Data Demand and Use

2012
Data Demand
and Use:
An Introduction to
Concepts
and Tools
Tara Nutley
Elizabeth Snyder
Nicole Judice
MS-12-54
Data Demand and Use:

An Introduction to Concepts
and Tools
MEASUREEvaluation
MEASURE Evaluation is funded by the U.S. Agency for International Development (USAID) through Cooperative
Agreement GHA-A-00-08-00003-00 and is implemented by the Carolina Population Center at the University of
North Carolina at Chapel Hill, in partnership with ICF International, John Snow, Inc., Management Sciences for
Health, Palladium, and Tulane University. The views expressed in this publication do not necessarily reflect the
views of USAID or the United States government. MS-12-54 (March 2012, Revised December 2015)
Acknowledgments
ThecoursewascreatedandreviewedbyMEASUREEvaluationstaffmembersandconsultants,
especiallyTaraNutley,NicoleJudice,ElizabethSnyder,TeresaHarrisonMelissaDunn,Samson
Bamidele,KarenForeit,JasonSmith,SivanGoobich,KatharineMcFadden,andAditiKrishna.ITsupport
wasprovidedbyEdVanDuinen.TomSwaseyprovidedvaluabledesignandlayoutsupport,andNash
Herndoneditedthecourse.
Notes
This publication follows an interactive version of the course found in MEASURE Evaluation's online
trainingresource,availableat:http://www.cpc.unc.edu/measure/training/onlinecourses.
Underlined,boldfacedwordsinthismanualdenotetermsdefinedintheGlossaryofTerms(page86).
DataDemandandUse:AnIntroductiontoConceptsandTools
TABLEOFCONTENTS
IntroductiontoDataDemandandUse.............................................................................................................6
DeterminantsofDataUse...............................................................................................................................18
KeyElementsofDecisionMaking...................................................................................................................29
InformationFlowandFeedback......................................................................................................................46
FrameworkforLinkingDatawithAction.........................................................................................................67
FINALEXAM.....................................................................................................................................................80
GLOSSARY........................................................................................................................................................86
DataDemandandUse:AnIntroductiontoConcepts
andTools
PURPOSE
Significanthumanandfinancialresourceshavebeeninvestedworldwideinthecollectionof
population,facility,andcommunitybaseddata.However,thisinformationoftenisnotusedbykey
stakeholderstoeffectivelyinformpolicyandprogrammaticdecisionmaking.Asaresult,manyhealth
programsfailtofullylinkevidencetodecisionsandsufferfromadecreasedabilitytorespondtothe
priorityneedsofthepopulationstheyserve.Manypossiblefactorsundermineevidencebased
decisionmaking.Somerelatetohowinformationflowstodecisionmakers,andhowtheymaketheir
decisions;otherstothecontextinwhichinformationiscollectedanddecisionsaremade;andyet
otherstotheorganizationalinfrastructureandtechnicalcapacityofthosethatgenerateandusedata.
Thiscourseaimstoprovidetheconceptualbasisfordatainformeddecisionmakingwithinan
organizationorprogram,oratthenational,state,ordistrictlevelsofgovernment.Alsoincludedinthe
courseareintroductionstoseveraltoolscreatedbyMEASUREEvaluationtofacilitatetheuseofdatain
decisionmaking.
OBJECTIVES
Thespecificlearningobjectiveofthecourseistoimprovetheunderstandingof:
theroleofdataindecisionmaking
thecontextofdecisionmaking
thedeterminantsofdatause
theimportanceofdatasharingandfeedback
TIME
Thiscoursetakesapproximatelythreehourstocomplete.Itfollowsaninteractiveversionfoundonthe
MEASUREEvaluationWebsiteat:https://www.cpc.unc.edu/measure/training/onlinecourses
AUDIENCE
Thiscourseisappropriateforhealthprofessionals,policymakers,andotherkeyhealthdecisionmakers
whoareinthepositiontousedatatoinformthedesign,implementation,monitoring,and
improvementofhealthprograms,andwellashealthprofessionalswhoacquireandanalyzehealth
dataandpreparethemfordistributiontoaudiencesofusers.Theseincludemonitoringandevaluation
specialists,dataclerks,orresearchers.Priortotakingthiscourse,itisadvisedtocompletetheM&E
FundamentalsCourseavailableontheMEASUREEvaluationWebsiteat:
https://www.cpc.unc.edu/measure/training/onlinecourses.
IntroductiontoDataDemandandUse
OBJECTIVES AND
OVERVIEW
OBJECTIVES
understand the importance of improving datainformed decision

making
understand the role of monitoring and evaluation (M&E) data in
decisionmaking
OVERVIEW
challengestousingdataindecisionmaking
thepurposesofM&E
examplesofdatause
Theneedforqualityhealthcareservicesisapparenttoallofus.
There is evidence to suggest that the global HIV epidemic is stabilizing,

althoughatanunacceptablyhighrate.Therewereanestimated33million
peoplelivingwithHIVatthecloseof2008,themajorityofwhomeither
needorwillsoonneedtreatment.
Approximately 1.7 million people died from tuberculosis (TB) in 2009.

Moreover,manynewcasesareresistanttomajorTBtherapeuticdrugs.
Eachyear,malariacausesnearly1milliondeaths,mostlyamongchildren
under5yearsofage,andanadditional190millionto325millionclinical
casesthatneedtobeaddressedbythehealthsystem.
InmuchofsubSaharanAfrica,thetransitionfromhightolowtotalfertility
rates(TFR)hasstalled.Intwothirdsofcountriesintheregion,therewas
nomeaningfulchangeintheTFRduringtheintervalbetweenthetwomost
recentDemographicandHealthSurveys.
Inmanycountries,youngpeoplethosebelowtheageof20accountfor
thelargestproportionofthepopulation.Inthenextfewyears,wewillsee
WHY IMPROVE
EVIDENCE-BASED
DECISION
MAKING?
largernumbersofpeopleneedinghealthservicesasthiscohortages.In
the face of this demand, many countries are experiencing inadequate
numbers and poor distribution of qualified health workers and an
inadequatehumanresourcessystemtosupportthem.
Itisextremelyimportantforgovernmentstomakethebestuseoftheir
limitedresourceswithinthiscontextofahighdiseaseburden,agrowing
population, and insufficient health services. There is an urgent need to
developtargetedstrategies,policies,andinterventionsthatarebasedon
qualitydata.
The importance of evidencebased decision making is expressed by a

nationallevel policymaker in Nigeria who participated in a data use
assessmentconductedbyMEASUREEvaluation.Theassessmentinvolved
interviews with a range of professionals at the national, regional, and
facilitylevels.
without information, things are done arbitrarily and one becomes

unsureofwhetherapolicyorprogramwillfailorsucceed.Ifweallowour
policiestobeguidedbyempiricalfactsanddata,therewillbeanoticeable
changeintheimpactofwhatwedo.
WHY ADDRESS
DATA DEMAND
AND USE?
Intodaysenvironment,manyhealthprofessionalshavebecome
overwhelmedwithcollectingandusingdatarelatedtoservicesthey
deliver.Insomecontexts,datarequirementsfromgovernmentand
donorshavegrownexponentially,tothepointwheresomeprovidersand
implementingpartnershavepagesandpagesofformstofillindaily.
Rarelyaredatausedtomonitorprogramsandmakedecisionsbeyond
individualpatientcare.Thisisahugelostopportunitybecausedataare
criticaltotheprogramimprovementanddecisionmakingprocess.
EVIDENCE-BASED
DECISIONMAKING
PROCESS
KnowledgeRecap
Selectthebestoptionfromthechoiceslistedbelow.
Question:Whyisitimportanttoinformdecisionswithdata?
a)Decisionsbasedonevidenceleadtobetterhealthoutcomes
b)Toimproveprograms
c)Tomakethebestuseoflimitedresources
d)Todeveloptargetedstrategies,policies,andinterventions
e)Alloftheabove
f)Noneoftheabove
Answersareonpage17.
Inordertounderstandthefactorsthatinhibitorencourageevidence
baseddecisionmaking,weneedtoreviewtheentireprocessthatleads
toevidencedbaseddecisionsandeventuallytoimprovedhealth
outcomes.Therearemanyothercontributingfactorsthataffectdata
use.

