needs assessment day to day. Laura Johnson and coauthor Elizabeth T. Robinson provided technical support in data analysis. Cindy Waszak Geary and Rebecca Dirks provided critical review. Partial support for this study was provided by FHI 360 with funds from the United States Agency for International Development Knowledge for Health (K4Health) Program, Cooperative Agreement No. GPO-A-00-08-00006-00 and the Bill & Melinda Gates Foundation under terms of the Measurement, Learning & Evaluation Project for Urban Reproductive Health Initiative, although the views expressed in this publication do not necessarily reflect those of FHI 360 or organizations funding this study.
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