Data Demand & Information Use (DDIU):

Data Demand & Information Use (DDIU):
Module 05_DDIU 4/16/2017 Data Demand & Information Use (DDIU): Strengthening Programs through Improved Use of Data

Module 05_DDIU 4/16/2017 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.

Module 05_DDIU 4/16/2017 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.

Module 05_DDIU SESSION OVERVIEW 4/16/2017 Introduction to Information Use: Local and International Intro Exercise: Information Use and Problems Key Concepts: Data – Information – Decision-making Decision Exercise Purpose of Dissemination & Utilization of Information Decisions and Decision-Making Dissemination & Utilization Plan / Tools Indicator - Decision Calendar Exercise Stakeholder Identification Data Use Constraints Exercise

Introduction to Information Use
Module 05_DDIU 4/16/2017 Introduction to Information Use

Module 05_DDIU 4/16/2017 BRAINSTORM ACTIVITY Sharing personal experiences on Information use and common information systems implementation problems Group 1/3: Why do we need information to monitor/evaluate health programs ? Group 2/4: What are the common problems found in the implementation of information systems due to political, social, and economic environments? Bullet 4. Note that the barriers could be political, social, and economical.

Main Uses of Health & Management Information - 1
Module 05_DDIU 4/16/2017 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

Main Uses of Health & Management Information - 2
Module 05_DDIU 4/16/2017 Main Uses of Health & Management Information - 2 To identify and monitor risk factors – assessment of levels and trends in exposure to factors that affect health To identify epidemics and ensure that effective control measures are taken To monitor timely and appropriate use of resources and identify gaps To communicate effectively with decision-makers and the public WHAT IS THE COMMON THEME ? DECISION-MAKING!

HMIS: Crucial Concepts
Module 05_DDIU 4/16/2017 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

Decision Focus of a HMIS
Module 05_DDIU 4/16/2017 Decision Focus of a HMIS Data Flows Information Decisions/ Actions Flows MIS USERS

Decision Focus of HMIS MIS: - Data/Information Processes:
Module 05_DDIU Decision Focus of HMIS 4/16/2017 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 System Information Decisions Actions User Management System

Module 05_DDIU 4/16/2017 Decision Focus of a HMIS SYSTEM DEVELOPMENT Decisions/ Actions Data Flows Information Flows MIS USERS SYSTEM INTERFACE

Module 05_DDIU 4/16/2017 Decision Focus of a HMIS USE(R) DEVELOPMENT Data Flows Information Decisions/ Actions Flows MIS USERS USER INTERFACE

COMMON PROBLEMS OF HMIS - 1
Module 05_DDIU 4/16/2017 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

COMMON PROBLEMS OF HMIS - 2
Module 05_DDIU 4/16/2017 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

HMIS ‘Maturing’ Problems
Module 05_DDIU 4/16/2017 HMIS ‘Maturing’ Problems Delays due to resource constraints as sustained support may not be available for longer periods Experience of a rapid turnover of staff, both trainers and trainees Views by new, especially expatriate, staff leads to regular questioning/review of the system, so that the system does not get the time to settle Stationary for the system remains a recurrent financial burden and a last budget priority There is an uncalled-for urge to introduce IT overtaking the implementation of the manual system Actual use of data/information is still low; needs the development of a ‘use' culture

HMIS Review in Tanzania (2-2000)
Module 05_DDIU HMIS Review in Tanzania (2-2000) 4/16/2017 Problem analysis iii Decreased health status Non-participatory decisions Ill-timed decisions Decreased health status Consequences Poor sharing down, up, laterally Non-evidence based decisions 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 Weak analysis Poor capacity for decisions Some information bypassing decision-makers Poor preparation of data for use Info effort seen as burden Contributing factors

HMIS Review in Zambia (3-2000)
Module 05_DDIU 4/16/2017 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

Module 05_DDIU 4/16/2017 Common DDIU Concepts

M&E IS AN ESSENTIAL PROCESS
Module 05_DDIU 4/16/2017 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

Module 05_DDIU DATA VS. INFORMATION 4/16/2017 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.