Theframeworkpresentedhereillustratestheentirecycleofevidence
baseddecisionmaking.Thisapproachillustratestheideal.Whenthereis
ademandfordata,thenecessaryresourcesareinvestedtocollectthat
data.Oncethedataarecollected,theywillbeanalyzedandsynthesized
intoaformatthatmakesthedataavailablefordecisionmaking.Once
available,thedatacanbeusedtoinformhealthprogramsandsystems.
Youwillnotethatinadditiontodatacollectionandthereforeavailability,
therearealsotheconsiderationsof:
securingthetechnicalandhumancapacitytomanageandanalyze
thedata
ensuringthattheinformationisavailableandinaformatthatis
easilyunderstoodbytherelevantstakeholders
fosteringtheinterpretationoftheinformationanditsultimate
usetoimprovepoliciesandprograms.
Thecyclesupportstheassumptionthatthemorepositiveexperiencesa
decisionmakerhasinusinginformationtosupportadecision,the
strongerthecommitmentwillbetoimprovingdatacollectionsystems
andcontinuingtousetheinformationgenerated.Theframeworkwillbe
discussedinmoredetailinUnit2.
Isthisidealframeworkofevidencebaseddecisionmakingwhatweare
experiencinginourownworkenvironments?Mostofuswouldagree
thatitisnot.
DISSATISFACTION
WITH LEVEL OF
SCIENTIFIC
EVIDENCE USED
IN POLICY
DECISIONS
A 2008 international survey conducted by the Overseas Development

Institute found that there is a high level of dissatisfaction among policy
makers,programimplementers,andresearcherswiththedegreetowhich
policydecisionsareinformedbyresearchevidence(Jonesetal.,2008)*.
Specifically, we see that 42% of policy makers, 60% intermediary

organizations,and54%ofresearchersstatedthattheyweredissatisfied
thattheirpolicymakingwasbeingbasedonevidence.Whyisthis?Why
are our decision makers not using data and evidence to inform their
decisions?
*Jones,&H.JonesandC.Welsh(2008)PoliticalScience?Strengthening
SciencePolicy Dialogue in Developing Countries. Working Paper 294.
London,UK:ODI.
KnowledgeRecap
Question:Selecttheactionbelowthatisastepinthedatauseprocess
butbyitselfisnotdatainformeddecisionmaking:
a)Usingdatatoallocatescarceresourcesamongseveraldifferent
programareas
b)Usingdatatodeterminewhythefertilitytransitionhasslowedinyour
country
c)Usingdatatodeterminewhichpopulationsarecontributinghighrates
ofHIVinyourcountry
d)Usingdatatocompleteareporttoadonor
f)Noneoftheabove
Answersareonpage17.
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Eveninthefaceofimprovementsinsystemstocollectquality
information,thereisoftenadisconnectbetweendecisionmakingand
availabledata.Muchofthedatacollectedarenotusedaseffectivelyas
theycouldbe.
CHALLENGES
Therearemanypossiblereasonsforthisdisconnect.Someofthemost
commonbarriersthatthwartafunctioningcycleofevidencebased
decisionmakingincludethefollowing:
Littleornocommunicationmaytakeplaceamongdatausers
(policymakers,serviceprogrammanagers)anddataproducers
(researchers,M&Eexperts).Asaresult,datacollectioneffortsdont
addressthekeyinformationneedsofthedatausers.
Thereislittlecapacitytocollect,analyze,andinterpretdata.Skillsare
lackingforensuringthatthedatabeingcollectedareofgoodquality.The
toolsandskillsneededtoanalyzeandthenapplytheanalysisto
programmaticneedsalsoareweakinmanycontexts.
Thereisntacultureofdatause.
Thevalueofdatainimprovingtheprovisionofservicesisnotfully
recognized,anditisthereforenotprioritized.Asaresult,datafrequently
arenotusedbeyondpopulatingareporttoadonororfillingoutaform.
THE RESPONSE
Whatcanwedotoaddressthesechallengesandimproveevidencebased
decisionmaking?
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WecancommittoutilizingdatathatresultfromM&Esystemsinthe
decisionmakingprocess.Thesedatacaninformthedesignofnew
programsandinterventions,planning,andmanagingprogramsand
facilitiesthat,intheend,contributetobetterhealthoutcomes.
MONITORING
AND EVALUATION
M&Esystemsunderpintheevidencebaseddecisionmakingprocess.The
dataallowustotrackprogressinthedeliveryofhealthservicesand
evaluatetheoutcomeandimpactoftheseservicesonthehealthstatus
ofourcommunities.
TherearemanydatasourcesthatcontributetotheM&Esystem.
Commondatasourcesinclude:
DATA SOURCES
Routinehealthinformationsystems(RHIS)RHIScapturedata
ontheservicesyouprovideinyourclinicalsettings.Duringthis
module,mostofourdiscussionswillrelyonservicedeliverydata
asadatasource.
CensusAcensusisacountingofpeopleinaspecificgeographic
area.Youareprobablyfamiliarwithyournationalcensusthat
enumeratesthenumbersofpeopleinyourcountry.Thisisalsoan
importantdatasourceinthehealthfieldbecauseitallowsusto
calculatethenumbersofpeopleinneedofspecificservices.
Surveys,evaluations,researchstudiesThesedatasources
captureinformationonspecifictopicsandpopulations.Theyhelp
12
usanswerspecificquestionsandfrequentlygiveusinformation
thatcanhelpustoimproveourprograms.
SurveillanceThistrackstheprevalenceofspecificdiseasesina
targetpopulationovertime.Prevalencereferstothetotal
numberofcasesofadiseaseinagivenpopulationataspecific
time.Thesedatahelpustoestimatetheburdenofspecific
diseases.
ManagementsystemsThereareothersourcesofdatathatwe
dontoftenconsider,suchasmanagementsystemsdata.For
example,budgetinformationcanhelpustrackourexpenditures
andilluminatewhatspecificprogramelementscost.Human
resourcesinformationcanhelpustoensurethatourhealth
facilitiesareappropriatelystaffed.
Whatarethepurposesofmonitoringandevaluation?
M&Eisanessentialprocessinprovidingeffectiveandefficientservices
andensuringthatprogramsarerelevantandsuccessful.Forexample,it
helpsustomakeinformeddecisionsaboutappropriatestaffingandthe
needforotherresources.
PURPOSES OF
MONITORING
AND EVALUATION
M&Ehelpsustomonitorourprogramsandknowwhetherthese
programsaremeetingtheirstatedgoalsandobjectives.M&Ehelpsusto
evaluatewhetherourprogramsarehavingtheirdesiredimpact.Ifwe
wanttoknowhowaprogramisperforming,wemightassessitagainst
targetsthathavebeensetforspecificindicatorsbytheprogramor
fundingagencyorgovernment.Forinstance,wemightassessifa
breastfeedingprogramisreachingitsgoalsinprovidingcounselingto
pregnantwomenduringantenatalcare(ANC)bythepercentageof
childrenundersixmonthswhoareexclusivelybreastfed.
M&Ehelpsustogeneratenewknowledgeaboutunderserved
populationsortheneedfornewservicesaroundanemerginghealth
issue.Wecanalsodiscoverfactorsthatinfluencehealthoutcomes,as
wellasotherimportantinformation.Theuseofmonitoringand
evaluationdataallowsproviderstomakeevidencebaseddecisionsto
designandmanagehealthprograms,whichresultsinbetterhealth
outcomes.
13
However,forM&Etohavethisdesiredimpact,M&Edataand
informationmustbesharedandusedstrategicallybyprograms,service
deliveryorganizations,policymakers,andotherstakeholders.
KnowledgeRecap
Question:Thepurposesofmonitoringandevaluationinclude:
a)Trackprogramprogress
b)Guidepolicymakers
c)Informdecisions
d)Assessprogramimpact
e)Alloftheabove
Answersareonpage17.
OftentimespeopleseeM&Easpolicingorasaprocessmeanttocriticize
andunderminetheirwork.Inothersituations,anM&Eunitisonly
establishedforthepurposeofreporting.
M&E SUPPORTS
DECISION
MAKING
Policymakers,programmanagers,andM&Especialistscanbepartnersin
progressdesigningnewprograms,makingimprovementstoplansand
programs,policymakingand,atthefacilitylevel,identifyinggapsand
opportunities.
StrongdecisionmakingandmanagementrelyonhighqualityM&Eor
strategicinformation.Withoutinformation,itisdifficulttomakean
effectiveandsuccessfuldecisionormanageshiftsinaprogram.
Finally,dataqualityislinkedtodatause.Asincreasedattentionisbeing
paidtodataquality,especiallyatthepointofdatacollection,thehealth
facilitylevel,itisimportanttoknowthatdataqualitynaturallyimproves
asindividualsandorganizationsunderstandhowusefuldataand
informationcanbe.
WecanuseM&Einformationto
14
informpoliciesandplans
raiseadditionalresources
strengthenprogramsandimproveresults
ensureaccountabilityandreporting
improvequalityofservicesprovided
contributetogloballessonslearned
KnowledgeRecap
Question:Avoluntarycounselingandtesting(VCT)clinicusesitsmonthly
reportstodeterminewhethertheyaremeetingthegoalofenrolling10
newclientseverymonth.TrueorFalse:Themonthlyreportsinthiscase
arebeingusedtoinformthecliniciftheirprogramissucceedingmeeting
itsobjectives.
a)True
b)False
Answersareonpage17.
Nowletslookatsomeexamplesofhowdatawereusedatdifferent
levelsofthehealthsystemtoimproveprograms.TheCtedIvoire
MinistryofHealth(MOH)andMEASUREEvaluationworkedtogetherto
improvedatacollectionandanalysis,informationavailability,and
informationuseconcerningHIV/AIDS.Asaresult,from2006to2008,the
numberofpeopletestedforHIVincreasedby77%,andthenumberof
peoplecounseledincreasedby72%.
VOLUNTARY
COUNSELING
AND TESTING IN
COTE DIVOIRE
MEASUREEvaluationandtheMOHbeganworkingtogetherin2004to
improvetheHIV/AIDSRHIS.Evaluatorsdecidedtofocusonbuilding
priorityHIVindicators,developingHIVdatacollectiontools,andadding
HIV/AIDSinformationtoexistingRHISdatareportingforms.
Oncedeveloped,theseHIVdatacollectiontoolsandrevisedRHISdata
collectionformsimproveddatacollectiononHIVservicesatthefacility
level.Withmoreeffectiveandreliablesystemsinplace,MEASURE
EvaluationandtheMOHbegancollectingdataonpreventionofmother
15
tochildtransmission(PMTCT),voluntarycounselingandtesting,and
careandtreatment.
Resultsfromthedatacollectioneffortwerecompiledina2005national
reportdistributedtotheMOHandkeypartners,includingtheWorld
HealthOrganization,theU.S.PresidentsEmergencyPlanforAIDSRelief
(PEPFAR)andPEPFARimplementingpartners,andtheGlobalFundto
FightAIDS,TuberculosisMalaria.ThereportfoundthatCtedIvoire
neededmajorimprovementsinservicedelivery,andthatVCTservices
wereoftenunavailableorinadequatelydistributed.
Inresponsetothereport,thenationalHIVcareandtreatmentprogram
createdandlaunchedstrategiestoimproveVCTcoverage.In2008,the
MOHconductedanotherroundofanalysis,toseeifthesestrategieshad
successfullyimprovedVCTcoverage.Thesynthesisofthesedatafound
majorimprovements:all18healthregionswereofferingVCT.Moreover,
from2005to2008,thetotalnumberofpeoplecounseledperyear
increasedfrom127,044to218,684,andthetotalnumberofpeople
testedperyearincreasedfrom111,147to197,428.
Nowletslookatanotherexample.InNigeria,MEASUREEvaluationhas
workedwiththeNigeriangovernment,internationalorganizations,and
otherimplementingpartnersinthedevelopmentofanewroutine
informationsystemforHIV/AIDScalledtheNigerianNationalRoutine
InformationManagementSystem,orNNRIMS.
USING NNRIMS
DATA TO INFORM
RESOURCE
ALLOCATION
Statesandlocalgovernmentshavebeentrainedinthesystem,and
regularlyprepareandreviewquarterlyreports.InNasarawaStateinthe
Domalocalgovernmentauthority(LGA),theLGAchairmannotedthat
only53peopleinDomaLGAtestedHIVpositiveinthefirstquarterof
2006.Thechairmanwasalarmedandalsoconcernedthattestingwasnot
yetwidespreadintheLGA.Asaresult,thechairmanprocured480HIV
testkitstobedistributedtofourlocalhealthfacilities,enablingmore
peopletobetestedforHIVinDoma.
Decisionsbasedonevidenceleadtobetterhealthoutcomes.
KEY MESSAGES
16
WeallhavearoleinM&Epartnersinprogress.
Highqualityinformationisneededfordecisionmakingatpolicy,
planning,andprogramlevels.
KNOWLEDGE
RECAP:
ANSWERS
ThepurposeofM&Eisnotjusttoproducemoreinformationbuttoinformaction.
Thecorrectanswersareasfollows:
Question:Whyisitimportanttoinformdecisionswithdata?
CorrectAnswer:e)Alloftheabove.
Question:Selecttheactionbelowthatisastepinthedatause
processbutbyitselfisnotdatainformeddecisionmaking:
CorrectAnswer:d)Whileusingdataforreportingisanimportant
stepinthedatauseprocess,itdoesnotguaranteethatthedata
willbeusedfordecisionmaking.Regulardataandreportreview
meetingshelptoensurethedataisusedindecisionmaking.
Question:Thepurposesofmonitoringandevaluationinclude:

