Data Demand & Use (DDU)

1. Data Demand & Use(DDU) Why we collect health-related data

2. 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

3. Understanding the need for data

4. 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

5. Power relationships Timing Competing priorities Public opinion Political ideology Arbitrariness Local culture of decision-making Other information sources Factors other than evidence-based information influence decisions

6. 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?

7. 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

8. Context Pressing need to develop health policies, strategies and interventions

9. 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

10. Why address data demand & use?

11. Evidence-based Decision Making Process

12. Level of Dissatisfaction that Policy is Based on Scientific Evidence Percent dissatisfied Overseas Development Institute, Jones et al., 2008.

13. 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

14. The Response Better Health Outcomes Data Informed Decisions Monitoring & Evaluation Systems

15. Group Participation How do you and your organization use data and information?

16. 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

17. “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

18. 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

19. Determinants of DDU

20. TECHNICAL ORGANIZATIONAL BEHAVIORAL What Determines Data Demand & Use? * 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).

21. 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

22. Data are often underutilized because of… Organizational constraints • Structural – roads, telecommunication • Organizational – clarity of roles, support, flow of information • Political interference

23. Data are often underutilized because of… Individual constraints • Decision maker attitudes, • Staff motivation, • Lack of “data culture”

24. TECHNICAL ORGANIZATIONAL BEHAVIORAL What Determines Data Demand & Use? CULTURE SOCIETY POLITICS * 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).

25. Discussion What barriers have you faced to using or getting others to use data and information?

26. 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

27. Assessment of Data Use Constraints Tool

28. Addressing Barriers to Using Data and Information in Decision-making

29. Activity:Assessment of Data Use Constraints Tool Choose 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

30. Addressing Barriers to Using Data and Information in Decision-making

31. 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

32. Context of decision-making

33. Discussion How can we ensure that information is being used to make diagnoses and inform decisions?

34. Context of Decision-making Data Stake-holders Decisions

35. Context of Decision-making Data Stake-holders Decisions

36. 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

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

38. Data Producers vs. Data Users Data 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

39. 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

40. Results of Involving Stakeholders in Data Use Process Relevance of data Ownership of data Appropriate dissemination of data Use of data

41. 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

42. 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

43. Stakeholder Analysis Matrix

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

45. 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

46. Stakeholder Engagement Plan Program issue Proposed activity Date

47. Stakeholder Engagement Plan Program issueDevelop plan (inc.M&E plan) to scale-up PMTCT programs throughout system Proposed activity Convene stakeholders to identify priorities based on available data and develop action plan DateNovember 2006

48. Context of Decision-making Data Stake-holders Decisions

49. Decision Areas • Program design and evaluation • Program management and improvement • Strategic planning • Advocacy and policy development

50. 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