data demand & use (ddu)

Data Demand & Use(DDU)

Why we collect health-related data

Session Overview Understanding the need for data

Importance of improving data informed decision making

Explain the context of decision-making Role of monitoring and evaluation data in decision making

Highlight determinants of data use List potential barriers to data use Assessment of Barriers to Data Use Tool

Explain the relationship of stakeholders to the data use in decision making cycle Stakeholder Assessment and Engagement Tools

Linking decisions and questions with potential data sources Identify priority decisions and programmatic questions Create a time-bound plan for using data in decision making Framework for Linking Data with Action Tool

Understanding the need for data

Decisions Within Programs

Ensure program activities are executed as planned & services are delivered as intended Are we doing the right things, doing them right, and

reaching those we intended? Decisions about:

employment & manpower mobilization & allocation of resources needed information and developing feedback channels

Factors other than evidence-based information influence decisions

Power relationships Timing Competing priorities Public opinion Political ideology

Arbitrariness Local culture of

decision-making Other information

sources

Understanding Decision-Making

What is the decision to be made? Who makes it? When and why is the decision made? How is the decision made? What information is needed?

What is my role in decision making?

Why Improve Data Informed Decision Making?

HIV epidemic Resurgence of TB Continued prevalence of malaria Pockets of stalled fertility decline Population burden Shortage of health care workers

Context

Pressing need to develop health policies, strategies and

interventions

Why Improve Data Informed Decision Making?

Increased financial investments for service delivery

Increased accountability requirements Improved national HMIS Increased demand for evaluation and other

research

Why address data demand & use?

Evidence-based Decision Making Process

Level of Dissatisfaction that Policy is Based on Scientific Evidence

Per

cent

dis

satis

fied

Overseas Development Institute, Jones et al., 2008.

Challenges

Integrated HMIS still not fully functioning Little or no communication between data

producers and data users Low capacity to collect, analyze & interpret data Limited or no culture of data use

Data collection and use not a priority

The Response

Monitoring & Evaluation Systems

Better Health

Outcomes

Data Informed Decisions

Group Participation

How do you and your organization use data and information?

We can use information to… Inform health policies and plans Raise additional resources Strengthen programs and improve results Ensure accountability and reporting Improve quality of services provided Contribute to global lessons learned

“Making Data Speak” in Thailand Need: Strengthen commitment of policy makers to

HIV Prevention Data: Behavioral and epidemiological data Response:

Analyzed data with Asian Epidemic Model and Goals model Determined responses and resources needed Communicated data to stakeholders

Decision/Action: Successfully emphasized prevention agenda in national

strategic plan and developed an operation plan to guide prevention programming

Key Messages

Decisions based on evidence lead to better health outcomes

We all have a role in M&E – partners in progress

High quality information is needed for decision-making at policy, planning and program levels

Purpose of M&E is not just to produce more information but to inform action

Determinants of DDU

What Determines Data Demand & Use?

ORGANIZATIONAL TECHNICAL

BEHAVIORAL

* Based on PRISM analytical framework (LaFond, Fields et al. 2005 The PRISM: An Analytical Framework for Understanding Performance of Health Information Systems in Developing Countries. MEASURE Evaluation).

Data are often underutilized because of…

Technical constraints Individual technical skills, Availability of computers, Data system design, Definition of indicators, Lack of data quality assurance protocols


Organizational constraints Structural – roads, telecommunication Organizational – clarity of roles, support,

flow of information Political interference


Individual constraints Decision maker attitudes, Staff motivation, Lack of “data culture”

What Determines Data Demand & Use?

ORGANIZATIONAL TECHNICAL

BEHAVIORALPOLITICS

CULTURE

SOCIETY

* Based on PRISM analytical Fields et al. 2005 The PRISM: An Analytical Framework for Understanding Performance of Health Information Systems in Developing Countries. MEASURE Evaluation).

What barriers have you faced to using or getting others to use data and

information?