CorrectAnswer:e)Alloftheabove.
Question:Avoluntarycounselingandtestingclinicusesits
monthlyreportstodeterminewhethertheyaremeetingthegoal
ofenrolling10newclientseverymonth.TrueorFalse:The
monthlyreportsinthiscasearebeingusedtoinformtheclinicif
theirprogramissucceedingmeetingitsobjectives.
CorrectAnswer:a)ThepurposeofthisM&Einformation(monthly
clinicreports)istodetermineifaprogramisontrackincarryingout
plannedactivities.
17
DeterminantsofDataUse
OBJECTIVES AND
OVERVIEW
Objectives
explainthedatauseconceptualframework
highlightthedeterminantsofdatause
listpotentialbarrierstodatause
Overview
thepurposesofM&E
examplesofdatause
DATA DEMAND
AND USE
Inthelastunit,webrieflydiscussedthedatademandanduseconceptual
framework.Thisframeworkdepictsthecycleofdatademand,collection,
availability,anduseinherenttomonitoringandevaluation.The
overarchingprincipleoftheframeworkisthatevidencebaseddecision
makingwillpromotetheachievementofimprovedhealthoutcomes.This
graphicpresentstheMEASUREEvaluationdatademandanduse
conceptualframeworkasacyclefromdemandtoutilization(which
18
directlyaffectsdemand);embeddedinthecycleisthedecisionmaking
process.
LetsstartatthebottomofthecirclediagramDatademandinvolves
stakeholdersactivelyandopenlyrequestingquality,healthrelateddata
andinformation.Datademandcouldincludemanagerialorpolicy
directivestocollectspecificdata,neworincreasedresourceallocation
fordatacollectionandanalysis(e.g.,budgetlineitems,establishingor
strengtheningstatisticalunitsinsideministriesorprograms,modifying
jobdescriptions),andrequestsforspecialanalyses.
Thenextboxattheleftsideofthediagramdatacollectionrepresents
theresponsetothedemandfordata.Informationissoughttoinformthe
datagap.Thiscouldbetheinitiationofanewresearchstudyorthe
requestforaspecialanalysisofexistingroutinehealthinformation.
Thenextboxatthetopofthediagramshowstheavailabilityofthenewly
collecteddata.Heredataaretransformedintoaformatthatcanbeeasily
understoodbytheuseranddisseminatedtotheenduser.Itisimportant
thatthedecisionmakerunderstandstheinformationneededtoinform
thedecision.
Last,theboxattherightsideofthediagramutilizationrepresentsthe
useofinformationinthedecisionmakingprocess.Adecisionmakermay
usedatatoinformthedevelopmentofastrategicplan,makeprogram
changes,orinitiateanewpolicy.
19