Module 05_DDIU 4/16/2017 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

UTILIZATION The process of putting:
Module 05_DDIU 4/16/2017 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

Module 05_DDIU 4/16/2017 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. Monitoring provides regular feedback to compare what was planned to actual events by tracking: costs personnel implementation time organizational development economic and financial results

WHY EMPHASIZE A FEEDBACK SYSTEM?
Module 05_DDIU 4/16/2017 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

ESSENTIALS OF M&E INFORMATION
Module 05_DDIU ESSENTIALS OF M&E INFORMATION 4/16/2017 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 To ensure use…it is important that M&E information maintains the qualities that we have been referring to throughout this week. These are:

INFORMATION (MIS) USE Focus should be knowledge generation
Module 05_DDIU INFORMATION (MIS) USE 4/16/2017 Focus should be knowledge generation

Why disseminate & utilize M&E information?
Module 05_DDIU 4/16/2017 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 Data should be collected, analyzed and disseminated to respond to policy and program-related issues. Contribute to decisions about change in program implementation Improve program interventions

Understanding Decision-Making
Module 05_DDIU 4/16/2017 Understanding Decision-Making

UNDERSTANDING DECISION-MAKING
Module 05_DDIU 4/16/2017 UNDERSTANDING DECISION-MAKING Decision Making: The process of choosing from among various alternatives using information at hand What decisions have you made already today???

Module 05_DDIU 4/16/2017 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?

IDENTIFYING DECISION-MAKERS (WHO)
Module 05_DDIU 4/16/2017 IDENTIFYING DECISION-MAKERS (WHO) Sector Health Education Commercial Function Policy Planning Budgeting Service delivery Advocacy Evaluation Level National Regional Local Decision Makers

DECISIONS WITHIN PROGRAMS (WHAT)
Module 05_DDIU DECISIONS WITHIN PROGRAMS (WHAT) 4/16/2017 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

Decision Making Exercise
Module 05_DDIU 4/16/2017 BRAINSTORM ACTIVITY Decision Making Exercise Divide in 5 groups: What decisions are being made in a: ARV/Treatment programme HTC TB/HIV PMTCT Divide into project groups and list on flip chart decisions they make (specifically) 10 minutes when done review as an entire group (10 minutes) - Feedback on this will include having the decision be clear and well defined

TYPES OF DECISIONS Policy, Planning & Advocacy
Module 05_DDIU 4/16/2017 TYPES OF DECISIONS Policy, Planning & Advocacy Program Design & Improvement Program Management & Operations Decisions are categorized into three types. These three types are not always mutually exclusive however, they are divided this way based on the following criteria: Who is involved in making the decision The type of data required to make this decision and how it is presented The process by which decisions of this type of made.. The reason it can useful to categorize decisions is because doing this can help operationalize integrating use of information into the decision making process- If you have a decision to make and the data that informs that decision what is the plan for entering for entering it into the process?

POLICY, PLANNING & ADVOCACY
Module 05_DDIU 4/16/2017 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 Considering that policy and advocacy decisions and issues typically require a specific process for formalization and approval they are there in their own category. This area includes national, sector-wide planning and resource allocation.

PROGRAM DESIGN & IMPROVEMENT
Module 05_DDIU 4/16/2017 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 Depending on the scope and timeline of the program there could be a wide range of program specific decisions that need to be made beginning with program design and improvement, scale-up, sustainability and possibly close out.

PROGRAM MANAGEMENT & OPERATIONS
Module 05_DDIU PROGRAM MANAGEMENT & OPERATIONS 4/16/2017 Number of staff to support program monitoring Reporting mechanisms Allocation of national program funds to districts or local implementers Aside from decisions that directly influence the content and success of a program are the operational and management decisions that will affect its success. These include administrative and financial decisions that a program manager must make in order to support an ongoing program. Administrative and financial data should be used to support these decisions.

Decision Making Activity continued…
Module 05_DDIU 4/16/2017 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. due to political, social, and economic environments? Bullet 4. Note that the barriers could be political, social, and economical.

