1. Data sources Facilitators’ Workshop on District Health Performance Improvement Lilongwe, 25 th – 27 th March 2015

2. Steps Diagnose Select interventions Define indicators Identify information sources and collect data Identify the bottlenecks Identify areas lagging behind Analyse the root causes of bottlenecks Intervene Prioritize solutions with all stakeholders Define an implementation and monitoring plan Support implementation Verify Monitor frequently using existing opportunities Adjust Take corrective actions to ensure impact

3. Characteristics of the information we need to gather Relevant for planning at local level: – to populate the bottleneck identification graphs and dashboards – to inform the causality analysis and the identification of solutions Quick, easy and sustainable to be collected Far from the standards used for research Still, reliable for decision making for programs

4. A difficult balance data quality and reliability sustainability and quick availability

5. household surveys, health facilities surveys, HSAs surveys HMIS, IHRIS, LMIS, LIMS, health facility reports, HSAs reports DHIS 2 (managerial dashboards integrating datasets) DHIS 2 (managerial dashboards integrating datasets) Data sources used to create indicators for bottlenecks analysis 2011 - 2014 2015 2016 on… MDG Endline Survey, SPA Survey

6. 2011 - 2014 Health Facility Surveys HSAs Survey Household Survey

7. Data from health facilities and CHWs PROs Relatively quick to obtain: in a couple of weeks the questionnaires can reach the facilities, are filled in and get back In most cases there is no need for sampling and all facilities can be involved. After routine data, the cheapest way of collecting data, since they can be done using the routine activities. CONs Require an additional data collection (but can pay off more than “fishing” data of poor quality from the HMIS) May be time consuming for the health personnel Require additional data entry and processing

8. Data from households PROs Provide information that is otherwise not available Avoid any problems with the denominators Quick way to gather information on many determinants CONs Require an additional data collection May be time consuming for the health personnel Require additional data entry and processing More expensive than using existing data Less frequent availability of data

9. 2015 Mapping HMIS, health facility reports, HSAs reports, Program surveys available IHRIS, LMIS, LIMS SPA Survey MDGs Endline Survey

10. 2016 Mapping HMIS, health facility reports, HSAs reports, Program surveys available IHRIS, LMIS, LIMS DHIS 2 – Managerial dashboards

11. Strengths of Routine Information Systems Continuously collected – suitable for frequent monitoring Existing system – no new data collection; – builds local capacity; – sustainable. Typically available at lowest administrative levels – District, facility catchment area Integral part of health system – direct link to health system actions

12. Problems with routine information systems Ensure good quality Ensure completeness Too many records and indicators not always relevant – Important indicators missing Perception at lower level is reporting is a “burden” and data is just for reporting to higher level Lack of use by different levels

13. Key challenges in improving the HMIS Build managerial dashboards Building capacity at different levels to process and utilize information for decision making Integrate different data sources in one common information software Capturing non-facility based (community level) information

14. Informing the causality analysis on the demand side FGDs to identify reasons behind demand side bottlenecks and get suggestions on possible solutions Light version Collect causes of behaviors and possible ways to change barriers Useful to explore in particular cultural barriers, financial barriers, acceptability of services, reasons behind drop outs…