KnowledgeRecap
Question1:Arequestforareviewofpastfinancialdatainorderto
determinetheamountofanewprogrambudgetrequestisanexample
of:
a)Datademand
b)Datacollection
c)Dataavailability
d)Datautilization
Question2:Thefindingsofacountrywidebehavioralhealthsurveywere
publishedandaspecialmeetingwasheldwithpolicymakerstoinform
themofthefindings.Inaddition,thedatasetwasmadeavailableonline
withspecificfeaturesthatallowuserstoautomaticallygenerategraphs
andchartsfortheirindicatorsofinterest.Theseactivitiesrepresent:
a)Datademand
b)Datacollection
c)Dataavailability
d)Datautilization
20
WHAT
DETERMINES DATA
DEMAND AND
USE?
Asweareallwellaware,thedatademandandusecycledoesnotalwaysfunctionaswehaveoutlined.
Therearemanyfactorsthataffectdatause.Letsconsiderwhythishappens.
Hereyouseethethreemaindeterminantsofdatause.Wedefinedeterminantasadeterminingor
causalelementorfactordirectlylinkedtodatause.Thethreedeterminantshighlightedare
organizational,technical,andbehavioral.
Organizationaldeterminantsthesedeterminantsrelatetotheorganizationalcontextthat
supportsdatacollection,availability,anduse,suchastheidentifiedproceduresandtheroles
andresponsibilitiesofthosethatcollect,analyze,disseminate,andusedata.
Technicaldeterminantsrefertothetechnicalaspectsofdatacollectionprocessesandtools,
suchasthedatacollectionprocesses,methods,forms,andM&Estaffskills.
Behavioraldeterminantsrefertothebehaviorofindividualswhoproduceandusedata.This
wouldcovertheirattitudes,values,andmotivation.
Allthreeoftheseareasaffectdatauseindecisionmaking.Letstakeamoreindepthlookateachof
thesedeterminants.
21
Organizationaldeterminantscanincludesuchconstraintsas:
inadequatehumanandfinancialresourcestoimplementM&E
systems
unclearjobrolesandresponsibilities
insufficientmanagementprocedurestosupportM&Eanddata
use
inadequaciesintheflowofinformationinanorganization
infrastructurelimitations,includingpoortelecommunicationsor
computerinfrastructure.
ORGANIZATIONAL
DETERMINANTS
Thedeterminantsofdatausefrequentlycontributetothe
underutilizationofdata.Forexample,letsdiscusssomeexamplesof
whatwemeanbythecategoriesofdeterminantsofdatause.
TECHNICAL
DETERMINANTS
Dataoftenareunderutilizedbecause:
theremaybealackoftechnicalskillsindataanalysisorcomputer
literacy
theremaybealackofcomputers
thedesignofthedatasystemmayposeconstraintstousingthe
data
thedefinitionofindicatorsmaynotbeappropriateforuseormay
bemoreresponsivetoreportingneedsthantheneedsof
programs
theremaybealackofdataqualityassuranceprotocols,whichcan
resultindatathatstakeholdersdonottrust.
Datacanalsobeunderutilizedbecauseofindividualbehaviors.For
instance,theattitudeofdecisionmakerswillplayabigrolein
determiningifdataandinformationareused.Ifdecisionmakershaveno
interestinusingdata,theywillmakedecisionsbasedonotherfactors.
Also,staffmotivationtocollectqualitydata,analyzethedata,anduse
themmaybelow.
BEHAVIORAL
DETERMINANTS
22
WHAT DETERMINES
DATA DEMAND
AND USE?
Inadditiontoorganizational,technical,andbehavioraldeterminants,we
alsoneedtorememberthatthepolitical,cultural,andsocialcontextsare
additionalfactorsthataffectthedemandforanduseofinformation,
becausedecisionmaking,sharingofinformation,datacollection,and
reportingalloccurwithinthesecontexts.Inaddition,sometimes
decisionsmaybemadebecausethedecisionmakerfeelsinhisorher
gutthatitistherightthingtodo.
Itisimportanttoassessalloftheseareaswhendevelopingastrategyto
improvedatause.Ideally,afullassessmentofaroutinehealth
informationsystemwouldbeconductedtoidentifystrengthsand
weaknessesintheseareas,suchasthePerformanceofRoutine
InformationSystem(PRISM)assessmentprocessdevelopedbyMEASURE
Evaluation.However,amoreconcise,rapidassessmentcanalsobe
helpful.
FormoreinformationaboutPRISM,pleasesee:
https://www.cpc.unc.edu/measure/tools/monitoringevaluation
systems/prism.
23

KnowledgeRecap
Question:AlackofsupportforM&Ewithinanorganizationisa/an
______________barriertodataandinformationuse.
a)Individualorbehavioral
b)Technical
c)Organizational
d)Noneoftheabove
Answersareonpage28.
Letsreviewarapidassessmenttoolthatcanbeusedtoidentifybarriers
todatause.
TheAssessmentofDataUseConstraintsprocessisatooldevelopedby
MEASUREEvaluationfortherapidassessmentofconstraintstodatause.
ItisbasedonthePRISMframeworkandassistsusersinimproving
understandingofthedemandfordataandtheconstraintsondatause.
Specifically,itidentifiesexisting:
ASSESSMENT OF
DATA USE
CONSTRAINTS
barriersandconstraintsondatause
bestpracticesindatause,sothesepracticescanbeapplied
elsewhere
24
Theassessmentisconductedbyinterviewingkeyinformantsatvarious
levelsofthehealthsystem.Theassessmentalsocanbeusedtoexamine
processeswithinafacilityororganizationandincorporatedintohealth
informationandorganizationalcapacitybuildingassessmentsatthe
nationalandsubnationallevels.
TheAssessmentofDataUseConstraintsinterviewguideisorganizedby
thethreedeterminantsofdatausediscussedpreviously.
Above,youseeanexamplefromtheAssessmentofDataUseConstraints
tool.Asyoucansee,thesequestionsareintendedtoidentifytechnical
constraints.Thereareadditionalsectionsofthetoolwithquestions
aboutindividual/behavioralandorganizationalconstraints.Therearetwo
versionsoftheassessmenttoolthataccommodatethedifferentneedsof
userswhenassessingbarrierstodatause.Thefirstinterviewingguide,
Version1:NationalandSubnational,aimstoprovideabroadviewof
constraintsatthenationalandsubnationallevelsbycollecting
informationfromdecisionmakersontheircurrentuseofdataandon
25
theirperceptionsoftheconstraintstodatauseforevidencebased
decisionmaking.Thesecondinterviewingguideisintendedtobeused
amongstaffworkingatthehealthfacilitylevel.Version2:Facilityaimsto
provideanunderstandingofconstraintstobothgeneratingandusing
dataatlowerlevelsofthehealthsystem,suchashealthfacilities,
thereforeseparateinterviewingguidesfordatausers(program
managers,clinicalstaff)anddataproducers(dataclerksandmanagers,
M&Estaff)havebeendeveloped.Version2;Facilityalsoprovidesmore
focusonindividualandorganizationalconstraintsthanVersion1:
NationalandSubnational.Inadditiontotheinterviewingguides,an
actionplanmatrixisprovidedtohelpparticipantswiththeprocessof
identifyinginterventionstoaddressthebarriersandconstraintsthatare
identifiedintheassessment.
TheAssessmentofDataUseConstraintstoolscanbeusedformally
whereasampleofkeyinformantsisidentifiedtorespondtothe
questionsoritcanbeusedinformallytoguideadiscussionaround
barrierstodatause.Ineithercontext,theassessmentusersalways
shoulddiscusshowtheyintendtoovercomethebarriersidentified.Data
usewillnotimproveinyoursettingsunlessaplanisoutlinedtoaddress
eachbarrieridentified.Formoreinformationaboutthistool,pleasevisit:
http://www.cpc.unc.edu/measure/tools/datademanduse/data
demandandusestrategiesandtools.html.
Byassessingandaddressingthebarrierstoevidencebaseddecision
making,youwillbuildasolidfoundationfordecisionmaking.As
mentionedearlier,therearemultiplefactorsthatcaninhibitevidence
baseddecisionmaking.Byremovingthesebarriers,youcanfacilitatethe
efficientfunctioningofthedecisionmakingcontext.
Determinantsofdatausearetechnical,behavioral,andorganizational
KEY MESSAGES
Decisionmakingoccurswithinpolitical,cultural,andsocialcontexts
26
TheAssessmentofDataUseConstraintstoolcanhelptoclarifythe
barriersinyourorganization
27