APPROACHES TO DECISION-MAKING (HOW)
Module 05_DDIU 4/16/2017 APPROACHES TO DECISION-MAKING (HOW) Rational/Scientific Political Routine Optional 1: Rational/Scientific approach Recognize the need for a decision Establish, rank, and weigh the decision criteria Gather available information Identify possible alternatives Evaluate each alternative with respect to all criteria Select best alternative. Utilize M&E information BUT IN THE REAL WORLD WE LIVE, OTHER OPTIONS DO EXIST. THE SAD SITUATION IS THAT THEY MAY NOT BE EVIDENCE-BASED Optional 2. Political (directives etc) Optional 3: Routine “the way things are done out here” you cannot identify why things are being done the way they are. No basis.

DETERMINATES of INFORMATION UTILIZATION that AFFECT DECISION MAKING
Module 05_DDIU DETERMINATES of INFORMATION UTILIZATION that AFFECT DECISION MAKING 4/16/2017 SYSTEMS APPOACH TECHNICAL APPOACH INDIVIDUAL BEHAVIOR CULTURE DECISIONS POLITICS SOCIETY Data demand and utilization are central to achieving evidence-based decision making. We need to consider three aspects of demand for information – not only the quality of the information (technical approach), but also the individuals who use or should use the information, and the health or organizational systems within which they operate. This is called the PRISM framework. This approach to Data Demand and Use is best illustrated by the strategic triangle linking Technical, Individual Behavior, and System. Sustainable demand for high quality health information is most likely to result from a strategy that simultaneously focuses on three fronts - improving technical quality of data and data tools, building individual capacity for understanding and using data, and strengthening the organizational context in support of data collection and use. This strategy should be pursued with a clear appreciation of the importance of understanding the political, cultural, and social context of decision making. In the slides that follow, we will fold individual behavior into systems and consider two ways of initiating the discussion – through the systems in which decisions are made, or through the information which is used or needed. These approaches are not mutually exclusive, but meet up in the middle. However, they do represent different ways of approaching the result of increased user demand. Decision making occurs within political, cultural, and social contexts

Traditional Health Management Decision Making
Module 05_DDIU 4/16/2017 Traditional Health Management Decision Making

UNDERSTANDING DECISION MAKING
Module 05_DDIU 4/16/2017 UNDERSTANDING DECISION MAKING What information? Why? Who else? Decision makers Decisions How?

Data Demand and Information Use (DDIU)
Module 05_DDIU 4/16/2017 Data Demand and Information Use (DDIU)

DDIU-Specific Framework
Module 05_DDIU 4/16/2017 DDIU-Specific Framework Improved Health Decisions Information Availability Information Use (decisions made) Data Collection & Analysis Data Demand This is a diagram of the DDIU conceptual framework. DDIU contends that evidence-based decision making is enhanced by: generating a sound demand for health information collecting and analyzing relevant health data making information available to decision makers, and finally using the information to improve health system performance Improved Accountability

What is DDIU? DDIU is a systematic approach that
Module 05_DDIU 4/16/2017 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. Key points… Simply put, DDIU is a process to help ensure that the health information that is produced is used, and as a result of using the information, there is an increased demand for this type of information. Engages stakeholders, decision makers and researchers Strengthens linkages between these groups Works to improve information production (quality and analysis) Based on existing best practices Builds capacity of counterparts Three new elements Consolidated approach Systematic Identifies problems, analyzes causes, develops solutions, monitoring and evaluating Relies on the use of innovative tools

4 Distinct Steps in the DDIU Process
Module 05_DDIU 4/16/2017 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 There are four distinct steps in facilitating data demand and information use. Step 1 is to assess the situation with regard to technical, individual and organizational-level determinants. The DDIU Assessment checklist will help with targeting the area that may require the most attention, and will assist the user in deciding which DDIU tool to use. Step 2 is to use the information produced from the assessment to define strategic opportunities in terms of the entry point of the DDIU activity, beneficiaries and stakeholders, and anticipated results. The third step is to select the DDIU tools and approaches to be applied and, finally, the fourth step is to use those tools and approaches and to document the impact of the DDIU activities in terms of the anticipated results from Step 2.

