Realist Evaluation of the Integrated Electronic Diagnosis Approach (IeDA) for the Management of Childhood Illnesses at Primary Health Facilities in Burkina Faso
Authors: Blanchet Karl , Sanon Vincent-Paul , Sarrassat Sophie , Somé Arsène Satouro 
Published: September 2020

Abstract
Background: Effective implementation of Integrated Management of Childhood Illnesses (IMCI) is often constrained by poor adherence to the guidelines. Burkina Faso introduced the IMCI strategy in 2003 but has suffered from limited implementation of the basic IMCI training and poor adherence to the algorithm. In 2014, Terre des Hommes (TdH), a Swiss non-governmental organisation, together with the Ministry of Health (MoH), launched the Integrated electronic Diagnosis Approach (IeDA) intervention in public primary health centres, 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 and to identify factors that may affect these mechanisms at health centre and community levels.Methodology: A realistic evaluation method was adopted. Data collection that took place between January 2016 and October 2017. Direct observation in health centres generated elements of information that helped to identify new issues or verify assumptions. The analysis of project reports from health facilities helped analyse the implementation of IeDA and the vision of the project by managers. In addition, interviews and focus group discussions provided evidence in relation to the perceptions, in-depth opinions and understandings of actors intervening in IeDA. In-depth interviews were conducted with 154 individuals including 92 healthcare workers from health centres, 16 officers from district health authorities, 6 members of health centre management committees. In addition, 5 focus groups (on average 11 people per group) were organised with mothers and carers. The initial coding was based on a preliminary list of codes inspired by the Middle Range Theory and on additional ideas that emerged from the fieldwork. In a second round of analysis, additional themes and patterns emerged.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 and task monitoring and training, supervision, support and recognition. Based on the mechanism of perceived organisational support, such combinations lead to a reorganisation of the health team and the distribution of roles before and during the consultation, and positive atmosphere that includes recognition of each team member, organisational commitment and sense of belonging. Every new comer starting in the health centre or the district are fully integrated into this new organisational culture and benefit from the same support and recognition. Conditions for such management changes to work include 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 shows that in management of healthcare workers, it is important to mix different management practices. 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.