How DTM can be useful for Health Clusters in the field DRAFT– do not use How DTM can be useful for Health Clusters in the field

A few words on DTM

DTM OPERATIONS OVERVIEW Since its inception in Iraq in 2004, DTM has expanded its coverage to reach 65 countries. Past and present implementation contexts include conflicts, natural disasters and complex emergency settings, from small and short-term cases to large-scale, regional and protracted displacement trends and migration crises.

DTM Components Tracks movement of flows at specific points MOBILITY TRACKING FLOW MONITORING Tracks movement of flows at specific points Tracks mobility and cross-sectoral needs in locations of interest (systematically) Groups and Location Sub-components: Baseline Area/Location Site/community Assessment (Stock population) Emergency Event Tracking (Sudden large movement of population) Sub-components: Baseline Assessment Flow Monitoring Registry REGISTRATION SURVEYs Gather specific information using sample from population of interest Registers individuals or households for beneficiary selection, vulnerability targeting and programming Explain all the components and explain that we will focus on the Site Assessment, as it is the most relevant for the Cluster Explain that as we do Flow Monitoring, some additional cooperation is possible between DTM and Health actors for emergencies like last Ebola crisis. Even datasets that we collect during normal Flow Monitoring activities identify routes, reasons for movements and nationalities, and can be used to better understand migration movements between countries during ‘non-emergency’ times. Households and Individuals Examples: Return Intention Community Perception Displacement Solutions Flow Monitoring Surveys Sub-components: Rapid Emergency Registrations Verification for Registration Biometric Registration

DTM Site Assessment and the Clusters Not all DTM components are always rolled out in every country: DTM is implemented according to need, so different components may be rolled out in different countries. DTM Site Assessment and the Clusters

Mobility Tracking- Site Assessment When Initial displacement Protracted displacement Regular monitoring How? Non specialized Key informants Non specialized enumerators observation Where? IDP Camps/Sites/locations Groups and Location Sub-components: Baseline Area/Location Site/community Assessment (Stock population) Emergency Event Tracking (Sudden large movement of population)

What DTM Site Assessment cannot do for the Cluster DTM Site Assessments cannot replace a Health assessments or programme monitoring DTM Site Assessments is done through Key Informants and Observation DTM Site Assessments does not interview Health specialists DTM Site Assessments enumerators are not Health specialists DTM Site Assessment cannot ask questions on diseases and cause for morbidity and mortality, and cannot provide epidemiologically-valid statistics DTM is one of many data sources for the Cluster…

So, why is DTM Site Assessment useful for the Cluster? DTM Site Assessments are regularly implemented (in rounds) and can monitor changes over time DTM Site Assessments collect inter-sectoral data, in addition to some sectors-specific data DTM Site Assessments have a very large territorial reach within the country DTM Site Assessments are implemented in a large number of crisis (very likely you will find a DTM exercise in your country of operation) Data are shared quickly after cleaning. Modalities of data sharing are flexible, including data for urgent action. Global Cluster and DTM have agreed on a list of recommended questions for Site Assessments DTM is flexible, and can be adjusted: it is focused on providing useful data for response

What DTM Site Assessment CAN do for the Cluster Provide estimates of population and groups at location level Monitor change over time in many locations Inform on access to services in many locations on an ongoing basis Raise red flags/alerts Provide information to help cluster prioritize their in-depth assessments

How can Cluster and DTM work on the field to obtain useful information for response

Common reasons for partial use of DTM data “If I had only one hour to save the world, I would spend fifty-five minutes defining the problem, and only five minutes finding the solution” (possibly, A. Einstein) Responders Responders were not involved in identifying/analyse the information they need The process involving responders was not based on best practices and did not fully succeed in providing useful and usable data Responders did not realize how they can use data for their work Responders are not aware of DTM data/products currently available – including those useful to them. Responders do know DTM well enough to realize what DTM can potentially provide Responders do not have time or technical support to analyse data Responders may not trust DTM data- as they are not clear on the methodology and process Responders know the methodology and process but do not consider them able to provide needed data (e.g., not the right unit of measurement for a specific information) DTM staff DTM staff does not know what data are useful for specific responders and therefore does not collect /share them DTM staff does not collect data in a way that is useful for response (e.g., not the right time, or unit of measurement, or break down) DTM staff does not analyse and share all collected data DTM staff does not have time to present data relevant for specific responders DO not read the slide: it is to highlight that there was work done to identify where we can improve. The following guidance was developed to alleviate such issues. Other Conflicts or perceived need for competition between agencies, Clusters or personalities are hindering the use of DTM data for responders’ work.