Step 1. Assess the Situation
Module 05_DDIU 4/16/2017 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

Step 1a. Supply & Demand Matrix
Module 05_DDIU 4/16/2017 Step 1a. Supply & Demand Matrix Data Supply Weak Improving 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 weak but increasingly used by policymakers & program managers for variety of purposes. Data deficiencies reduce quality of decision making. Statistics & other sources of evidence are improving & being increasingly used for decision making. This results in better policy & program design & implementation. Improving 1Adapted from C. Scott “Measuring Up to the Measurement Problem: The role of statistics in evidence based policy-making”. Prepared for Paris 21, 2005

Recall: Determinants of Information Use
Module 05_DDIU 4/16/2017 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 In the DDIU approach, there are three main determinants of use. The first, and possibly most important determinant, are the behavioral aspects of those who produce and use the information. If health system information is to be used, the decision maker must be open to the idea of using the information to make decisions - and see value in using it. The other determinants of information use are: the technical aspects of data processes and tools the system/organizational context that supports data collection, availability and use, and DDIU is a strategy to address these three components, and can be used to identify opportunities for and constraints to use.

Step 1b. DDIU Assessment Checklist
Module 05_DDIU 4/16/2017 Step 1b. DDIU Assessment Checklist Technical: Do users know what data they want? Are goals & objectives expressed in data terms? Are data systems functioning well? Are there any data processing constraints? Organizational: Are all stakeholders allowed access to data? Are there clear roles & responsibilities defined for info. use? Are data flow channels clear and followed? Are data quality norms established and enforced? Behavioral: Do stakeholders value information when making decisions? Are public health staff motivated to use data & information? Are public health staff trained in data analysis? Will information-sharing lead to lack of promotion or job loss?

Steps in the DDIU Process
Module 05_DDIU 4/16/2017 Steps in the DDIU Process Identify Issue Step 1: Assess Situation Step 2: Identify Strategic Opportunities DDIU Entry Point Analysis Identify anticipated results There are four distinct steps in facilitating data demand and information use. Step 1 is to assess the situation with regard to technical, individual and organizational-level determinants. The DDIU Assessment checklist will help with targeting the area that may require the most attention, and will assist the user in deciding which DDIU tool to use. Step 2 is to use the information produced from the assessment to define strategic opportunities in terms of the entry point of the DDIU activity, beneficiaries and stakeholders, and anticipated results. The third step is to select the DDIU tools and approaches to be applied and, finally, the fourth step is to use those tools and approaches and to document the impact of the DDIU activities in terms of the anticipated results from Step 2.

Step 2. Identify Strategic Opportunities
Module 05_DDIU 4/16/2017 Step 2. Identify Strategic Opportunities Source of Data Type of Decisions Decision makers (Stakeholders)

Step 2. Determining Entry Points for DDIU
Module 05_DDIU 4/16/2017 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?

Step 2. Identifying the Entry Points
Module 05_DDIU 4/16/2017 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

Step 2. Program Stages Matrix
Module 05_DDIU Step 2. Program Stages Matrix 4/16/2017 Stage Decisions Type of Data Stakeholders 1. Problem ID & recognition 2. Selection of response 3. Implementation & program monitoring 4. Evaluation

Module 05_DDIU 4/16/2017 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 There are four distinct steps in facilitating data demand and information use. Step 1 is to assess the situation with regard to technical, individual and organizational-level determinants. The DDIU Assessment checklist will help with targeting the area that may require the most attention, and will assist the user in deciding which DDIU tool to use. Step 2 is to use the information produced from the assessment to define strategic opportunities in terms of the entry point of the DDIU activity, beneficiaries and stakeholders, and anticipated results. The third step is to select the DDIU tools and approaches to be applied and, finally, the fourth step is to use those tools and approaches and to document the impact of the DDIU activities in terms of the anticipated results from Step 2.

