1. DATA DEMAND AND USE: S HARING I NFORMATION AND P ROVIDING F EEDBACK Session 5

2. Session Objectives Understand the importance of feedback in program improvement and management List potential barriers to providing feedback Consider how to improve feedback mechanisms in participants own work 2

3. Session Overview Define feedback Examples of feedback Possible ways of providing feedback Group discussion 3

4. We are always giving patient forms and data to our M&E Unit, who then gives data to donors and the government. I am the head doctor and I never have the chance to look through the data before they go up. We just keep giving data up and up, and we never hear back about it… Head of ART facility, Nigeria

5. Importance of Feedback Information needs to be shared: At timely and regular intervals Within, between, up, and down Paves path between data collectors and users at all levels of the health system

6. Importance of Feedback Leads to greater appreciation of data: Improved data quality Influences collection of appropriate data Important element of management and supervision: Creates opportunity to monitor & improve program services Incentive for staff

7. Implementing Partner Director Program Manager Program Site Facility Manager/ Head Doctor Staff Department Department Head Staff Donor

8. Examples of Feedback Sharing information within a facility or organization Sharing aggregated service provision data from facilities within a district or between provinces Meetings between facility and supervising agency to review and discuss information Meetings between donor and NGO to review information and discuss challenges and opportunities

9. Working Toward a Culture of Information Use Information becomes an integral part of decision-making processes, including planning, problem solving, choosing alternatives, feedback, etc. Empowers people to ask questions, seek improvement, learn, and improve quality

10. Higher Levels: District, Province, National Analysts, Evaluators Service Delivery Point Feedback Managers, Government, Donors Program Compiled Data Clinical histories, Service Statistics Reports Information Flow

11. Variety of Formats Narratives Summaries, bulleted items, graphs, charts In-person discussion One-on-one Staff meetings, district meetings Speeches to staff Supervision visits

14. Quarterly Performance Indicators #IndicatorNumeratorDenominatorPercentage ART 1% of eligible clients placed on ART # of new clients on ARTSum of # of new clients on ART and clients on ART waiting list 100% 39 2% of current ART clients # of active clients on ART# of cumulative clients on ART 92% 16201765 3% of ART clients in 6 month cohort undergoing repeat CD4 testing # of clients for whom repeat CD4 testing was done at 6 months Total # of active ART clients in 6 month cohort 94% 147156 Pediatric ART 1% of children current on ART # of active children on ART# of cumulative children on ART 78% 4558 ART Care Follow-up 1% of non active ART patients who have stopped ART. # of patients who stopped ART. # of non active ART patients. 0% 0145 2% of non active ART patients who transferred out. # of patients who transferred out. # of non active ART patients. 6% 8145 3% of non active ART patients who died. # of patients who died.# of non active ART patients. 73% 106145 4% of non active ART patients who have been lost to follow- up. # of patients who have been lost to follow-up. # of non active ART patients. 16% 23145

15. When developing a feedback mechanism, consider… The information being shared Who will benefit from feedback The format of the feedback mechanism The forum in which the feedback will be shared How often the feedback will be provided How the feedback will move to the next level Document the process

16. Potential barriers to providing feedback Hierarchy Role clarification – data clerk & M&E officer Approval requirements to distribute data Lack of knowledge of what information stakeholders need

17. Group Participation Discuss barriers to providing feedback that you have experienced in your work Discuss the benefits of feedback that you have experienced in your work Identify: Two stakeholder groups that would benefit from receiving feedback The ideal mechanism to provide feedback to them

18. Key Messages Sharing information within, between, up, and down the health system/project/organization is essential to data use Address barriers to feedback Create a formal feedback mechanism Feedback should be: timely, regular, constructive, descriptive, helpful, and collaborative

19. THANK YOU! MEASURE Evaluation is a MEASURE project funded by the U.S. Agency for International Development and implemented by the Carolina Population Center at the University of North Carolina at 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 not necessarily reflect the views of USAID or the U.S. Government. MEASURE Evaluation is the USAID Global Health Bureau's primary vehicle for supporting improvements in monitoring and evaluation in population, health, and nutrition worldwide. Visit us online at http://www.cpc.unc.edu/measure