Data Demand & Information Use (DDIU):

1. Data Demand & Information Use (DDIU): Strengthening Programs through Improved Use of Data

2. SESSION GOAL • To enhance the understanding of key concepts of data and information dissemination and utilization for the purposes of information sharing, accountability, and programme improvement.

3. SESSION OBJECTIVES • By the end of this session, participants will be able to: • Define key concepts and the purposes of data and information dissemination and utilization, and how it relates to strengthening the overall M&E capacity. • Demonstrate an understanding of decisions and decision making. • List common barriers to information dissemination and utilization, and propose methods to overcome them.

4. Introduction to Information Use

5. Main Uses of Health & Management Information - 1 • To assist in planning health programmes by showing which health and disease problems are significant and worthy of specific intervention • To monitor the implementation and effectiveness of a specific control programme by comparing the extent of the problem before and after the implementation of the programme • To identify and effectively target an affected population • high risk groups (e.g. by age, gender, occupation) • geographical areas where a problem is common

6. HMIS: Crucial Concepts • Both health (service delivery) data and management data are collected and processed into information for decision-making • It does not make sense to have a health management information system unless it contributes to decision-making and action at different levels of the health service

7. Decision Focus of HMIS Information System • MIS: • - Data/Information Processes: • Collection/compilation • Calculation/analysis • Reporting/dissemination • - Databanks: e.g. • Population • Service statistics • Morbidity/mortality data • Human resources • Financial data • Unit activities • Transport pool • Other organizations info • Other data • Users: e.g. • Top management • Unit managers • Planners • Donors • Operational staff • Researchers • Statisticians • Used in: e.g. • - Reviews • Media: reports • articles, minutes • - Meetings, • discussions Information Decisions Actions User Management System

8. Decision Focus of a HMIS SYSTEM DEVELOPMENT Decisions/ Actions Data Flows Information Flows MIS USERS SYSTEM INTERFACE

9. Decision Focus of a HMIS USE(R) DEVELOPMENT Information Decisions/ Actions Data Flows Flows MIS USERS USER INTERFACE

10. COMMON PROBLEMS OF HMIS - 1 • Too much health oriented; too little attention is given to management information • Other sector information is virtually non-existent • Despite much data being collected, too little of it is processed, and used • Most data collected and information processed is numerical in nature • Vertical programme information systems at different levels of implementation and functioning

11. COMMON PROBLEMS OF HMIS - 2 • Information systems are still too centralized • No participatory selection of indicators • No monitoring of the HMIS itself • Resource requirements poorly assessed • HMIS are not given sufficient time to mature and perform • HMIS as a health sector monitoring tool is too minimal and (possibly therefore) marginalized

12. HMIS Review in Tanzania (2-2000) Problem analysis iii Non-participatory decisions Decreased health status Decreased health status Ill-timed decisions Consequences Non-evidence based decisions Poor sharing down, up, laterally Poor monitoring of performance iii iiiiiiii Low use of data HMIS unit not able to contribute effectively Low initiative for using data Inadequate access to data Poor capacity for decisions Weak analysis Some information bypassing decision-makers Poor preparation of data for use Info effort seen as burden Contributing factors

13. HMIS Review in Zambia (3-2000) • Lack of data validation due to lack of supervision • Dissemination and feedback from national level lacking • Difficulties in separation of hospital HMIS • Difficulties in on-time reporting • Stationary supply not sustained • No pre-service training in HMIS done; pre-service training does not train managers anyway • Need better documentation on software • The real costs of the system (human, financial, paper) have not been quantified

14. Common DDIU Concepts

15. M&E IS AN ESSENTIAL PROCESS that produces information to: • Make informed decisions regarding operations management and service delivery including effective and efficient use of resources as well as future programme planning • Determine the extent to which the program/project is on track and to make any needed corrections accordingly • Evaluate the extent to which the program/project is having or has had the desired impact

16. DATA VS. INFORMATION Can be used interchangeably, but: • Data often refers to raw data, unprocessed information. • Information usually refers to processed data, or data presented in some sort of context.

17. DISSEMINATION The process of sharing information or systematically distributing information or knowledge to potential users and/or beneficiaries • Should produce an effective use of information Thus • The goal of dissemination is utilization

18. UTILIZATION The process of putting: • Information to use, such as to make decisions, to make changes, or to take other specific actions designed to improve outcomes. • M&E information is to be applied in planning, policy making, program administration/ management, and delivery of services

19. FEEDBACK • The transmission of information to parties for whom it is relevant and useful so as to facilitate learning. • Collection and dissemination of information, conclusions, recommendations and lessons learned from the experience.

20. WHY EMPHASIZE A FEEDBACK SYSTEM? • Maintains interest & ownership of M&E stakeholders • Validates M&E budget, results • Motivates partners & participants for improved data collection and data quality • Increases collective stock of knowledge • Must be well-organized to be effective

21. ESSENTIALS OF M&E INFORMATION • M&E information must: • be manageable and timely • be presented according to the audience’s • interest • capacity to understand and analyze • time, competing demands on time • have transparent quality (VRIPT) • focus on activities, results of interest • focus on meaning and direction for action

22. INFORMATION (MIS) USE Focus should be knowledge generation

23. Why disseminate & utilize M&E information? • Strengthen programs • Engage stakeholders • Ensure accountability and reporting • Advocate for additional resources • Inform Policies • Contribute to global lessons learned

24. Understanding Decision-Making

25. UNDERSTANDING DECISION-MAKING Decision Making: The process of choosing from among various alternatives using information at hand What decisions have you made already today???