Discussion

Assessment of Data Use Constraints Tool

Purpose To improve understanding of the demand for data and the

constraints to data use

Description Key informant interview guide designed to identify

constraints Identifies effective practices in data use Two versions - Facility level assessment & national and

sub-national assessment

Assessment of Data Use Constraints ToolTechnical Constraints

Technical constraints are related to the ability to generate high-quality data and analyses.

RA8 Have you ever had an experience while making a policy or program related decision when you were concerned about the quality of the information being used?

RA9 Are there multiple sources of information or statistics for issues of importance to you, and have you experienced any problems caused by having different estimates?

RA10 I am interested in knowing about technical capacity for collecting and using information. Does your agency have the technical capacity to produce reliable information without a lot of external technical assistance?

RA11 Does your agency have the technical capacity to ensure access to and availability of reliable data?

RA12 Has there been an occasion when data quality or local technical capacity made it difficult for you to use information in making a decision?

RA13 How would you have gone about preventing this situation?

Barrier: Steps involved

PersonResponsible

Other stake-holders

General timeline

Addressing Barriers to Using Data and Information in Decision-making

Activity:Assessment of Data Use Constraints ToolChoose a note taker

Discuss barriers to data use experienced in your work. Here are some questions to start your discussion:

Have you ever had an experience while making a policy or program related decision when you were concerned about the quality of the information being used?

Does your agency have the technical capacity to ensure access to and availability of reliable data?

What specific challenges have you experienced among your staff when it comes to using data?

How does your organization support having the necessary information to make decisions?

Time for activity: 45 minues

Barrier: Lack of technical capacity in M&E

Steps involved

PersonResponsible

Other stake-holders

General timeline

Proposed Intervention: Train all program managers in X organization on basic monitoring and evaluation (indicators, developing M&E plan, documenting results, managing towards results, etc.)

Identify funding

Director Deputy, program mgr

January2008

Seek out trainers and curricula

M&E Specialist

Deputy director, Training coordinator

February 2008

Addressing Barriers to Using Data and Information in Decision-making

Report Back on the Assessment of Data Use Constraints Tool

Share priority barriers Discuss solutions crafted Present action plan for two priority barriers Report back: 2 groups, each 10 minutes

Context of decision-making

Discussion

How can we ensure that information is being used to make diagnoses

and inform decisions?

Stake-holders

Decisions

Context of Decision-making

Data

What is a Stakeholder?Any person, group or organization with a particular interest in a policy or program Government agencies Beneficiaries Policymakers Funding agencies Providers / Implementers Civil society Researchers M&E Specialists

Stakeholders Non-governmental organizations Professional associations Religious leaders Journalists/media Private sector/business

Data Producers vs. Data UsersData producers think that decision-makers:• Value “political” considerations over evidence• Are unprepared to measure or evaluate the consequences of

their decisions

Decision makers or data users think that health researchers and M&E specialists: Lack responsiveness to priorities Favor numbers / jargon to transparent communication Prefer written reports to face-to-face conversation

Importance of Knowing Your Stakeholders

View activities from different perspectives

Have different degrees of understanding

Need/want different information

Need information at different levels of complexity

Have different intensities of interest

Have different roles in the decision making process

Results of Involving Stakeholders in Data Use Process

Relevance of data Ownership of data Appropriate dissemination of data Use of data

Stakeholder Analysis Matrix & Engagement Plan

Clarifies who has interest in a program and what that interest is

Identifies who can help a program and how, and who can hurt it

Helps you use this information for the success of the planning effort

Stakeholder Analysis Matrix

The Stakeholder Analysis tool is a matrix framework and process for:

Identifying stakeholders Defining their roles and resources Identifying dynamics among stakeholders Setting the optimum stakeholder group

Stakeholder Analysis MatrixName of stakeholder organization, group or individual

Stakeholder descriptionPrimary purpose, affiliation, funding

Potential role in the issue or activity

Level of knowledge of the issue

Level of commitmentSupport or oppose the activity, to what extent, and why?

Available resourcesStaff, money, technology, information, influence

Name of stakeholder organization, group or individual

Stakeholder descriptionPrimary purpose, affiliation, funding

Potential role in the issue or activity

Level of knowledge of the issue

Level of commitmentSupport or oppose the activity, to what extent, and why?