Question:Arequestforareviewofpastfinancialdatainorderto
determinetheamountofanewprogrambudgetrequestisan
exampleof:
CorrectAnswer:a)Datademand
Question:Thefindingsofacountrywidebehavioralhealthsurvey
werepublishedandaspecialmeetingwasheldwithpolicymakers
toinformthemofthefindings.Inaddition,thedatasetwasmade
availableonlinewithspecificfeaturesthatallowusersto
automaticallygenerategraphsandchartsfortheirindicatorsof
interest.Theseactivitiesrepresent:
CorrectAnswer:c)Dataavailability.
Question:AlackofsupportforM&Ewithinanorganizationisa/an
____________barriertodataandinformationuse.
CorrectAnswer:c)System/organizationaldeterminantsrepresent
thebroadercontextthatsupportsdatacollection,availabilityand
use.Thiscanincludeorganizationalfactorssuchastheclarityof
rolesofthosewhonotonlyproducebutuseinformation,support
fromorganizationalleadershipfortheneed,useandfundingof
informationsystems,humanandfinancialresources,andtheflow
ofinformationthroughouttheorganization.
KNOWLEDGE
RECAP ANSWERS
28
KeyElementsofDecisionMaking
Objectives
explainthekeyelementsofdecisionmaking
definetheconceptofstakeholders
explaintheimportanceofinvolvingstakeholdersthroughoutthe
datauseindecisionmakingcycle
introducetheStakeholderEngagementTool
Overview
thepurposesofM&E
examplesofdatause
keyelementsofdecisionmaking(stakeholders,questions,data)
OBJECTIVES AND
OVERVIEW
KEY ELEMENTS OF
DECISION
MAKING
Above,youseeagraphicdepictingthekeyelementsofdecisionmaking.
Tomakeadecision,threeelementsarecritical:
data
questions
theinvolvementofstakeholders
ThepointofthisgraphicistoshowthatALLTHREEelementsareequally
important.Withoutallofthesecomponents,youwillfailtomakean
evidencebaseddecision.
29
ELEMENTS OF
DECISION
MAKING: WHAT IS
A STAKEHOLDER?
Letsfirstdiscussstakeholdersrolesinthecontextofdecisionmaking.
Astakeholderisanyonewhohasastakeorinterestinthedecisions
beingmade.Weoftenthinkofgovernmentagencies,policymakers,
fundingagencies,andevenimplementersorprovidersasstakeholders.
However,weoftendonotthinkofthebeneficiariesofhealthprograms
asstakeholders,andyettheyare.Thepeoplethatourprogramsand
servicesstrivetoservemakedecisionsaboutseekingservicesand
continuingtoseekcare.Itisvitaltoconsiderabroadvarietyof
stakeholderswhendesigningandimplementinganyprogramorservice.
Aswebegintotalkaboutstakeholdersinthedatauseprocess,itis
importanttothinkaboutdatausersanddataproducers.Datausersare
typicallyconsideredtobetheconsumersofhealthinformation:They
manageprograms,makepoliciesanddecidehowresourcesareallocated.
DataproducersaretheM&Eprofessionalsortheresearchers.We
typicallythinkonlyofdatausersasourstakeholdersbut,asyoucansee
fromthelistbelow,stakeholdersincludemorethanprogrammanagers,
policymakersanddataproducers.Examplesinclude:
governmentagencies
beneficiaries
policymakers
fundingagencies
providers/implementers
civilsociety
researchers
M&Especialists
30
nongovernmentalorganizations
professionalassociations
religiousleaders
journalists/media
privatesector/business
KnowledgeRecap
Question:Whyisitimportanttoengagestakeholdersinthedecision
makingprocesses?
a)Differentstakeholdershavevariedperspectives
b)Tobuildconsensus
c)Differentstakeholdershavedifferentinformationneeds
d)Alloftheabove
Answersareonpage41.
First,letsconsidersomefundamentaldifferencesbetweendata
producers(e.g.,researchers,M&Especialists)anddatausers(e.g.,
decisionmakers).
DATA PRODUCERS
VS. DATA USERS
Generallyspeaking,dataproducersareeducatedtobeobjective,
analytical,anddetailoriented.
Decisionmakersneedtoberesponsive,actionoriented,decisive.
31
Thesefrequentlyopposingapproachescontributetothebreakdownin
thedecisionmakingcycle.Forexample,dataproducersmaythinkthat
decisionmakers:
valuepoliticalconsiderationsoverevidence
areunpreparedtomeasureorevaluatetheconsequencesoftheir
decisions
DecisionmakersordatausersperceivethathealthresearchersandM&E
specialists:
lackresponsivenesstohealthpriorities
favornumbersandjargonovertransparentcommunication
preferwrittenreportstofacetofaceconversation
Thesedifferences,perceivedorreal,ofteninhibitmeaningfulinteraction
betweenthetwogroups.Whendatausersanddataproducersdont
worktogether,informationdoesntreachdecisionmakerswhenthey
needit;andinformationneedsarenotcommunicatedtodataproducers
astheydesigntheirdatacollectionefforts.
Itisimportanttorecognizethatdifferentstakeholderswillaffectthe
evidencebaseddecisionmakingprocessindifferentways.Different
stakeholders:
viewactivitiesfromdifferentperspectives
havedifferentdegreesofunderstanding
need/wantdifferentinformation
needinformationatdifferentlevelsofcomplexity
havedifferentintensitiesofinterest
havedifferentrolesinthedecisionmakingprocess
Byensuringavariedgroupofstakeholdersinthedatauseprocess,you
cantailordatacollectionanduseeffortstothespecificneedsofthe
stakeholders,thusincreasingtherelevanceofthedatauseactivityto
localneeds.Ownershipofdataisbuiltsothatwhenevidencebased
decisionsaremade,thenecessarybuyinexiststomovethedecision
IMPORTANCE OF
KNOWING YOUR
STAKEHOLDERS
RESULTS OF
INVOLVING
STAKEHOLDERS IN
DATA USE
PROCESS
32
forward.Stakeholderinvolvementstrengthenstheinformationcycleand
highlightsthevalueofdatatoprogramimprovement.
Whenstakeholdersunderstandthedatatheyareusing,itincreasesthe
relevanceandownershipofthedata,aswellastheappropriate
dissemination,whichinturnincreasestheuseofdata.
Nowthatwehavediscussedtheimportanceofinvolvingstakeholders,
letsdiscusshowtoensureappropriatestakeholderinvolvementinthe
datauseactivity.
STAKEHOLDER
ENGAGEMENT
TOOL
MEASUREEvaluationhasdevelopedtheStakeholderEngagementTool,
whichissimilarinnaturetotoolsdevelopedbyotherorganizationsthe
StakeholderAnalysisandEngagementtool.TheStakeholderEngagement
ToolconsistsofaStakeholderAnalysisMatrixandaStakeholder
EngagementPlan,whichcanbeusedtosystematicallyandformally
assessallofourstakeholders.Thematrixandplanhelpclarifywhohasan
interestintheactivity;whatthatinterestis;whocanhelptheactivity,
andhow;whocanhurtit;andhowthisinformationcanbeleveragedto
ensuresuccess.Thematrixhelpsidentifyandprioritizenecessary
stakeholders,whiletheengagementplanhelpscreateaplantoinvolve
theidentifiedstakeholders.
33
STAKEHOLDER
ANALYSIS MATRIX
Letsfirstlookatthematrix.Thistoolhelpstoidentifyindividualsand
groupsthatarestakeholdersinanM&Eordatauseactivity,eitheras
contributors,influencers,orbeneficiaries.
Thetoolprovidesastructuredwaytodefinetherolesthatstakeholders
playintheactivityandassesstheresourcestheycouldbringtobear.
Italsoprovidesaframeworkforassessingtheinterests,knowledge,
positions,alliances,resources,power,andimportanceofvarious
stakeholders.Whowillresisttheinitiative?Whowillsupportit?Whatare
theirreasons?
Thetoolhelpstoassesswhichstakeholderstoincludeintheprocessby
determiningtherelativepriorityofstakeholders.Whichstakeholders
havethehighestpriority?Whocandothemostinsupportofthe
activity?
34
HOW TO INVOLVE
STAKEHOLDERS
Nowthatwevetalkedaboutwhoyourstakeholdersare,itisimportant
tothinkabouthowtoengagetheminyouractivity.Remembertoplanto
engagestakeholdersthroughouttheactivity,notjustatthebeginningor
end.Ontheprogramsideateitherthenationalorsubnationallevels,one
canengageusersandproducersinmanyways.Examplesinclude
opportunitiesatquarterlymeetings,eitherforinterpretationofprogram
orRHISdata.
InM&Esystemimprovement,theinvolvementisusuallyatthenational
levelbutstillinvolvesbothusersandproducers.Oftenopportunities
centeraroundnationalindicatorsordatasystems.
Herewevelistedafewideas,butcanyouthinkofothers?
Onceyouanalyzeeachofthestakeholders,itishelpfultocreatea
stakeholderengagementplantoensurethatstakeholdersareinvolved
throughouttheactivity.
Thefirstcolumnliststhestakeholder,whilethesecondliststhepotential
roleofthatstakeholder.Thethirdcolumnshowshowyouplantoinvolve
thestakeholder,andthefinalcolumnlistswhoisresponsibleforensuring
involvement.FormoreinformationabouttheStakeholderEngagement
Toolpleasevisit:http://www.cpc.unc.edu/measure/tools/datademand
use/datademandandusestrategiesandtools.html.
35

