CONTEXT OF DECISION MAKING

Module 2

PART 1: DETERMINANTS OF DDU

Part 1: Session Objectives

Highlight the determinants of data use List potential barriers to data use Introduce the Action Plan to Address Barriers

to Data Use tool

What Determines Data Demand & Use?

ORGANIZATIONALTECHNICAL

BEHAVIORAL

* 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).

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

Data are often underutilized because of…

Organizational constraints Structural – roads, telecommunication Organizational – clarity of roles, support,

flow of information Political interference

Data are often underutilized because of…

Individual constraints Decision-maker attitudes, Staff motivation, Lack of “data culture”

What Determines Data Demand & Use?

ORGANIZATIONALTECHNICAL

BEHAVIORALPOLITICS

CULTURE

SOCIETY

* 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).

What barriers have you faced to using or getting others to use data and

information?

Group Participation

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

subnational assessments

Assessment of Data Use Constraints ToolTechnical Constraints

Technical constraints are related to the ability to generate high-quality data and analyses.

RA8 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?

RA9 Are there multiple sources of information or statistics for issues of importance to you, and have you experienced any problems caused by having different estimates?

RA10 I am interested in knowing about technical capacity for collecting and using information. Does your agency have the technical capacity to produce reliable information without a lot of external technical assistance?

RA11 Does your agency have the technical capacity to ensure access to and availability of reliable data?

RA12 Has there been an occasion when data quality or local technical capacity made it difficult for you to use information in making a decision?

RA13 How would you have gone about preventing this situation?

Barrier: Steps Involved

PersonResponsible

Other Stake-holders

General Timeline

Action Plan for Addressing Barriers to Data Use

Small Group Activity 2: InstructionsChoose 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: 1 hour

Barrier: Lack of technical capacity in M&E

Steps Involved

PersonResponsible

Other Stake-holders

General Timeline

Proposed Intervention: Train all program managers in X organization on basic monitoring and evaluation (indicators, developing M&E plan, documenting results, managing toward results, etc.)

Identify funding

Director Deputy, Program mgr

January2008

Seek out trainers and curricula

M&E Specialist

Deputy director, Training coordinator

February 2008

Action Plan for Addressing Barriers to Data Use

Small Group Activity: Report Back

Share priority barriers Discuss solutions crafted Present action plan for two priority barriers Time for report back: Each group has 10–15

minutes

PART 2: CONTEXT OF DECISION MAKING

Part 2: Session Objectives

Explain the context of decision making Define the concept of stakeholders Explain the importance of involving

stakeholders throughout the data use in decision making cycle

Introduce the Stakeholder Analysis and Engagement tools

Group Participation

How can we ensure that information is being used to make diagnoses

and inform decisions?

Stake-holders

Decisions

Context of Decision Making

Data

Stake-holders

Decisions

Context of Decision Making

Data

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

Stakeholders Nongovernmental organizations Professional associations Religious leaders Journalists/media Private sector/business

Data Producers vs. Data UsersData 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

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

Results of Involving Stakeholders in Data Use Process

Relevance of data Ownership of data Appropriate dissemination of data Use of data

Stakeholder Analysis Matrix & Engagement Plan

Clarify who has interest in a program and what that interest is

Identify who can help a program and how, and who can hurt it

Help you use this information for the success of the planning effort

Stakeholder Analysis Matrix

The Stakeholder Analysis Matrix is a framework and process for:

Identifying stakeholders Defining their roles and resources Identifying dynamics among stakeholders Setting the optimum stakeholder group

Stakeholder Analysis MatrixName of stakeholder organization, group, or individual

Stakeholder descriptionPrimary purpose, affiliation, funding

Potential role in the issue or activity

Level of knowledge of the issue

Level of commitmentSupport or oppose the activity, to what extent, and why?

Available resourcesStaff, money, technology, information, influence

Name of stakeholder organization, group, or individual

Stakeholder descriptionPrimary purpose, affiliation, funding

Potential role in the issue or activity

Level of knowledge of the issue

Level of commitmentSupport or oppose the activity, to what extent, and why?

Available resourcesStaff, money, technology, information, influence

National AIDS Control Committee

Involved in planning, implementation, M&E of all HIV/AIDS programs in the country; approves donor and NGO-funded HIV/AIDS programs

Facilitates the stakeholder meeting, prepares for meeting by identifying data sources and preparing an agenda

High – receives reports on PMTCT activities from MCH division at MOH; Medium level of knowledge of int’l guidelines and studies

Strongly supports activity but hesitant to use international data sources. NACC opposes use of the DHS and most recent international estimates, as it considers these sources to overestimate HIV prevalence

Staff available to facilitate; Room and computers available for meetings at NACC headquarters

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

How to Involve Stakeholders 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

Stakeholder Engagement Plan

Stakeholder organization, group,

or individual

Potential role in the activity

Engagement strategy

How will you engage this stakeholder in the activity?

Follow-up strategyPlans for feedback or

continued involvement

Program issueProposed activityDate

Stakeholder Engagement Plan

Stakeholder organization, group, or individual

Potential role in the activity

Engagement strategyHow will you engage this

stakeholder in the activity?

Follow-up strategyPlans for feedback or

continued involvement

National AIDS Control Committee (NACC)

Facilitates the stakeholder meeting, prepares for meeting by identifying data sources and preparing an agenda that allows for the sources to be discussed

The NACC is the lead in this activity. It will be important for the NACC to involve more specifically the PMTCT coordinator, clinical care coordinator, and National AIDS Program Coordinator

The NACC is responsible for following up with the prioritized stakeholders

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

Stake-holders

Decisions

Context of Decision Making

Data

Decision Areas

Program design and evaluation Program management and improvement Strategic planning Advocacy and policy development

Program Design and Evaluation

Design Select messages for prevention campaigns

Evaluation Determine if new program approaches are

needed to ensure that health impact objectives are met

Program Management and Improvement

Management Determine if the program is meeting its

process objectives Improvement

Develop new strategies to increase coverage

Strategic Planning

Identify geographic areas of highest need

Determine human resource allocation Determine which of offered services is

making the greatest impact

Advocacy and Policy Development

Identifying and quantifying underserved populations

Identifying focus areas for new policies

Stake-holders

Decisions

Context of Decision Making

Data

Data and Information Census Vital events data Surveillance data Household surveys Facilities-level service statistics Financial and management information Modeling, estimates, and projections Health research

Stake-holders

Decisions

Factors Other than Data that Influence Decisions

Data

Political Ideology

Competing Priorities

Power Relationships

Public Opinion

Arbitrariness

Stakeholders Involve new counterparts

Strengthening the Decision-making Process

Decisions Understand service delivery realities

Data May require additional data

Small Group Activity 3: Instructions Break into small groups. Each group should select a decision that they make in

their work settings and complete the Stakeholder Analysis Matrix around that decision.

A minimum of 7 stakeholders should be identified. Complete the Matrix across the columns for 1–2

stakeholders. Select one stakeholder and complete the Stakeholder

Engagement Plan for that stakeholder. Time for activity: 45 minutes

Group Work Report Back Have note taker transfer your final Stakeholder

Analysis Matrix onto flip chart paper Share the decision your group chose Share the priority stakeholders selected Choose 1 stakeholder and share the entire row

from the Matrix for that stakeholder Share the Engagement Plan for the same

stakeholder Time for report back: 10–15 min per group

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