Available resourcesStaff, money, technology, information, influence

National AIDS Control Committee

Involved in planning, implementation, M&E of all HIV/AIDS programs in the country; approves donor and NGO-funded HIV/AIDS programs

Facilitate the stakeholder meeting, prepares for meeting by identifying data sources and preparing an agenda

High – receives reports on PMTCT activities from MCH division at MOH; Medium level of knowledge of int’l guidelines and studies

Strongly support the activity, but hesitant to use international data sources. NACC opposes use of the DHS and most recent international estimates as they consider these sources to overestimate HIV prevalence

Staff available to facilitate; Room and computers available for meetings at NACC headquarters

Stakeholder Analysis Matrix Program issue Develop plan (inc. M&E plan) to scale-up PMTCT programs throughout systemProposed activity Convene stakeholders to identify priorities based on available data and develop action planDate November 2006

How to Involve Stakeholder Quarterly program management meetings

Quarterly meetings to interpret RHIS data Involvement of facility staff to interpret program

data M&E System improvement

Indicator planning and/or harmonization Data quality review meetings

Stakeholder Engagement Plan

Stakeholder organization, group

or individual

Potential role in the activity

Engagement strategy

How will you engage this stakeholder in the activity?

Follow-up strategyPlans for feedback or

continued involvement

Program issueProposed activityDate

Stakeholder Engagement Plan

Stakeholder organization, group or individual

Potential role in the activity

Engagement strategyHow will you engage this

stakeholder in the activity?

Follow-up strategyPlans for feedback or

continued involvement

National AIDS Control Committee

Facilitate the stakeholder meeting, prepares for meeting by identifying data sources and preparing an agenda that allows for the sources to be discussed

The NACC is the lead in this activity. It will be important for the NACC to involve more specifically the PMTCT coordinator, clinical care coordinator and National AIDS Program Coordinator

The NACC is responsible for following up with the stakeholders prioritized

Program issue Develop plan (inc. M&E plan) to scale-up PMTCT programs throughout systemProposed activity Convene stakeholders to identify priorities based on available data and develop action planDate November 2006

Stake-holders

Decisions

Context of Decision-making

Data

Decision Areas

Program design and evaluation Program management and improvement Strategic planning Advocacy and policy development

Program Design & Evaluation

Design Select messages for prevention campaigns

Evaluation Determine if new program approaches are

needed to ensure that health impact objectives are met

Program Management and Improvement

Management Determine if the program is meeting its

process objectives Improvement

Develop new strategies to increase coverage

Strategic Planning

Identify geographic areas of highest need

Determine human resource allocation Determine which of offered services is

making the greatest impact

Advocacy and Policy Development

Identifying and quantifying underserved populations

Identifying focus areas for new policies

Stake-holders

Decisions

Context of decision-making

Data

Data and Information Census Vital events data Surveillance data Household surveys Facilities level service statistics Financial and management information Modeling, estimates and projections Health research

Stake-holders

Decisions

Factors Other than Data that Influence Decisions

Data

Political Ideology

Competing Priorities

Power Relationships

Public Opinion

Arbitrariness

Stakeholders Involve new counterparts

Strengthening the Decision-Making Process

Decisions Understand service delivery realities

Data May require additional data

Activity: Stakeholder matrix & engagement plan

Break into small groups Each group should select a decision that they make in

their work settings and complete the stakeholder analysis around that decision.

A minimum of 7 stakeholders should be identified Complete the matrix across the columns for 1-2

stakeholders. Select one stakeholder and complete the stakeholder

engagement plan for that stakeholder Time for activity: 45 minutes

Group Work Report Back Have note taker transfer your final Stakeholder

Analysis Matrix onto flip chart paper Share the decision your group chose Share the priority stakeholders selected Choose 1 stakeholder and share the entire row

from the matrix for that stakeholder Share the Engagement Plan for the same

stakeholder 2 groups report back: 10 minutes each

Linking decisions and questions with potential data sources

Building Data Use into Your Work PLAN PLAN PLAN ! Regularly review your data – schedule time Use the Framework for Linking Data With Action Engage in dialogue with stakeholders to fully

understand the decisions they makeinformation they need best way to present that information

Elements of the Framework

Decision makers and stakeholders with potential interest in your data

Decisions / Actions that the stakeholder makes (possible uses of data)

Questions to which the stakeholder requires answers

When the decision will be made

Elements of the Framework cont’d Indicators and/or data of interest (to respond to

stakeholder need) Source of data How will data be presented (what types of

analyses, graphs, formats)?

