Transforming district health systems into learning health systems: An improved strategy from the District.Team...

District Health Systems (DHS) are essential for delivering healthcare services, particularly in low- and middle-income countries. However, they often struggle with inefficiencies, inadequate data utilization, and limited learning capacity. Transforming DHS into Learning Health Systems (LHS) offers a strategic pathway to strengthening health systems governance, improving service delivery, and fostering continuous adaptation. This paper draws insights from District.Team, a digital learning platform piloted in Benin and Guinea in 2016-2017, designed to enhance real-time knowledge exchange and decision-making among District Health Management Teams (DHMTs). The District.Team strategy employed structured learning cycles to address key health system challenges, including maternal deaths surveillance and response and epidemiologic preparedness. The platform enabled peer-to-peer learning, facilitated data visualization, and encouraged collaborative problem-solving. Participation rates of district medical officers (DMOs), the heads of DHMTs, remained high across the five learning cycles in each country. For instance, during Cycle 1 (district health system characteristics), 85% (29/34) of DMOs in Benin and 100% (38/38) in Guinea completed the online questionnaire, with active engagement in online discussions. By the final cycle (maternal deaths surveillance and response), 61% and 74% of DMOs in Guinea participated in questionnaire filling and discussions, while in Benin, 44% contributed to the online discussions. DMOs reported improved decision-making processes, enhanced engagement with health data, and strengthened collaboration. Despite its successes, the District.Team strategy faced challenges such as limited integration into national health programs, weak institutional support, time constraints for DMOs, and infrastructural limitations, including unreliable internet connectivity and electricity shortages. Building on lessons learned, an improved strategy, referred to as District.Team ⁺ , is proposed to ensure sustainability and scalability. District.Team ⁺ incorporates a knowledge translation component, aligns with national health information systems (e.g., DHIS2), allows for the conduct of research or integration of existing research, and expands the learning community to include policymakers, healthcare providers, and communities. It aims to strengthen evidence-based practice and decision-making, practice-informed policymaking, and adaptive health management within health systems. District.Team ⁺ highlights the potential of digital learning platforms to support the transformation of DHS into LHS, provided they are embedded in national structures, adequately resourced, and aligned with broader health system priorities.