Module 05_DDIU 4/16/2017 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

DDIU Tools http://www.cpc.unc.edu/measure
Module 05_DDIU 4/16/2017 DDIU Tools Stakeholder Engagement/Analysis Decision Calendar Assessment of Data Use Constraints Information Use Mapping PRISM (4 Tools) Today I will describe five of the core DDIU tools: These include the Decision Calendar, Assessment of Constraints to Data Use, Information Use Map, Stakeholder Engagement and PRISM Tools. This is not intended to be a comprehensive or exhaustive list of tools. As more tools and approaches are field-tested and refined, they will be added to this core list. Also, as you will see through the course of this presentation, data use can be facilitated without the use of these tools – there are a variety of other tools and approaches that MEASURE Evaluation staff bring to the table to enhance data use. It is important to note that these tools can be used independently and in different combinations as required in particular country contexts.

Module 05_DDIU 4/16/2017 Stakeholder Analysis

Stakeholder Analysis Purpose Description
Module 05_DDIU 4/16/2017 Stakeholder Analysis Purpose Facilitate identification and engagement of appropriate stakeholders in the decision process so data initiatives reflect their needs and values Description Framework for assessing key players and their interests, knowledge, alliances, resources, and power People are more likely to use data in their decision making if they have been involved from the beginning, they believe the data are of high quality, and they feel the specific data address their priorities. Engaging stakeholders early and systematically in the research process can provide the opportunity for the right questions to be asked in the right way, and, in turn, to define data activities that will generate quality information that can be used. The Stakeholder Engagement tool is a matrix framework and process for: Identifying stakeholders. Defining their roles and resources. Identifying dynamics among stakeholders – their interests, knowledge, resources, power and importance. Creating an engagement plan. And finally, Tracking stakeholder engagement. The Stakeholder Engagement tool represents a guide to asking the right questions, but there is no one way or specific protocol for gathering the necessary information. Useful information to add to the matrix and plan can surface in any encounter, not just in meetings specifically designed for this tool. The process begins by asking a key informant to identify the key stakeholders. During discussions with those individuals, they will likely identify other stakeholders. Ultimately the matrix will capture the contributions, roles and engagement strategies of stakeholders and groups at different levels and with different vested interests

What is a Stakeholder? Some Examples of Stakeholders Donors
Module 05_DDIU 4/16/2017 What is a Stakeholder? Some Examples of Stakeholders Donors Country Directors Implementing Agencies Surveillance System Personnel Beneficiaries Program Managers Policy Makers Journalists/Media Your Supervisor or Colleagues Private Sector Your Own Organization (Remember – you are stakeholders too!) A stakeholder is anyone who has a “stake” in your program

3 Types of Stakeholders Beneficiary Implementer Policymaker
Module 05_DDIU 4/16/2017 3 Types of Stakeholders Beneficiary e.g. HIV/AIDS client, MARP Implementer e.g. NGO staff, clinician, program manager Policymaker e.g. School board, donor or donor groups, government, media/journalist

Each has a different stake!
Module 05_DDIU 4/16/2017 Each has a different stake! Beneficiary Efficiency Effectiveness Quality Implementer Efficiency (rapid turnover) Reputation (cost effectiveness, survival or growth of organization, clientele, market share) Policymaker Correct or improved policies Correct political decisions Fulfill responsibilities & obligations Quality reputation, re-election or re-appointment

Implications for Data Use & Communication
Module 05_DDIU 4/16/2017 Implications for Data Use & Communication Different stakeholders view activities from different perspectives have different degrees of understanding of the program need different information want different information need/want information at different levels of complexity have different intensities of interest

Stakeholder Analysis Who are the stakeholders?
Module 05_DDIU 4/16/2017 Stakeholder Analysis Who are the stakeholders? What is the stakeholder’s vested interest in the program? Determine each stakeholder’s role How can the stakeholder support the strategy? What can he contribute? What type of opposition might exist? How can the opposition be swayed? Stakeholder’s Role in the Program What influence does the stakeholder have? What resources are available to stakeholder? What types of constraints does he/she face?

Stakeholder Analysis - Steps
Module 05_DDIU 4/16/2017 Stakeholder Analysis - Steps Step 1a - Identify stakeholders and their program expectations and/or results Who is (are) the stakeholder (s)? What category of stakeholders are they?

