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

2. User Centered design in the context of the BID Initiative1

3. 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.

4. 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.

5. 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
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6. 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.
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7. 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.
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8. User advisory groups (UAG)

9. 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
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10. 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)
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11. 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
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12. Ordinary People Making a Difference
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13. 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
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14. transferring uag momentum
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15. 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
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16. 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
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17. Experience from UAG Member
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18. Thank You……

19. Connect with us!