How Might We Overcome the Health Data Utilization Challenge?

Despite significant headway, routine immunization and new vaccine introductions still face strong challenges related to collecting and using quality data for planning, management, and performance improvement. Prioritizing and adequately addressing these challenges is difficult without understanding the full context in which they occur.

Through roughly 200 conversations with healthcare workers and managers from Community all the way up to National levels, we gained a deeper understanding of the factors that lower participants’ ABILITY and MOTIVATION to utilize data for decision-making. These factors have been synthesized into the 8 Root Causes Framework (pictured below).

The 8 Root Causes framework was shared with stakeholders in each country during a series of co-creation workshops. Based on input during these workshops, the team identified 7 Priority Areas for intervention that cut across all three geographies.

In compiling these Priority Areas, we did not focus on what’s new, rather we set out to identify what is most impactful for change. This means we evaluated all of the Root Causes and Sub-causes to identify the ones that were both high priority to the system actors and relatively less difficult to fix. As such, while some of the Priority Areas may not be new, we believe they are crucial to highlight.

While there is a growing emphasis on improving data quality and utilization, few data-specific roles exist within the system, especially at the lower levels. Most data collection, reporting, and review work is done by personnel who don’t consider it to be a core part of their job, meaning the work is often rushed, deprioritized, or outsourced to unofficial workers.

Adding or developing additional data-proficient personnel throughout the lower levels of the system, as well as carving out dedicated time for completing specific tasks will help to establish data as a priority and create opportunities for more meaningful utilization of data by all actors.

Some managers and healthcare workers have data skills and appreciate the value of good data, yet are unable to perform their basic data-related duties due to a lack of funds for airtime, internet, and transport or reporting tools.

Ensuring that the basic resource needs are consistently met is a cost-effective way to increase the productivity of healthcare workers and managers, meaning skills and resources already on the ground will be utilized more effectively.

Facility level tools are siloed according to how the data needs to be used at higher levels and not designed with facility workflows or the data-needs of frontline healthcare workers in mind. This makes data collection duplicative and unnecessarily time-consuming and forces facility staff to create additional tools to utilize the data for their needs.

Redesigning tools around the facility workflows and information needs will reduce the amount of time needed to collect the data and lower the threshold for data utilization at the facility level.

The current DHIS-2 user system experience is poor, often the result of bugs or system lags that hinder the ability to input, manage or retrieve data. Inconsistencies between the data fields in paper reports and DHIS-2 significantly slow down data input and, at times, can introduce errors.

Modernizing and debugging DHIS-2 could mean significantly less time spent on data entry and more time for data verification and analysis. Leveraging existing DHIS-2 apps to provide access to data on mobile devices (with more efficient offline capability and, clear guidance on interoperability when computers and internet are available) could also make data more accessible to busy managers and Facility level staff.

Interactions between system levels tend to be sparse and one-way, with data primarily moving up from the Community and Facility levels. Insights from the collected data rarely make their way back to the facilities and feedback is given only when data is missing or inaccurate, leaving lower level actors feeling disconnected from the decision-making process.

With the integration of more streamlined, flexible and individualized interactions between levels, we can increase and promote involvement and ownership, accountability, sharing, appreciation and use of data. This can also promote better data understanding and awareness across levels and transform currently passive interactions into more engaged, trusted and useful ones.

With limited resources and time, current Supportive Supervision activities are mainly geared towards enforcing protocol and catching major issues. Because the visits are infrequent and rarely EPI-specific, the emphasis is put on going down the checklist to take the “facility vitals” over building skills and having meaningful interactions with staff. Feedback is also not well documented or shared with staff. Not surprisingly, healthcare workers tend to see themselves as protocol-followers, not decision-makers.

With more emphasis placed on skill-building and better documentation and continuity between visits, Supportive Supervision activities and opportunities
for mentoring and coaching (such as via well-facilitated and interactive review meetings or facility monthly exchanges that include community representatives) have the potential to improve healthcare worker motivation and agency.

A lot of time and resources, especially at the Subnational level, are dedicated towards official, data-based planning procedures such as generating work plans and annual budgets, intended to help utilize immunization program resources more strategically. Unfortunately, these activities frequently fail to reflect the reality on the ground, as the data used in the planning is not always accurate. Furthermore, those ultimately responsible for allocating money towards the immunization program don’t always have the necessary context to set appropriate priorities.

Plans are made based on optimistic anticipated government allocations and/or partner funding that may not materialize. When funding does arrive, it is usually less than projected and frequently delayed (particularly for at least the first three months of the fiscal year and sometimes longer). Local managers therefore run out of resources and/or are forced to abandon their long-term plans to address more immediate needs such as paying overdue bills and taking care of emergencies.

Political and administrative decision-makers (such as the Executive Committee and Assembly members) need to be more proactively engaged to ensure that funding priorities are guided by data and that more accurate funding information is available and clearly communicated for planning purposes. Partner funding mechanisms also need to be more predictable and timely, so they can be incorporated into the official planning work.

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