Nowletsreturntotheelementsofdecisionmakinganddiscuss
questions.Decisionsinthehealthsectorcanbegroupedintofourgeneral
types,andeachareahasprogrammaticquestionswhichshouldbe
answeredpriortodecisionmaking.Thedecisionspertainto:
programdesignandevaluation
programmanagementandimprovement
strategicplanning
advocacyandpolicydevelopment
ELEMENTS OF
DECISION
MAKING:
DECISION/
QUESTION AREAS
Decisionsrelatedtoprogramdesignandevaluationcouldinclude:
selectingkeymessagesforpreventioncampaigns
identifyingandchoosingnewstrategiestoincreasetheimpactof
specificservices
determiningifnewprogramapproachesareneededtoensure
thathealthimpactobjectivesaremet
Correspondingquestionsmightincludethefollowing:
PROGRAM
DESIGN AND
EVALUATION
Whichthreepreventablehealthissuesaremostcommonin
districtX?
Whatdoesrecentresearchsayaboutthelatestandmost
effectivehealthservicesforthehealthareasaddressedinclinicA?
36
Arethecurrenthealthprogramsinacommunitymeetingthe
communitieshealthneeds?
Examplesofdecisionsthatarerelevanttoprogrammanagementcould
include:
decidingifaprogramismeetingitsobjectivesforexample,
trainingthestatednumberofproviders
decidingwhattodotoincreasethecoverageofprogramservices
PROGRAM
MANAGEMENT
AND
IMPROVEMENT
Hastheprogrammetitsstatedtargets?
Aretheservicesavailablemeetingtheneedsofthecommunity,
andaretheprogramsequippedtodosoinatimelymanner?
Examplesofdecisionmakinginstrategicplanningcouldinclude:
identifyinggeographicareasofhighestneed
determininghumanresourceallocation
determiningwhichpopulationgroupstotargettogetthegreatest
declinesinadiseaseprevalence
STRATEGIC
PLANNING
WhichdistrictintheprovincehasthehighestincidenceofHIV?
Indistrictx,whatisthenursetopatientratio?
Whichthreesubpopulationswereresponsibleforthegreatest
numberofnewHIVcaseslastyear?
Decisionsaroundadvocacyandpolicyformulationcouldinclude:
identifyingfocusareasorpopulationsfornewpolicies
determiningifaspecificpopulationisunderserved
ADVOCACY AND
POLICY
DEVELOPMENT
37
Aretherelawsinplacewhichmakeserviceprovisionmore
difficult?
Doallsubpopulationshaveequalaccesstoservices?
ELEMENTS OF
DECISION
MAKING: DATA
Nowletsdiscussthelastelementinthecontextofdecisionmaking
data.Asyouknow,therearemanysourcesofdataandinformationthat
wecanuseindecisionmaking,fromthenationalleveltothefacilitylevel,
andevenasconsumersorbeneficiariesofhealthservices.Wehavelisted
someofthemorecommonsources.Theyinclude:
census
vitaleventsdata
surveillancedata
householdsurveys
RHIS
financialandmanagementinformation
modeling,estimates,andprojections
healthresearch
Allrelevantdatasourcesshouldbeconsideredwhenmakingevidence
baseddecisions.Itisimportanttopromotetheexistenceofavailable
datasourcestopotentialusersandoutlinethetypesofinformation
containedineachsource.
38
KnowledgeRecap
Question:Inthecontextofdecisionmaking,whichofthefollowing
elementsiscriticalfordatainformeddecisionmakingtooccur?
a)Data
b)Questions
c)Stakeholders
d)Politicalaffiliation
e)b&d
f)a,b&c
Answersareonpage41.
Insummary,wecanstrengthenthedecisionmakingprocessby:
involvingnewdatausecounterpartsandstakeholders(weneed
toinvolvepotentialusersofthedatafromtheoutsettoensure
thattheinformationweareproducingcanbeused)
understandingtheservicedeliveryrealitiesonthegroundsoasto
understandthedecisionsbeingmaderoutinelyandhowtheycan
beinfluencedbyevidencebasedinformation(byunderstanding
theintendedaudiencesandwhatinformationisimportantto
themandtheirprogramstheinformationthatiscollectedwillbe
moreuseful)
STRENGTHENING
THE DECISIONMAKING
PROCESS
39
highlightingthevalueofinformationtoprogramimprovementso
thatdatausersseethevalueofdataanddemandit,whichwill
alsohelptoimprovethequalityofdata
TheStakeholderEngagementToolcanhelptoclarifythebarriersinyour
organization.
KEY MESSAGES
Everydecisionismadeinthecontextofavailabledataandstakeholders.
Criticallyassessingandinvolvingstakeholderswillfacilitateevidence
baseddecisionmaking.
Inearly2009,theNationalAIDSControlCommissionofRwanda(CNLS)
andpartnersconductedseveralanalyticreviewsandexercisestoform
theevidencebaseforthedevelopmentofRwandasNationalStrategic
Plan20092012.Insupportofthis,amodesoftransmission(MOT)HIV
incidencemodelingexercisewasconductedinanefforttoestimatethe
distributionofnewHIVinfectionsinRwandaacrossdifferentHIVrisk
groups.Accordingtothemodel,threegroupsemergedastheprimary
contributorstoHIVincidence:HIVserodiscordantcouples,femalesex
workers,andmenwhohavesexwithmen(MSM).Detaileddemographic,
epidemiologic,andbehavioraldatawererequiredforeachpotentialrisk
groupinthecountrytoinformthemodel.Aslocaldatawerenot
availableforallriskgroups,theexerciseusedregionaldatafromsub
SaharanAfricaforsomeriskgroups.Assuch,whentheresultswere
presentedatthenationallevel,manywereskepticaloftheirrelevance,
andsomedecisionmakersquestionedtheexistenceofMSMinRwanda.
CASE STUDY: TEST

YOUR
KNOWLEDGE
Astherewerenodataabouttheexistence,practices,orHIVrisksamong
MSMinRwandatosupportthemodelresults,itwasclearthat,ifthe
strategicplanwastobebasedonevidence,concretedatawereneeded.
Inresponse,theCNLScommissionedastudytodescribetheMSM
40
populationinKigali,thecapitalofRwanda,toexplorethenatureof
sexual/riskactivityintheMSMpopulation,establishmensopinions
regardingpotentialHIVpreventionactivities,andexplorethefeasibility
ofamorecomprehensivebiobehavioralsurveillancestudyofMSM
nationally.Thestudywasdesignedtoinformbothprogramsandpolicy.
Becauseofthestakeholderinvolvementintheresearchprocess,the
studyresultswereimmediatelytrustedandunderstoodbythekeydata
users.Datafromthestudywereusedinseveralkeyways.Afterahigh
leveldisseminationmeetinginDecember2009,MSMwereidentifiedasa
prioritygroupinthenationalHIVplan.Thisplacementinthestrategic
planatthenationallevelnotonlyvalidatedtheexistenceofMSM,italso
recognizedthemasaprioritygroupinneedofHIVrelatedservices.Asa
result,acostedplanwasdevelopedandusedtosecuresupportfromthe
GlobalFundtoFightAIDS,TuberculosisandMalariaforMSM
programminginRwanda.TheU.S.CentersforDiseaseControland
Prevention(CDC)alsousedthedatatosupportabudgetallocationto
twoorganizationsonetoprovidehealthservices,preventativecare,
andsupporttoMSMinRwanda,andtheothertoreachMSMthrough
communityoutreachandbehaviorchangecommunication.Inaddition,
theU.S.AgencyforInternationalDevelopmentdecidedtofundafollow
upqualitativestudyonHIVriskbehaviorsamongthisgroupandexplore
issuesofacceptabilityofHIVpreventionservices.
Thestudyalsoplayedakeyroleinanhistoricpolicydecision.In2007,the
governmentbegantheprocessofrevisingthecountryspenalcode,
whichwasoriginallydraftedinthe1960s.Theoriginalcode,while
outlawingsamesexmarriage,didnotspecificallymentionhomosexuality.
Proposedrevisionstothecodewould,however,criminalizesamesex
behaviorandthosethatencourageorinciteit,aswellasmandatefines
orimprisonmentforthoseconvictedofpracticinghomosexuality.
CivilsocietygroupsinRwandaworkedtofighttherevisionsandin2009
draftedapositionpaperopposingthem.Thepaperwassubmittedtothe
41
presidentandparliament.ThestudyconductedbyCNLSwastheonly
evidenceofMSMexistenceinRwandaandwasusedasthesupporting
evidenceforthepositionpaper.Throughthiswidespreadadvocacy,the
positionpapercirculatedtoalllevelsofgovernment.Asof2011,abillto
decriminalizehomosexualityinRwandahadpassedthreelevelsof
governmentandwasawaitingsignatureintolaw.
42

