Following the epidemic, the USAID Global Development Lab’s Ebola Team conducted research to understand current models for providing HIS technical assistance to ministries of health within the region and options for moving short term technical assistance to long-term sustained capacity. Specifically, advanced health informaticians and software engineers were identified as lacking, contributing to the inability to integrate disparate data systems at the pace required during the Ebola epidemic. Findings from the 2016 USAID report Fighting Ebola with Information included a specific recommendation to “build staff technical capacity and data literacy” in order to “leverage digital systems and real-time data in support of operations, programs, and decision-making” (p. 12).

Given WAHIT’s design as a one-year proof of concept initiative, understanding if and how WAHIT could be sustained beyond the initial year was a priority from the start. In June 2019, with WAHIT funding set to end, WAHO and WAHIT conducted a sustainability workshop to identify strategies to maintain WAHIT beyond September 2019. As of 2021, the team is fully in existence, still donor funded. WAHO is still requesting approval to make the team a permanent part of their structure.

Partnerships bring diversity in the skillset, experience, and positioning needed for systemic change. The partnership structure of WAHIT was intentionally curated and leveraged throughout the implementation of WAHIT. USAID led the overarching strategy and design of the program. WAHO brought long-standing regional presence, reach, and technical leadership within health, policy, and governance. Finally, HP+ complemented the partnership with technical health informatics capability and operations.

WAHIT trained 254 health information system experts on various topics. WAHIT’s capacity building activities were specifically targeted to build individual-level technical capacity so that individuals within ministries of health have the necessary skills to improve health information systems regionally. While individual capacity building activities were targeted through WAHIT’s implementation activities, WAHIT had resonating effects that improved organizational and digital ecosystem capabilities.

Through WAHIT, WAHO has been able to streamline reporting, provide technical assistance to member states, and detect/ respond to new diseases such as COVID-19.

The main challenges were the insufficient length of WAHIT’s technical assistance and uncertainty regarding sustainability of the team. Many trainees felt that WAHIT never had enough time to fully and deeply cover the training topics and/or to stay in the countries until all the technical issues raised were fully and completely addressed. A reoccurring piece of feedback early on was that the “fly in, fly out” model typically used for technical assistance did not foster sustainable HIS capacity at the MOH level.

The duration of WAHIT technical assistance missions and training was limited due to WAHO policies. To adapt, WAHIT phased country missions into separate trips and provided remote engagement via email and WhatsApp while they were back in the office. Informant feedback indicated that in-person support was generally preferred, however, WAHO policies and financial resources for travel had to be adhered to.

The journey to establish WAHIT shows that new models to support countries in health information system improvements and building local capacity are possible with the right combination of partnership, flexibility, and alignment. Infused throughout this story are lessons learned along the way. Key lessons that the digital health community can learn from for future activities aimed to strengthen digital health capacity at both individual and country levels include: Balancing Sustainability with Results; Harnessing the Power of Partnerships; Building Gender-Inclusive Capacity; and Cultivating Capacity at all Levels.

In the design of future informatics capacity building initiatives, and as WAHIT grows, gender inclusion should be considered from the onset. For example, when there is flexibility in team location, analyzing the availability of the local talent pipeline disaggregated by gender (if available) can help to identify a location with a larger female applicant pool, avoiding issues related to relocation. Alternatively, considering short-term consulting assignments or allowing remote work may provide more flexibility with limitations related to work schedules and location. Considering these factors could have helped the team be more inclusive of women with the requisite skillset, however, more is ultimately needed to build the pipeline of female technology experts in West Africa in general.

WAHIT is proof that new ways of providing technical assistance while building capacity are possible with the right approach, partnership, and motivation. As USAID continues to support countries on their journey to self-reliance, strengthening country-level digital capability, including equipping the next generation workforce, will be critical.
Digital capacity building projects can learn from WAHIT’s innovative model, implementing through adaptive management approaches and collaborative partnership models.

It's an amazing team!