Stakeholder Analysis - Steps
Module 05_DDIU Stakeholder Analysis - Steps 4/16/2017 Step 2: Determine what each stakeholder wants to know and their intended uses for that data What is each stakeholder’s interest in the programme? What do they already know? What do they want to know (What are their questions?) What is their intended use for the data?

Uses that Stakeholders have for the Data
Module 05_DDIU Uses that Stakeholders have for the Data 4/16/2017 To improve HIV/AIDS program performance (For example: hire more staff, train staff, buy more supplies) To give feedback to program staff (For example: regular staff meetings, including field staff)

Uses that Stakeholders have for the Data (cont.)
Module 05_DDIU 4/16/2017 Uses that Stakeholders have for the Data (cont.) To make decisions about the future direction of the program (For example: scaling-up services/expanding coverage, identifying new geographical areas and/or other services to be added to the program) To communicate program successes and challenges to the community (For example: newspaper articles, press conference, town hall meeting)

STEP 3: Determine Stakeholder’s influence over the programme
Module 05_DDIU 4/16/2017 Stakeholder Analysis - Steps STEP 3: Determine Stakeholder’s influence over the programme What influence does the stakeholder have with the program? How will this impact on how you prioritize data collection?

Step 4: Determine each stakeholder’s role in the M&E implementation
Module 05_DDIU 4/16/2017 Stakeholder Analysis - Steps Step 4: Determine each stakeholder’s role in the M&E implementation Whether the stakeholder can: Be a data or information provider; Make decisions based on M&E findings; or Become a beneficiary of change arising from the M&E findings; etc Each stakeholder may have several roles.

Module 05_DDIU 4/16/2017 Decision Calendar

Decision Calendar Rationale Description
Module 05_DDIU 4/16/2017 Decision Calendar Rationale Explicitly and systematically align decisions with appropriate data resources Description Management tool that helps stakeholders understand need for good supporting data In many cases, a wealth of data resources are available, but research reports are sitting on a shelf and are not being used to influence decisions. In other cases, existing data resources are inadequate for decision making, perhaps because research processes did not consider how data might be used later, or decision makers do not have confidence in the data. Finally, critical policy/program decisions need to be made, and there is not enough information to support the best decisions or to advocate persuasively for the required resources. In your country work, you have probably seen some if not all of these situations. The Decision Calendar helps to resolve these mismatches. It aligns data resources with the decisions they would support, and vice versa. The tool helps program managers appreciate the need for good supporting data, helps data managers visualize how their work can be applied, and helps all stakeholders prioritize decisions and data-collection activities. The Decision Calendar can be developed and applied at the international, regional, national or local level, and can be used in a variety of arenas – policy, planning, programmatic, etc. This tool is intended to be a working document that should be revised as a program or activity develops.

Decision Calendar – 3 Key purposes
Module 05_DDIU 4/16/2017 Decision Calendar – 3 Key purposes Encourages greater use of information in decision making Identifies & documents key policy/program decisions Identifies information needed to support those decisions Encourages better use of existing information Identifies existing data resources Uncovers new ways to use this information to support evidenced-based decision-making Monitors the use of information in decision making Provides timeline for monitoring progress in decision making process Provides systematic way of identifying data use by program managers, donors & consultants (sets of stakeholders)

Decision Calendar - Approach
Module 05_DDIU 4/16/2017 Decision Calendar - Approach Working Tool integrated into annual work plans, regularly monitored, referenced & updated Initial creation or update triggered by Specific, identified decision to be made Stakeholders need more evidence-based decisions Existing information underutilized New data collection activity being planned

Decision Calendar - Approach
Module 05_DDIU 4/16/2017 Decision Calendar - Approach Host country representative must have ownership Must reflect perspectives, needs & interests of people who will use it – secure buy-in Collaborative & Iterative process Can be applied internally by program manager etc., or developed with outside assistance Process entails meeting with key stakeholders to brainstorm decisions & data requirements, ongoing Draws on multiple resources Strategic plan for targeted program or organization M&E Plan or results framework Assessments of M&E systems or information use Specific data sources

Decision Calendar – 2 Approaches
Module 05_DDIU 4/16/2017 Decision Calendar – 2 Approaches Program managers & decision-makers Identify key decisions to be made Determine key stakeholders for decisions Document data sources required for decisions Clarify next steps M&E Specialists Review available data sources Conduct subsequent analysis as needed Identify key findings of analysis Identify key decisions that could be influenced by findings Present insights to appropriate stakeholders Process steps not necessarily sequential!