CaseStudyQuestions
Question1
ThecommitmenttobasingthedevelopmentoftheNationalStrategicPlanondatademonstrated:
a) Datademand
b) Datautilization
c) Dataavailability
d) Datacollection
Question2
Theprimarystakeholdersinthiscasestudyinclude:CNLS,CDC,USAID,MSMandpolicymakers.Theinvolvementofvariedand
diversifiedstakeholdergroupscontributedto:
a) Theidentificationofprogrammaticquestionsandthecorrespondingdatasourcesthatwouldinformthestrategicprioritiesin
thenationalstrategicplan
b) ThedevelopmentofanewresearchcenterintheNationalSchoolofPublicHealth
c) ThehighownershipanduseofMSMthestudyfindings
d) Regionalunitstooverseetheimplementationofnationalpolicies
e) AandC
Question3
Pleaseidentifythedataproducerfromthebelowlist:
a) CNLS
b) CDC
c) USAID
d) MSM
e) Policymakers
f) Alloftheabove
g) Noneoftheabove
Question4
Whattypesofdatawereusedtomakethedecisions?
a) Censusdata
b) RegionaldataonMSMpopulations
c) DHSdata
d) RwandaspecificMSMdata
e) B&D
f) Alloftheabove
Question5
PleaseidentifytheactionsthatweretakenbasedontheresultsoftheMSMdatacollectionactivity:
a) HIVpreventionservicestargetingMSMweredeveloped
b) AcompletebodyofknowledgewascreatedaboutMSMinRwanda
c) AfollowupstudywascommissionedtodeterminethehighriskHIVgroupsinRwanda
d) MSMactivitywasdecriminalized
e) A&D
f) C&D
Question6
ChoosetheTWOstatementsbelowthataretrueaboutthedatainformeddecisionmakingprocessthatsupportedthe
developmentoftheNSPinRwanda:1)DatausersanddataproducersworkedtogethertocreateadatainformedNSP2)The
NSPdatauseprocesstookplaceduringasinglemeeting;3)RecommendationsintheNSP(specificallypreventionprogramsfor
MSM)werefundedbydonorsandimplemented;4)ThefindingsofCNLSstudyonMSMwerequestionedbecauselocal
ownershipoftheMSMdatawasnotbuilt.
a) Statements1&2aretrue
b) Statements2&4aretrue
c) Statements3&4aretrue
d) Statements1&3aretrue
43
Question1
ThecommitmenttobasingthedevelopmentoftheNationalStrategicPlanondatademonstrated:
Thecorrectansweris"a".TheMOHinRwandawantedtoensurethattheir5yearHIVprogramwas
targetedthecorrecttargetgroups.Todothistheyneededdataonwhichpopulationsweregeneratingthe
mostnewHIVinfections.

Question2
Theprimarystakeholdersinthiscasestudyinclude:CNLS,CDC,USAID,MSMandpolicymakers.The
involvementofvariedanddiversifiedstakeholdergroupscontributedto
Thecorrectansweris"e".Theinvolvementofdatausersanddataproducersfromdifferentorganizations
allowedtheprioritydataneedstobeidentified.Bytargetingwhatinformationdecisionmakersneededto
informtheirprogramsthenewlycollecteddatawashighlyrelevanttotheupcomingdecisionmaking
process.Therelevanceofthedataandtrustinthedatacollectionprocessultimatestrengthenedthe
ownershipofthefindingsandcontributedtotheextensiveuseoftheMSMstudyresults.
Question3
Pleaseidentifythedataproducerfromthebelowlist:
Thecorrectanswerisa)CNLS.

Question4
Whattypesofdatawereusedtomakethedecisions?
Correctanswer:e)B&D

Question5
PleaseidentifytheactionsthatweretakenbasedontheresultsoftheMSMdatacollectionactivity:
Thecorrectansweris"e."HIVpreventionservicestargetingMSMweredeveloped&MSMactivitywas
Decriminalization.
Question6
ChoosetheTWOstatementsbelowthataretrueaboutthedatainformeddecisionmakingprocessthat
supportedthedevelopmentoftheNSPinRwanda.1)Datausersanddataproducersworkedtogetherto
createadatainformedNSP2)TheNSPdatauseprocesstookplaceduringasinglemeeting3)
RecommendationsintheNSP(specificallypreventionprogramsforMSM)werefundedbydonorsand
implemented.4)ThefindingsofCNLSstudyonMSMwerequestionedbecauselocalownershipofthe
MSMdatawasnotbuilt.
Thecorrectansweris"d."InclusionofdataintheNSPwasalongandmultiphasedprocess.Datawere
gatheredfortheanalyticreviewsincludingtheMOT.Oncetheseanalyseswereconductedmeetingswere
heldtodiscussanddebatethefindings.MeetingstoagreeonandplantheMSMstudywerealsorequired
aswellasweredatadisseminationandinterpretationmeetings.Onceallthedatawereavailable,many
discussionsensuedtoplanactivitiesbasedonthedataandtoprepareacostedplanforHIVprogramming.
AsoutlinedintheMEASUREEvaluationdatademandanduseconceptualframework,datauseispartofa
cycle.Thecycleisaffectedbythedemand,collectionandavailabilityofdata.Inthisexample,notonlydid
datauseresultfromaprocess,itwasacceptedbecausethroughouttheprocesslocalownershipofthe
datawasencouraged.
CASE
STUDY
ANSWERS
44
Question:Whyisitimportanttoengagestakeholdersinthe
decisionmakingprocesses?
KNOWLEDGE
RECAP ANSWERS
CorrectAnswer:d)Byunderstandingthedecisionsyour
stakeholdersaremakingandtheirinformationneedsyoucantailor
datacollection.Throughthis,informationismorerelevantto
variousstakeholders.Differentstakeholdersmayhavedifferent
prioritiesandinformationneeds,andbymakinginformationmore
relevanttotheirneedsitismorelikelythattheywilluseittoinform
theirdecisions.
Question:Inthecontextofdecisionmaking,whichofthe
followingelementsiscriticalfordatainformeddecisionmakingto
occur?
CorrectAnswer:f)Data,questionsandstakeholdersarethethree
criticalelementsfordatainformeddecisionmaking.
45
InformationFlowandFeedback
Objectives
identifyopportunitiesforimprovingdataproductionanduse
understandtheimportanceoffeedbackinprogramimprovement
andmanagement
identifyopportunitiesforimprovingfeedbackmechanisms
identifypointswhereanalysisanddatacouldsupport
programmaticdecisionmaking
listpotentialbarrierstoprovidingfeedback
considerhowtoimprovefeedbackmechanismsinparticipants
ownwork
OBJECTIVES AND
OVERVIEW
Overview
informationflow
informationusemap
guidetoexpandinguseofinformation
definefeedback
examplesoffeedback
possiblewaysofprovidingfeedback
46
OBJECTIVES AND
OVERVIEW
Earlier,wediscussedthedatademandanduseconceptualframework,
whichdepictsthecycleofdatademand,collection,availability,anduse
inherenttomonitoringandevaluation.Theoverarchingprincipleofthe
frameworkisthatevidencebaseddecisionmakingwillpromotethe
achievementofimprovedhealthoutcomes.TheMEASUREEvaluation
datademandanduseconceptualframeworkisacyclefromdemandto
utilization(whichdirectlyaffectsdemand);embeddedinthecycleisthe
decisionmakingprocess.
Inthisunit,wewillfocusondataavailability,indicatedatthetopofthe
diagram.Heredataaresynthesizedandtransformedintoaformatthat
canbeunderstoodeasilyandthenaredisseminatedtousers.Fordata
informeddecisionmakingtooccur,thedecisionmakermustunderstand
theinformationthatisneededtoinformthedecision.Thetoolsand
strategieshighlightedinthissectioncanhelptosynthesizeandtransform
dataintoinformation,communicatethatinformationtodifferent
audiences,andalignavailableinformationwithdecisions.
WearealwaysgivingpatientformsanddatatoourM&Eunit,whothen
givesdatatodonorsandthegovernment.IamtheheaddoctorandI
neverhavethechancetolookthroughthedatabeforetheygoup.We
justkeepgivingdataupandup,andweneverhearbackaboutit
PURPOSE OF
UNDERSTANDING
DATA FLOW
Headofantiretroviraltherapyfacility,Nigeria
47

