Moving beyond capacity: A journey to evidence-based action

The multi-crises that have affected Lebanon since 2011 caused a surge in the influx of international funds, resulting in a lack of coordination among funding agencies, healthcare providers and local stakeholders, and impeding efficient healthcare provision.

At its learning sites, American University of Beirut is mentoring the newly established Municipal Health Committee in the Municipality of Majdal Anjar in the Zahle District of the Beqaa Governorate. During the first cycle of participatory action research (PAR) undertaken at the learning site, the team focused on capacity building of committee members to enable them to understand and practice evidence-based governance. The main objective was to shape the new local health governors to value knowledge production in tailoring practices, while being informed by community needs.

What problem is being addressed?

In a previous case study, The power of knowledge: Evidence-based action in the local governance of a health system, we outlined our efforts to address the absence of a culture of evidence-based action and decision-making within the Municipal Health Committee, highlighting successful strategies such as capacity building and persuasion. In this case study, we delve into the underlying structural barriers hindering committee adherence to scientific, evidence-based and transparent governance.

In reality, Municipal Health Committee members still tend to hastily engage in random health-related activities and campaigns, without adequate evidence informing the actual needs of the community. This impulsive approach led them to overlook the importance of employing rigorous monitoring indicators to cater for those who are in real need of these activities. Moreover, they still struggle to develop the right tools for the triage of beneficiaries and selection criteria, neglecting those truly in need of assistance and hindering effective targeting of resources and support.

What did we do?

Appointment of an embedded researcher

After the establishment of the committee and the deployment of several activities under the Municipal Health Committee Strategic Plan, we appointed an embedded researcher, Youssef Abdel Khalek, to oversee the Municipal Health Committee activities. His main role is to direct the committee towards implementing evidence-based processes rather than random activities. Moreover, he set and started to generate process indicators, while initiating a database and orchestrating a continuous data flow. The team maintains weekly follow-up meetings with Youssef to support him with strategizing committee activities based on rigorous data and its crucial role in adapting practices to align with the specific needs of the community they serve.

Continuous mentorship

To link knowledge to practice, capacity building activities were complemented with close mentorship by the team. Daily communication via a WhatsApp group and side conversations with Municipal Health Committee members allowed the team to closely mentor every member of the committee and guide their contributions towards Universal Health Coverage. This helped create a vital link between theoretical knowledge and practical application, ensuring that Municipal Health Committee members not only gained knowledge but also received guidance on how to apply it effectively in their journey of establishing local health governance.

Engagement in dissemination and partnerships with external to Municipal Health Committee stakeholders

The team provided Municipal Health Committee members with opportunities to participate in various stakeholder engagement and dissemination activities to increase their exposure to evidence-based governance. Initially, committee members engaged with the directors and the teaching bodies to implement the School Health Program in all schools in Majdal Anjar. They conducted several meetings with school personnel to discuss and launch various plans including first aid training, dental health, nutrition and physical activities. The team was present in these meetings and tried to direct the discussions about the activities to be implemented from random to integrated plans in the curriculum and the structure of the schools.

Likewise, Municipal Health Committee members were engaged in several dissemination activities during the ReBUILD Annual Meeting 2023 in Lebanon (more on that here). They led the meeting with the consortium at the learning site where all members of the Municipal Health Committee presented their respective projects and explained how these projects fit with the Strategic Plan. They also organized and chaired the Municipal Health Committee dissemination event at the Municipality of Majdal Anjar, attended by the consortium, government officials, mayors, religious leaders, health providers, scouts and other stakeholders. Their participation culminated in Dr Fadi el Halabi, Municipal Health Committee member and representative of the Syrian refugee informal sector, giving a talk about inclusiveness within the committee during the ReBUILD symposium during the same visit.

Impact

Municipal Health Committee engagement and continuous mentorship from the team has significantly shaped committee members into becoming aware of the importance of evidence-based planning and practices. As a result, a set of tools was developed to prompt continuous data flow from all ongoing activities as part of the Municipal Health Committee Strategic Plan, emphasizing evidence generation and tracking impact over the years.

During one of the early committee meetings, the Mayor assuredly stated, “Our main health problem is the lack of medication. People do not have access to their chronic medications. We need medication.” When asked what medications are needed he failed to name one, showing a lack of baseline data about the needs of the community he was serving. At a later stage, committee members adopted a more evidence-based approach to tackle the shortage of medication, developing and disseminating via WhatsApp and social media a questionnaire enquiring about chronic diseases and medication, and collecting and analysing data to quantify prevalence and shortages in Majdal Anjar.

Under the Health Awareness Strategy of the Municipal Health Committee Strategic Plan, committee members developed online assessment tools to be filled-in by participants in the various awareness sessions about breastfeeding, safe environments for children and vaccinations. These tools gather data about socio-demographics, healthcare-seeking behaviours, antenatal and postnatal care, breastfeeding practices and misconceptions, and vaccination dropouts. It became clearer to the Municipal Health Committee members how this data can be used to inform and orientate their activities towards better understanding and serving the community. For instance, by gathering data on breastfeeding practices, the committee team of health educators refined the key messages delivered during awareness sessions, focusing on dispelling misconceptions that contribute to low breastfeeding rates rather than adopting the classic focus on motivation of women by emphasising the benefits of breastfeeding. Pre- and post-tests to assess the impact of health awareness sessions given by the committee team of volunteers were collected from all beneficiaries.

Clearly, Municipal Health Committee members are being shaped into advocates for evidence-based interventions, through continuous mentorship and knowledge-to-practice linkage. By fostering evidence-based decision-making, committee members can address community health needs more effectively and ultimately improve health outcomes within the community.
Baseline data collected from the community about breastfeeding, chronic diseases and shortages in medication is being analysed and will feed into guiding the Municipal Health Committee Strategic Plan and respective activities to better serve the community.

Moreover, a significant improvement was detected in breastfeeding awareness as the average increased from 41.1% in the pre-tests to 92.2% in the post-tests completed by beneficiaries (a total of 109 women) who attended the community breastfeeding awareness sessions. It is the beginning of a transformative journey of strengthening local governance of health systems, recognizing the importance of channelling this data flow into a centralised database managed by the Municipal Health Committee, with comprehensive population data to form a health repository.

Further information

• Find more on this study and its outputs here.
• There are other ReBUILD for Resilience case studies here 

Image: Members of the MHC and ReBUILD team outside the Majdal Anjar municipality building