Types of Decisions Made
Module 05_DDIU 4/16/2017 Decision Calendar Indicator System Level Users Types of Decisions Made Frequency Number of service deliverers trained on HIV/AIDS prevention Local: Regional: National: Donor: Global Fund Funding Annually

Decision Calendar Indicator System Level Users Types of decisions made
Module 05_DDIU 4/16/2017 Decision Calendar Indicator System Level Users Types of decisions made Frequency of Reporting & Decision Making % of men, women & children with advanced HIV infection who are receiving ARV combination therapy according to national guidelines Local Regional National NAP Donor UNGASS Global Fund Funding Annually

Brainstorming Activity
Module 05_DDIU 4/16/2017 Brainstorming Activity Indicator – Decision Calendar Exercise In your groups Pick 2 (other) program indicators and determine Users Types of decisions that can be made Frequency

Data/Information Use Constraints
Module 05_DDIU 4/16/2017 Data/Information Use Constraints

Assessment of Data Use Constraints
Module 05_DDIU 4/16/2017 Assessment of Data Use Constraints Rationale Vast amounts of data & reports that will never be used for decision-making due to constraints or barriers Description Key informant interview guide designed to identify barriers & constraints to data use Identifies best practices in data use so they can be applied Aids in designing & prioritizing approaches for addressing barriers and constraints The Assessment of Data Use Constraints is a tool for rapid assessments that : Identifies existing barriers and constraints to data use. Identifies existing best practices in data use, so these practices can be applied elsewhere. The assessment is made by interviewing key informants at various levels, such as national and district-level policymakers and program managers from the public and private sectors. The assessment can also be used to examine processes within a single organization, and can be incorporated into health information and organizational capacity-building assessments at the national and sub-national levels. As Ed discussed, there are three different types of determinants and constraints to the use of data and information – the behavior of individuals who produce and/or use data, the technical aspects of data processes and tools and the system/organizational context that supports data collection, availability and use. The interview guide is organized by these three categories to examine individual constraints, such as an individual’s motivation to use data in their work;

Assessment of Data Use Constraints – Types of Constraints
Module 05_DDIU Assessment of Data Use Constraints – Types of Constraints 4/16/2017 Organizational Processes not support use of data for various reasons Not officially sanctioned Sensitive material Lack of established channels for data sharing Technical Shortage of computers or software Lack of good definitions for indicators Use of different sources for same indicator or different algorithms in creating it Individual Shortages of M&E skills (manage, interpret & use data) No guidelines to establish protocols for data collection & use Lack of motivation & incentive to produce high quality data or to rely on data for decision making

Assessment of Data Use Constraints – Purpose
Module 05_DDIU 4/16/2017 Assessment of Data Use Constraints – Purpose Identifies barriers & constraints to data use Why M&E systems not producing all value they could Why findings are inconsistent among different reporting entities What are impediments for sharing data Identify best practices in data use Good existing information flow to serve as example for improvements in other initiatives Provide essential knowledge for addressing constraints & barriers Demonstrating ways of overcoming them in each of the three areas Plan M&E system to change, acknowledge (work around) what you cannot change (underlying political/other environment)

Assessment of Data Use Constraints – Approach
Module 05_DDIU 4/16/2017 Assessment of Data Use Constraints – Approach Focuses on organizational, technical & individual constraints Interview process should include range key informants Decision makers: those responsible for policies, operational protocols, project design, resource allocation Interview individuals Up to 2/3 can be at national level, but at least 1/3 at provincial/district ½ from public sector incl. MOH, NAC, other ½ from NGO sector Include policymakers & program managers Focus is on host-country public or private sector decision makers