Approach: Profiles needed for Evidence- Based Decision-Making IM Expert: Data and analysis Subject Matter Expert: Interpretation: Making sense of analysis Context /Cultural Expert Translation: What does it mean in this context? Decision-Maker (at Strategic, Programmatic and Operational level): Take action Evidence-based decisions and response Lack of evidence Lack of cultural understanding Lack of sectoral understanding Lack of action Evidence – based decision making and response is generated by the interaction of four main skillsets. Excluding even only one of them undermines the veracity and usefulness of results. The modalities and process of their interaction must be rigorous and predictable, for results to be useful and usable Discounting Information Management (IM) skillset results in lack of evidence. Discounting the subject matter or the cultural expertise prevents make sense of information (for a specific sector and in a specific culture/context). Excluding decision-makers results in lack of appropriate action. Only mention that we have been jointly working within the Grand Bargain on how data can be used more and we identified that it is about linking amongst decision makers, sectoral, IM and context experts Modified by EDAUUR - Grand Bargain Work Stream for Needs Assessment

Global Cluster and DTM Site Assessment questions Mention that DTM and Global Cluster worked to identify basic number of useful information DTM can provide to the clusters in the field, that can be collected through DTM site assessment methodology.

Why? Determinants of health Perceptions Enumerators background&Health

1. Alert 1.1 Unusual number of deaths (Human) 1.2 Unusual number of deaths (Animal)

2. Access to health 2.1 Distance to health facilities (in time) 2.2 Obstacles to accessing health 2.3 Specific groups facing obstacles to access health 2.4 Specific obstacles to access 2.5 Availability and access to medicine 2.6 Care for people with disabilities 2.7. MPHSS support availability

3. SRMH 3.1. Female healthcare workers presence 3.2 Women giving birth out of healthcare centre 3.3 ANC/PNC

4. Patients perspective 4.1 Health seeking behaviours 4.2 Presence of distress due to crisis

Exercise 1 Split in XX groups Use Handout 1 (Health Data Analysis and Dissemination Plan): Read the questions highlighted for your group Consider the visualization and descriptive analysis Discuss what the use of such information can be for your work Fill the column Analysis/use that can be done by sectoral experts (e.g., Clusters) Write them on the flip chart 5 Minutes Instructions for facilitator: 1) Divide the participants in group (one coordinator and 1 IMO at least in each group) 2) Depending on the number of groups, assign 3-4 questions to each group, by highlighting the relevant questions on the handouts 3) Distribute to each participant a copy of Handout 1 - Health Data Analysis and Dissemination Plan (with the correct highlighting) 4) Ask them to read the questions, Consider the visualization and descriptive analysis and discuss in the group for 5 minutes to fill the column on Analysis/Use done by Clusters (they write the answer on the flip chart –with question number) 5) Ask each group to provide one answer per round, and collect all post-its for adjustment of the Data Plan. 6) Give time for comments to plenary 7) Facilitator summarizes what we just did (Objectives of the exercise) –next slide: Looked at some questions in details, now you are familiar with the questions in the Data Dictionary Familiarized yourself with the Data Analysis and Dissemination Plan (you now know a common tool with DTM, and this can help you understand each other better) You consider the questions from the prospective of the end product: the use. However, you had to deal with the limitation of the results (visualization and descriptive analysis) You got familiar –as a group- with the difference between descriptive analysis and interpretation You got familiar with roles in analysis (DTM can do data analysis but cluster should do interpretation)

Exercise 1: what did we just do? We looked at some questions in details, now we are more familiar with the questions in the Data Dictionary We also familiarized ourselves with the Data Analysis and Dissemination Plan (we have now a common tool with DTM, and this can help you understand each other better on the field) We consider the questions from the prospective of the end product: the use. For that, we had to deal with the limitation of the results (i.e., we considered visualization and descriptive analysis) We got familiar –as a group- with the difference between descriptive analysis and interpretation We got familiar with roles in analysis (DTM can do data analysis but cluster should do interpretation –with DTM support)

Analysis: Agreeing on Options for Analysis DTM and Clusters Early on, it is important to agree (between DTM and Clusters in the field) on who does what and the flow of the analysis process.