Framework For Linking Data With Action

Decision/ Action

Program/Policy Question

Decision Maker(DM) Other Stakehold-ers (OS)

Indicator/data

Data Source

Timeline(Analysis) (Decision)

Commu-nication Channel


Decision/ Action


Decision Maker(DM) Other Stakehold-ers (OS)

Indicator/data

Data Source

Timeline(Analysis) (Decision)

Commu-nication Chanel

What Are Decisions?

Choices that lead to action All decisions are informed by questions All questions should be based data

Decisions Allocation of resources across countries/

states / districts/facilities Revising OVC program approaches to

emphasize fostering and adoption Develop and institute workplace policies on

HIV/AIDS in all institutions in state X Hire and allocate staff to facilities

Programmatic Questions What percentage of HIV+ pregnant women in

care are actually delivering in health facilities?

What percentage of clients starting ART are lost to follow up?

Are the number of family planning clients decreasing?

What percentage of pregnant patients who are HIV+ are actually receiving ART?


Decision/ Action


Decision Maker (DM) Other Stakeholders (OS)

Indicator/data

Data Source

Timeline(Analysis)(Decision)

Commu-nication ChanelDMOS

Are we reaching testing targets in PMTCT?Do we have sufficient test kits?What is nurse:Client?


Decision/ Action



Indicator/data

Data Source



Are we reaching testing targets in PMTCT?Do we have sufficient test kits?What is nurse:Client?

DM – Head of Regional Health Committee OS – Other providers, Division of Clinical Training


Decision/ Action



Indicator/data

Data Source



Are we reaching testing targets in PMTCT?Do we have sufficient test kits?What is nurse:client?





Indicator/data

Data Source





711 form indicators K41, B73, B 91

Service statistics Logistics manage-ment system


Decision/ Action



Indicator/data

Data Source


Commu-nication ChanelDM OS






Decision/ Action



Indicator/data

Data Source







Dec. 2010,March 2011,June 2011, September 2011,December 2011


Decision/ Action



Indicator/data

Data Source


Commu-nication Chanel DMOS





Dec. 2010


Decision/ Action



Indicator/data

Data Source







Dec. 2010 Short summary presented to facility manager at weekly clinic meeting


Decision/ Action



Indicator/data

Data Source



Hire more PMTCT counsel-ors





Dec. 2010 Short summary presented to facility manager at weekly clinic meeting

Framework for Linking Data with Action

Creates a time bound plan for information informed decision making

Encourages greater use of existing information

Monitors the use of information in decision making

Activity:Framework for Linking Data with Action Select a note taker On flip chart paper create the Framework table Brainstorm 3 decisions or questions in columns 1 & 2 Complete the remaining columns Time: 1 hour

Small Group Activity - Report Back

Remaining group will have 10 minutes to present their completed Framework

Group discussion - are there other data sources that might have been used in this decision? Were there other stakeholders that should have been considered? (10 minutes)

MEASURE Evaluation is a MEASURE project funded by theU.S. Agency for International Development and implemented bythe Carolina Population Center at the University of North Carolinaat Chapel Hill in partnership with Futures Group International,ICF Macro, John Snow, Inc., Management Sciences for Health, and Tulane University. Views expressed in this presentation do notnecessarily reflect the views of USAID or the U.S. Government.MEASURE Evaluation is the USAID Global Health Bureau'sprimary vehicle for supporting improvements in monitoring andevaluation in population, health and nutrition worldwide.

data demand & use (ddu)

Documents

context of decision

evaluation data

health policies

health surveys

health system

data useassessment of

data use toolexplain

data demand usedduwhy