Creating an Enabling Environment for Data Systems and Use with Governance and Policies

1. DATA USE PARTNERSHIP Creating an Enabling Environment for Data Systems and Use with Governance and Policies Sub-Theme 1: Technologies supporting data for health system decision-making Cluster: Ethics and governance of technologies for management of health data 7th East African Health & Scientific Conference Dar-es-salaam-Tanzania 27th -29thMarch, 2019

2. Outline • Background and Rationale • Focus of the review and methodology • Findings • Conclusion and Recommendations • Discussion.

3. DUP Tanzania: Strengthening Governance and Policy 17 Investment recommendations One of them is .. • To strengthen governance processes and policies for digital health, DUP is creating an enabling environment for the successful, long-term implementation of the entire Road Map. In order to ensure relevant policies, strategies and guidelines relevant for data systems and use are in place.

4. Methodology of the review • Phase one: documentary review to understand relevant structures and guiding documents exist potentially in promoting data use. • Phase two: stakeholders consultation to clarify issues identified in the review and gather their opinions about; • the data use situation currently • what influence data use and • what should be done to increase the responsiveness of central guidance (policies, guidelines and strategies), structures, systems and processes to enhance data use in the health sector. • A total of 48 stakeholders within the Government were consulted.

5. Scope of the review • Health sector documents;- • Health Policy, Health sector Strategic Plan, Health information systems strategies, policy guidelines and Program or disease specific strategies. • 2. Health sector structure (MOHCDGEC and PORALG);- Directorates, Units, Working groups and Committees • 3. Stakeholders (MOHCDGEC, PORALG and CPs);- • Directorates, Vertical Programs and Initiatives, MDAs, Research Institutions and Development Partners.

6. RESULTS

7. Key take away messages • Central guidance is important for enabling information demand and use. • Many investments have led to data availability; more focus to data quality and data use. • Individual data availability is still a challenge. • Structures within both PORALG and MoHCDGEC are relevant and have great potential to promote data use at all levels. • There are challenges in understanding the set up, mandate and staffing of M&E and ICT Departments of the Ministry of Health. • Capacity building for data analysis, interpretation and use is required at scale. • Monitoring and evaluation outputs influence data use and consequently motivate actors to look for alternative sources and mechanisms to bridge information gaps. • The influence of ICT in promoting data use is dependent on how business processes are communicated and clarified.

8. Policies, Strategies and Guidelines • Finding 1. • The 2007 Health policy did not clearly stipulate the policy commitment in promoting evidence-based decisions in the health sector at all levels. • Reasons • Health policy is considered a generic statement then actors will translate into relevant strategies in promoting the wellbeing of the population. Data use promotion is not an activity rather a process that will require investments in skills, technology and leadership to enforce guidelines and role model data use practices • Consequences • The limited emphasis in data use in the health policy(2007) led to limited emphasis on data use practice and investments to facilitate data use in the strategic documents translating health policy such as implementation strategy and HSSP IV • Recommendations • Upcoming health policy to consider data use policy commitment clearly to stimulate attention in terms of resources and enforcement of practice of data use

9. Policies, Strategies and Guidelines… • Finding 2 • There are several documents to guide data systems and use these include Health Information System Policy Guideline, Data Dissemination and Use Strategy, Monitoring and Evaluation Strengthening Initiative and e-health strategy. • Reasons • These document were developed to fill in the gaps of not having guidance on data systems and use • Consequences • Having several documents create difficulties in tracking its use and comprehension by the intended users • Recommendation • Harmonize guiding documents regarding M&E and ICT

10. Governing Structures • Finding 1 • eHealth structures working in parallel with SWApstructures and they do not meet regularly. • Reasons • eHealth as an initiative needed to start vertically in order to set the ground on how the sector will be guided to adapt technology to support its business operations • Consequences • eHealth steering committee and Project Management Office work outside the SWAP structures where health business operations are defined. • Due to such limited linkages there is proliferation of various systems to meet the needs of the actors which create unnecessary workload to already stretched staff • Recommendation • Create clear linkage between eHealth structures and SWAP structures for proper coordination and guidance.

11. Governing Structures.. • Finding 2 • Challenges of M&E section –in term of set up, mandate, roles and staffing. • Reason • The set-up of M&E section, mandates, role and staffing is not clearly defined. • Consequences • M&E section encounter challenges in control over aspect of Health Information across the health sector. • Recommendations • Assessment of current M&E Section to inform its set-up, mandates, roles and staffing. The 12 components approach by UNAIDS for M&E systems strengthening was proposed to be used during the assessment.

12. Governing Structures.. • Finding 3 • Directorates and Technical Working Groups are potential platforms to promote data use but their ToRs do not include roles in promoting data use. • Reason • Data use not clearly stipulated in the roles and functions of directorates within which TWGs are anchored, hence the same limitation cascade to TWGs • Consequence • Data systems and use is not a serious agenda in all TWGs. • No clear link between M&E and ICT TWG with other TWGs. There are no clear mechanisms as to how the TWGs shall link. • Recommendations • Institutionalize data use in Ministries Directorates and ToRs of TWGs • Strengthen linkages between ICT and M&E TWG and other TWGs • Increase capacity of M&E Departments to forge appropriate linkage with technical departments to reflect and package health data into information that will stimulate attention of all actors.

13. Factors influencing data use practice • Finding 1 • Quality of data is still considered low. • Reasons • Staff at facility due to workload they do not fill the forms on spot; they fill registers later after they have served the clients. • Data collection tools at facilities is paper based increasing chances for erroneous recording. • Negligence, lack commitments and data use cultures of some front line health care workers. • Consequences • Multiple inconsistent estimates of the same information from different source thus making it difficult for users to use the data • Recommendations • Integrate information systems to reduce multiple requirements to facility staff • Enforce mechanisms on evidence based decision – such as allocation of resources based on the evidence of data.

14. Factors influencing data use practice… • Finding 3: • Limitations on Data Analysis, interpretation, dissemination and use • Reasons • For several years there has been incremental development in ensuring data quality is improved. • Focus of the capacity building was much enhancing supply of quality data and less on analytical skills to increase engagement with data to produce useful information • Consequences • The outputs of M&E therefore became less analytical as it lacked appropriate synthesis. • Recommendations • Build capacity of M&E Departments to function as a “control tower” to provide necessary alerts to health system. • Redefine the communication function within the sector beyond Public relations for appropriate interpretation skills of health information

15. Factors influencing data use practice… • Finding 2 • Limited analytical capacity reduces the ability for health providers to utilize and use data they produce • Reason • Data Analysis is not a major component of health providers’ trainings • Consequences • Health providers collect and send information to the ministry. They do not use it for facility decision making on daily basis. • Recommendations • Update in-service curriculum to develop skills relevant to promote data use. • Equip Zonal Health Resource Centers (ZHRCs) and HTIs with skills to deliver trainings that are relevant to data use • Prepare a data use guides to provide guidance to Health Facility Governing Committees on available data from their facility and how they can be used.