Assessment of Data Use Constraints – Approach
Module 05_DDIU 4/16/2017 Assessment of Data Use Constraints – Approach Adaptable like other tools presented In one assessment, standardize (for all informants) the interview process Interview process includes consent and confidentiality Encourage respondents to think proactively about possible resolutions Not all constraints resolved, but at least addressed, for example Economic constraints Political constraints Socio-cultural constraints

Brainstorming Activity
Module 05_DDIU 4/16/2017 Brainstorming Activity Data Use Constraint Exercise In your group context Use Assessment of Data Use & Constraints by interviewing at least 2 people in your group Write up the summary table Present and discuss to group

OTHER DATA ASSESSMENT AND USE TOOLS
Module 05_DDIU 4/16/2017 OTHER DATA ASSESSMENT AND USE TOOLS Assessment Tools: M&E S.W.O.T. Audience Analysis Data Use Tools: My M&E Role Activity Results & Dissemination Plan Utilization plan Successfully Implementing Information Use by finding consistent and systematic ways to facilitate increase use of information

In Summary: DISSEMINATION AND UTILIZATION STRENGTHENING M&E CAPACITY
Module 05_DDIU 4/16/2017 In Summary: DISSEMINATION AND UTILIZATION STRENGTHENING M&E CAPACITY Effective data use is the key to unlocking the door to increased M&E capacity

Data Use in Effective M&E
Module 05_DDIU 4/16/2017 Data Use in Effective M&E 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 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

PURPOSE OF M&E (THE BIG PICTURE)
Module 05_DDIU 4/16/2017 PURPOSE OF M&E (THE BIG PICTURE) Program Improvement Share Data with Partners Reporting/ Accountability Therefore this fits into the BIG PICTURE OF M&E in the following manner as demonstrated by the diagram

Module 05_DDIU 4/16/2017 Key Message on M&E There should be no enemies in M&E - we are all (stakeholders) in it together We are dependent on each other – together we can find solutions and achieve much more than each on our own

to strengthen overall M&E capacity
Module 05_DDIU 4/16/2017 REMEMBER... Information: must be based on quality data in order to be useful and must be communicated effectively in order to be useful Information must be used in order to strengthen overall M&E capacity

Module 05_DDIU 4/16/2017 FINALLY... If you identify problems early in implementation, you can respond promptly by modifying your program strategy, reassigning staff or shifting financial resources to improve the chances of meeting your program goals and objectives. Use Information Effectively for decision-making and action taking and Disseminate Information Consistently

Lessons Learned: Zambia
Module 05_DDIU 4/16/2017 Lessons Learned: Zambia Ownership, commitment and understanding need to be constantly fostered and reinforced at all levels of the health system and with partners No matter how good the information system is, it can only succeed if other management (and skills) problems are addressed concurrently Follow-up to training and on-going supportive supervision are critical Information officers, at all levels, need to have their status and skills raised to a higher level Emphasis on data validation should be included in training and follow-up Paper system is not cheap - a mechanism for sustaining supplies needs to be considered from the outset

Quote’s on Information & Decisions
Module 05_DDIU Quote’s on Information & Decisions 4/16/2017 Finagle’s Law: The information you have is not the information you want The information you want is not the information you need The information you need is not the information you can get The information you can get costs more than you want to pay Robin Chambers: “much of the material remains unprocessed, or if processed, unanalyzed, or if analyzed, nit written up, or if written up, not read, or if nor read, nor used or acted upon. Only a miniscule proportion, if any, of the finding affect policy and they are usually a few simple totals” Sect. 5 Miscellaneous and Sacro Sardonic Laws of Science: Good decisions come from wisdom Wisdom comes from experience Experience comes from bad decisions THANK YOU!

Visit us online at http://www.cpc.unc.edu/measure.
Module 05_DDIU 4/16/2017 MEASURE Evaluation is funded by the U.S. Agency for International Development (USAID) through Cooperative Agreement GPO-A and is implemented by the Carolina Population Center at the University of North Carolina in partnership with Futures Group, John Snow, Inc., ORC Macro International, and Tulane University. Visit us online at

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