1. CONTEXT OF DECISION MAKING Module 2

2. PART 1: DETERMINANTS OF DDU

3. 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

4. What Determines Data Demand & Use? ORGANIZATIONAL TECHNICAL 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).

5. 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

6. Data are often underutilized because of… Organizational constraints  Structural – roads, telecommunication  Organizational – clarity of roles, support, flow of information  Political interference

7. Data are often underutilized because of… Individual constraints  Decision-maker attitudes,  Staff motivation,  Lack of “data culture”

8. What Determines Data Demand & Use? ORGANIZATIONAL TECHNICAL BEHAVIORAL POLITICS 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).

9. What barriers have you faced to using or getting others to use data and information? Group Participation

10. 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

11. Assessment of Data Use Constraints Tool Technical Constraints Technical constraints are related to the ability to generate high-quality data and analyses. RA8Have 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? RA9Are there multiple sources of information or statistics for issues of importance to you, and have you experienced any problems caused by having different estimates? RA10I 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? RA11Does your agency have the technical capacity to ensure access to and availability of reliable data? RA12Has there been an occasion when data quality or local technical capacity made it difficult for you to use information in making a decision? RA13How would you have gone about preventing this situation?

12. Barrier: Steps Involved Person Responsible Other Stake- holders General Timeline Action Plan for Addressing Barriers to Data Use

13. Small Group Activity 2: Instructions Choose 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

14. Barrier: Lack of technical capacity in M&E Steps Involved Person Responsible 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 DirectorDeputy, Program mgr January 2008 Seek out trainers and curricula M&E Specialist Deputy director, Training coordinator February 2008 Action Plan for Addressing Barriers to Data Use

15. 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

16. PART 2: CONTEXT OF DECISION MAKING

17. 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

18. Group Participation How can we ensure that information is being used to make diagnoses and inform decisions?

19. Stake- holders Decisions Context of Decision Making Data

20. Stake- holders Decisions Context of Decision Making Data

21. 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

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

23. Data Producers vs. Data Users Data 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

24. 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

25. Results of Involving Stakeholders in Data Use Process Relevance of data Ownership of data Appropriate dissemination of data Use of data

26. 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

27. 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

28. Stakeholder Analysis Matrix Name of stakeholder organization, group, or individual Stakeholder description Primary purpose, affiliation, funding Potential role in the issue or activity Level of knowledge of the issue Level of commitment Support or oppose the activity, to what extent, and why? Available resources Staff, money, technology, information, influence

29. Name of stakeholder organization, group, or individual Stakeholder description Primary purpose, affiliation, funding Potential role in the issue or activity Level of knowledge of the issue Level of commitment Support or oppose the activity, to what extent, and why? Available resources Staff, 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 issueDevelop plan (inc. M&E plan) to scale up PMTCT programs throughout system. Proposed activityConvene stakeholders to identify priorities based on available data and develop action plan. Date November 2006

30. 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

31. 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 strategy Plans for feedback or continued involvement Program issue Proposed activity Date

32. 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 strategy Plans 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 issueDevelop plan (inc. M&E plan) to scale up PMTCT programs throughout system. Proposed activityConvene stakeholders to identify priorities based on available data and develop action plan. Date November 2006

33. Stake- holders Decisions Context of Decision Making Data

34. Decision Areas  Program design and evaluation  Program management and improvement  Strategic planning  Advocacy and policy development

35. 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

36. Program Management and Improvement  Management  Determine if the program is meeting its process objectives  Improvement  Develop new strategies to increase coverage

37. Strategic Planning  Identify geographic areas of highest need  Determine human resource allocation  Determine which of offered services is making the greatest impact

38. Advocacy and Policy Development  Identifying and quantifying underserved populations  Identifying focus areas for new policies

39. Stake- holders Decisions Context of Decision Making Data

40. 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

41. Stake- holders Decisions Factors Other than Data that Influence Decisions Data Political Ideology Competing Priorities Power Relationships Public O pinion Arbitrariness

42. Stakeholders new counterparts Involve new counterparts Strengthening the Decision- making Process Decisions realities Understand service delivery realities Data data May require additional data

43. 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

44. 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

45. 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