Creating Demand for Data Through User Centered Design Global Digital Health Forum Dr. Cliff Hara, Ms. Mandy Dube, Ms. Emily Carnahan 19 November 2018

User Centered design in the context of the BID Initiative 1

BID Initiative There are strong challenges related to data quality around immunizations in Africa, yet few can identify which problems matter most and where. Lack of reliable, accessible, actionable data on the barriers impeding immunizations coupled with trained and empowered data users at all levels. The Challenge Empower countries to enhance immunization and overall health service delivery through improved data collection, quality, and use. The Vision Partner with demonstration countries Tanzania and Zambia to: Identify the most pressing routine immunization service delivery problems. Develop, perfect, and scale solutions with the users on the ground throughout the health system. Facilitate peer learning with other sub-Saharan African countries in design, testing, and applying interventions. The Approach Today we’re talking about UCD in the context of the BID Initiative. Routine immunizations and new vaccine introductions are two of the best buys in global health, particularly in Africa. Yet we know that many are still being missed with this life saving tool. And much of this is due to the fact that we don’t have the information of who they are or where they are. Global stakeholders and national governments acknowledge that there are strong challenges related to data quality, yet few can identify which problems matter most and where. Do we have 25, one percent problems? Or one, 25 percent problem? Without reliable, easily accessed, and actionable data on the barriers impeding immunizations, coupled with trained and empowered data users at all levels, those interested in improving immunization coverage don’t have the needed data and tools to make the best decisions. The BID Initiative, funded in May 2013, was developed to help address challenges related to data quality and use. It is grounded in the belief that better data, coupled with better decisions will lead to better health outcomes. Our vision is to empower countries to enhance immunization and overall health service delivery through improved data collection, quality, and use. And sharing through a peer learning network the interventions, best practices, and tools across the region for greater impact. Reaching this vision requires a holistic investment in information system products, data management policies and the practices of people that use them. While our initial focus is on immunization data to first test and prove our approach, the BID Initiative is designed to spread across several health verticals such as nutrition or maternal, newborn and child health. If we’re successful, a true tipping point will occur—one in which countries can access, analyze, and act upon accurate immunization data anytime, anywhere—resulting in improved immunization outcomes and healthier families and communities. We’re taking a user-centered approach at a lot of levels, both within our demo countries, and across countries through the BLN. Today we’ll focus our presentation on Zambia, and the role that the UCD has played.

BID’s Guiding Principles Before I talk about the specifics of BID, I think that it is very important to talk about the core principles embedded in BID that should benefit all. Utilize a coordinated approach. Coordinate with other key initiatives and organizations to collaborate on and/or share experiences to strengthen national immunization systems and integrated delivery of care. Country ownership and capacity development. Focus on countries’ primary ownership and responsibility for establishing good governance and for providing effective, high-quality immunization services for all, as well as identifying and addressing capacity-building needs. Interoperability. Where possible, any system modules developed will be closely coordinated with existing information system dependencies. Innovation. Leverage the latest learning and technology to ensure the design of an innovative solution. Sustainability. Consider the solution’s need for long-term sustainability throughout its development process and the work with demonstration countries. Openness. Remain committed to openness and include promotion and use of open architecture, industry-based standards, and transparent, shared processes and methodologies, and openly share requirements and other technology knowledge components. Strategic reuse. Organize to extract reusable components from appropriate projects and build new, shared components and platforms as required. Research, monitoring and evaluation. Contribute to the body of knowledge that informs future investment through utilization-focused research.

The Journey to Scale Key challenges Need to understand the impact of implementing eHealth infrastructure Lack of funding for scale Belief that every country needs a unique solution(s) for their challenges Lack of interaction and information exchange among peers from different countries doing the same work Lack of national ownership of interventions Lack of linkages between the levels and across vertical programs of the health system 19 November 2018

Early and sustained government and user engagement at all levels of the health system will result in contextually appropriate, acceptable, sustainable, and feasible solutions that can be scaled within and across countries. 19 November 2018

PATH’s data use culture conceptual framework UAG has a prominent role in defining the people, products, policies, and practices to be designed as BID Initiative solutions. We believe a package of solutions that touches on these “4 P’s” can improve the data use cycle pictured at the center. 19 November 2018

User advisory groups (UAG)

Priority Setting Working with Government at national level, priorities that were identified included: Addressing the denominator issue Improving data quality and use Stock management at facility level Interventions intended for facility level implementation but throughout all levels of the health system the key request was data visibility 19 November 2018

Choosing the Right Solutions and Making Them Visible BID MOH TWG at National Level BID UAG at District Level Composition of UAG District Community Medical Officer (DCMO) / Principle Nursing Officer District Maternal and Child Health (MCH) Coordinator District Health Information MS officer Facility MCH in charge/Alternate (1 from each of the 4 testing facilities) Two (2) Neighbourhood Health Committee (NHC) Chairperson (from East & West Zones) BID Initiative staff (3) 19 November 2018

Role of the District UAG Provide key information to help develop a set of interventions Based on firsthand field experiences Advocate the work of the BID Initiative to other health workers Communicating the value of the interventions Battle skepticism from new users Acknowledging the challenges Focusing on the short- and long-term benefits 19 November 2018

Ordinary People Making a Difference 19 November 2018

Examples of Decisions Influenced or Questioned by the UAG Selection of interventions (e.g. barcodes and video games) Involvement of community health workers at the facility Multiple IDs Addresses for defaulter tracing Indicators and their visualization Data visibility: web vs android User interface Bugs System logic and workflow redesign 19 November 2018

transferring uag momentum 19 November 2018

Providing opportunities for sharing experiences The Plans Providing opportunities for sharing experiences District cross site visits Providing opportunities for ‘competition’ Dashboards showing how one facility is performing compared to other similar facilities and the district averages Providing opportunities for support WhatsApp group 19 November 2018

Providing opportunities for exposure The Plans Providing opportunities for exposure Featuring on BID media platforms Providing opportunities for evaluation and feedback Help desk Data use guide reference list and job aid Supportive supervision Formal M&E 19 November 2018

Experience from UAG Member 19 November 2018

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