Data Sharing: Jointly identify data-sharing modalities A visualizations of various data-sharing modalities helps Clusters and DTM teams identify the appropriate modality for each dataset What With whom & Why How When Specific datasets (might include personal data). E.g. protection cases, or number of UAC in a site Shared with specific responders & for Immediate Action: Referrals & Alerts Establish sharing mechanisms & tools (e.g., Service mapping, referral paths) and Data Sharing Agreements (LEG) During data collection / As data come in TIME Global DTM website, HDX, ReliefWeb, Country website, mailing lists, hard copies at meetings…) After data cleaning, processing and analysis All public data Publically Shared Specific datasets (do not include personal data) E.g., Protection & GBV data not traceable to specific people Shared with specific actors/groups for response, advocacy, analysis and more. E.g., Protection Cluster, GBV AoR Establish sharing mechanisms, tools, frequency and Data Sharing Agreements After data cleaning & processing

Exercise 2 Go back to your group Identify 1 information need (and its use) that is not included in the Data Dictionary, but you think it is important in your context. Write both info need and use on the flipchart Reflect in your group on whether this information can be collected through DTM or not (if not, find another information that DTM can collect for you) Phrase the question in the best way possible and identify some options for answers Use visualization and descriptive analysis to verify that the question and options for answers would provide what you need (visualization should be hand made) You can include the new info need, question and answers at the end of your Data Analysis and Dissemination Plan (empty rows) 10 Minutes Facilitator: have the groups report back to plenary and give space for comments. takes photos of the flipcharts for possible adjustments of the DD

Exercise 2: what did we just do? We learned to go through a decision- making tree to identify what information can and cannot come form DTM Site Assessment We learned how to frame the conversation with DTM when we want DTM to capture additional data for the cluster (discuss the information need and use, and only later the phrasing of the question) We transformed an information need into a dataset and then into a question with options We used the Data Analysis and Dissemination Plan structure to agree on a question, options, its descriptive analysis and use We also remembered that we can make visualizations without computers

Decision-Making tree for Clusters on using DTM to collect data Decision this info will help us take Information Need: what do we need to know? Decision Makers, IM and Sectoral Experts: Cluster Members, Cluster Coordinator and IMO Use available Secondary Data YES Is this Information already available? IM Expert: Cluster IMO NO What level of measurement and accuracy are sufficient to provide such information, in the context? IM Experts and Sectoral Experts: Cluster Members / Coordinator & Cluster IMO Community level (Non Specialized Key informants/ Observation) Community level (Specialized Key informants /Observation) Clear information needed and its use (e.g., use mock-up chart to clarify details of information) Frequency (How often the information should be updated) Is info for public dissemination or restricted? Preconditions that should be in place before asking the question Type of suggested non specialized Key Informant How will the interpretation be done by the cluster? (e.g., in the first cluster meeting following the DTM round, with DTM coordinator/ and cluster IMO presence…) Facility level Cluster IMO Coordinator, & Cultural expert agree on this and IMO approaches DTM Cluster can approach DTM on Site Assessment with the following: Individual level (Surveys) Use other Systems IM Expert: Cluster IMO Cultural Expert, Sectoral and IM Experts: DTM coordinator, Cluster IMO & Cultural expert How and when should the information be shared (excel, website, email, encrypted…) Who (and when) does the descriptive analysis of this dataset? (e.g., DTM team, or Cluster IMO, or jointly…) Type of descriptive analysis needed Phrasing of questions and options for answers Data analysis and dissemination plan is jointly filled. Cluster agrees with DTM coordinator on the following:

Jointly identify information needs: From Use to Questions - walking backwards For sectoral data, SDR should be carried out by Clusters/WG, to identify their information gaps

At global level: At country level: How else can DTM and Health Clusters further engage for the benefit of displaced persons? Your opinion matters! At global level: At country level:

Where can you find DTM reports and data? DTM public data and reports are online and available at: https://displacement.iom.int/, http://migration.iom.int/europe/ and http://www.globaldtm.info/ (through a search by Country). For questions and support, contact the DTM coordinator in your country (ask DTMSupport@iom.int for his/her contact details).

Thank you!