26. In the process of understanding decisions and decision making, it is important to understand: • What is the decision to be made? • Who makes the decision? • When or why is the decision made? • How is the decision made? • What information is needed? More over: • What is my role in decision making?

27. IDENTIFYING DECISION-MAKERS (WHO) Sector Health Education Commercial Function Policy Planning Budgeting Service delivery Advocacy Evaluation Level National Regional Local DecisionMakers

28. DECISIONS WITHIN PROGRAMS (WHAT) Decisions ensure program activities are executed as planned and services are delivered as intended • Are we doing the right things, doing them right, and reaching those we intended? • Decisions about employment & manpower • Decision about mobilization & allocation of resources (physical & financial) • Decisions about needed information and developing channels for feedback

29. BRAINSTORM ACTIVITY Decision Making Exercise Divide in 5 groups: What decisions are being made in a: • ARV/Treatment programme • HTC • TB/HIV • PMTCT

30. TYPES OF DECISIONS • Policy, Planning & Advocacy • Program Design & Improvement • Program Management & Operations

31. POLICY, PLANNING & ADVOCACY • HIV/AIDS Workplace Policy • Family Planning Counseling Protocol • National allocation of funds to a Health Information Unit • HIV/AIDS National Strategy Document

32. PROGRAM DESIGN & IMPROVEMENT • Design of Prevention of Mother to Child Transmission of HIV/AIDS program • Procurement of drugs and commodities • Improving performance of family planning counselors

33. PROGRAM MANAGEMENT & OPERATIONS • Number of staff to support program monitoring • Reporting mechanisms • Allocation of national program funds to districts or local implementers

34. Decision Making Activity continued… • THREE TYPES OF DECISIONS: • Policy, advocacy & planning • Program design& improvement • Program Management & operations • ACTION: • Organize the brainstorming answers by the 3 types of decision-making. • Post on wall accordingly.

35. APPROACHES TO DECISION-MAKING(HOW) • Rational/Scientific • Political • Routine

36. Traditional Health Management Decision Making

37. Data Demand and Information Use(DDIU)

38. Information Availability Data Collection & Analysis Information Use (decisions made) Data Demand DDIU-Specific Framework Improved Health Decisions Improved Accountability

39. What is DDIU? • DDIU is a systematic approach that • Applies best practices • Applies appropriate tools • Helps increase demand for quality health-related data  • Ensures that resulting information is used in an evidence-based decision-making process.

40. 4 Distinct Steps in the DDIU Process Getting Ready to Engage: Identify Issue or Problem • Step 1: Assess Current Situation • DDIU Supply & Demand Matrix • DDIU Assessment Checklist

41. Step 1. Assess the Situation • Systematic approach to diagnose areas needing attention • DDIU assessment tools help identify opportunities to increase data demand and use • Supply & Demand Matrix • DDIU Assessment Checklist

42. Step 1a. Supply & Demand Matrix Data Supply Improving Weak Statistics & other evidence sources weak; policymakers & program managers make little use of them. Evidence-based program & policymaking are not practiced. Quantity & quality of statistics & other sources of evidence improving, but not used for decision making because policymakers & program managers lack incentives &/or capacity to use them. Weak Data Demand and Information Use Statistics & other sources of evidence are improving & being increasingly used for decision making. This results in better policy & program design & implementation. Statistics & other sources of evidence weak but increasingly used by policymakers & program managers for variety of purposes. Data deficiencies reduce quality of decision making. Improving 1Adapted from C. Scott. 2005. “Measuring Up to the Measurement Problem: The role of statistics in evidence based policy-making”. Prepared for Paris 21, 2005

43. Recall: Determinants of Information Use • Behavioral aspects • Decision maker attitudes, staff motivation • Technical aspects • Technical skills, availability of computers, data system design • Organizational aspects • Structural – roads, telecommunication • Organizational – clarity of roles, support, flow of information

44. Steps in the DDIU Process Identify Issue Step 1: Assess Situation • Step 2: Identify Strategic Opportunities • DDIU Entry Point Analysis • Identify anticipated results

45. Step 2. Identify Strategic Opportunities Source of Data Type of Decisions Decision makers (Stakeholders)

46. Step 2. Determining Entry Points for DDIU • What decisions, data, & stakeholders involved? • Is activity focused on RHIS, enhancing use of specific M&E data set or research finding? • Is activity focused on particular problem, issue or set of decisions that need to be made? • Is the activity focused improving information use at the national, district, facility or community level? • Is there a group of stakeholders that require DDIU skills?

47. Step 2. Identifying the Entry Points • Program Stages as entry points for DDIU. Each cell is an entry point, as the intersection of • Program Stages • Problem identification • Selection of response • Implementation & program monitoring • Evaluation • Domains affecting decision making • Decisions • Types of data needed • Stakeholders

48. Step 2. Program Stages Matrix

49. Steps in the DDIU Process Identify Issue Step 1: Assess Situation Step 2: Identify Strategic Opportunities Step 3: Develop Strategy (select tools & approaches) Assessment tools:Stakeholder Analysis, PRISM, Constraints to Data Use DDIU Tools: Decision Calendar, Info. Use Mapping DDIU Support Interventions: TA, Capacity building, Targeted data use workshops

50. Steps in the DDIU Process Identify Issue Step 1: Assess Situation Step 2: Identify Strategic Opportunities Step 3: Develop Strategy • Step 4: Apply and Assess Strategy • Applying tools and approaches • Verifying anticipated results