Thesituationdescribedaboveiswhathappenswheninformationisnot
shared.Unfortunately,thisiscommontomanyfacilities,programs,and
countries.
Thesimpleprocessofgraphicallychartinginformationflow,usingsuch
formatsasaninformationusemap,helpsparticipantsbetterunderstand
theirroleinthegreaterhealthinformationsystemandtheimportance
ofcollectingdatainthefirstplace.Whenpeoplecanseethevalueof
data,theybecomemorecommittedtoconsistent,sustainable,high
qualitydatacollectionandregularanalysisofthosedata.
Chartingtheflowofdataandinformationwillallowustoidentify
opportunitiesforimprovingdatacollectionandanalysis,increase
availability,andensuredatause.Wecangraphicallyrepresenttheflow
ofdataandinformationatanylevel.
INFORMATION
FLOW
Whendiscussingtheimportanceofcommunicatingandsharing
information,itishelpfultolookatinformationflow.ExistingM&E
systemstypicallyfocusondatacollectionandreportingtohigherlevels
whilelittleattentionispaidtohowthedatacanbeusedlocallyfor
programimprovements.Asaresult,therearemanymissedopportunities
forfeedbackmechanismsandtheidentificationofspecificwaysinwhich
thedatacanbeanalyzedandusedtoinformprogrammonitoringand
decisionmaking.
48
Whydodataandinformationoftennotflowastheyshould?Typical
scenariosincludingthefollowing:
Localdataarenotbeingusedlocally.Often,dataaretalliedand
reportedupthelevels,butrarelyareanalyzedandusedtosupportmid
coursecorrectionsatthelevelatwhichtheyweregenerated.Service
providersandprogrammanagersoftenstruggletomeettheneedsof
theirclientsaswellastheoftentimeintensivereportingduties.Inmany
situations,datacouldbeusedtoinvestigatetrendsovertime,compare
differentareas,setprioritiesandgoalsforfutureyears,compare
progressagainstdefinedgoals,andadvocateforfundingorpolicies.
REASONS TO
ASSESS
INFORMATION
FLOW
Higherlevelinformationdoesnotreturnbacktothelocallevel.
Considertheexampleofafamilyplanningclinicatwhichdatareveala
decliningtrendinuseoforalcontraception.Theprovidersknewthat
womencomplainedaboutthesideeffects,buttheydidnotknowhow
muchtheoverallcontraceptionrateswerebeingaffected.Thedistrict
andregionalofficersknewcontraceptionratesweredecliningbutdidnot
knowwhy.Therewasaneedtobringtheseinformationsourcesand
stakeholderstogether.
Localdataarenotassessedinbroadcontext.Forexample,indistrictX,
10%ofthepopulationintheregionisexpectedtoreceiveaserviceand
onedistrictisonlyreaching2%.Obviously,thereisalargeservice
coveragegapinthisdistrictbutdecisionmakersatthefacilitiesandthe
districtofficedonotnecessarilyknowthisbecausetheymaynotbe
awareofhowtheirservicedeliveryratescomparetoregionalobjectives.
Thereislittleincentivetoproducehighqualitydata.Peopleinvolvedin
localleveldatacollectioneffortsoftendonotseethepurposein
collectingthedata.Theyhaveadifficulttimeappreciatingtheirrolein
thelargercontextofthehealthinformationchainand,asaresult,spend
lessenergyincollectingthedataorpayingattentiontodetails.
Sincethereissuchalargeamountofmoneyandeffortbeingdevotedto
collectingdataandreportinginhealthinformationsystems,itonlymakes
sensetomaximizetheimpactofthosedataforrealworldbenefits.
Providersandprogrammanagersalikeneedtoolstohelppinpointthe
blockagesininformationfeedbackandtofindopportunitiesfordatause.
Thisiswhereaninformationusemapissovaluable.
49
KnowledgeRecap
Question:Pleaseselectallofthepossiblereasonstoassessinformation
flow:1)Staffturnoverratesarehigh;2)Localdataarenotbeingused
locally;3)Higherlevelinformationdoesnotreturnbacktothelocallevel;
4)Localdataarenotassessedinbroadcontext;5)Fundinghasbeencut
forprogramactivities
a)1,2&5
b)2,3&4
c)4&5
d)2,3&5
Answersareonpages5859.
Aninformationusemapisaflowchartthatcandiagnoseandimprove
problemswithinformationflow.Theframeworkthatallowstheuserto:
INFORMATION
USE MAPPING
createaschematicrepresentationoftheexistingstateofahealth
informationsystemorsubsystem
identifygapsanddeficienciesinthatinformationflowquickly
throughvisualrepresentation
identifyopportunitiesfornewfeedbackmechanismstoshare
highlevelanalysisandreportswithlowerlevelsofthe
informationhierarchy
50
identifypointsintheprocessatwhichadditionalanalysisanduse
ofdatacouldleadtoimprovedprograms
prioritizerecommendationsandformulateanactionplanto
implementthem
Aninformationusemapcanbedevelopedandappliedatthe
international,regional,national,orlocallevel.Themapcanbean
ongoingguidelinetoassessprogresstowardtheexpectedfuturevision.
ThemapcanalsobecomeastandardpartofanM&Esystemrevisited
andrevisedatregularintervals,orwheneveranewsurveyorspecial
studyisbeingdesigned.Formoreinformationoninformationusemaps
pleasevisittheDataDemandandUseToolKitpage.
INVESTIGATING
INFORMATION
FLOW IN
DOMINICA
LetslookatanexampleofhowmappinginformationflowinDominica
improveddataflowand,ultimately,betteruseofdata.
InDominica,localhealthcentersandhospitalssentdataonthenumber
ofpeopletheytestedforHIV/AIDS,whilelabssenttestresults.A
statisticianaggregatedthedataandsentaquarterlyreporttothe
DominicaMinistryofHealth,whichinturnsentaquarterlyreporttothe
CaribbeanEpidemiologyCenter(CAREC)andanannualreporttothe
primeminister.
51
Thetroublewasthatlocalfacilitiesnevergotthesereports.Managersin
localfacilitiesdidntknowhowtheircenterscomparedtootherfacilities
ortonationaltrendsandgoals.Weretheyontrackwiththeirprograms
ornot?
Theseinformationgapsquicklybecameapparentwhendatacollection,
analysis,anduseprocesseswerevisualizedinaninformationusemap.
Datawerebeingreportedbutnotused.Reportsdidnotgetbacktothe
providersofsourcedata.Themappingexerciseidentifiedwaystoshare
insightsdowntheline,whichwouldleadtomidcourseimprovementsin
pretestcounselingandgreateracceptanceofHIV/AIDStesting.
INFORMATION
FLOW
IMPROVED IN
DOMINICA
TheaboveInformationFlowMapshowstheimprovementsinthe
informationflowsystem.
52
IMPORTANCE
OF FEEDBACK
Theflowchartaboveshowshowdatacaneffectivelyflowfromthe
servicedeliveryleveltothehigherlevelsresponsibleforthesupervision
ofprograms,i.e.,uptheinformationhierarchytothedistrictand,
eventually,nationallevels.Youseeintheboxontheleftthatdataare
collectedatthefacilitylevelforaspecificprogramarea.Thenthesedata
passtohigherlevels(boxontheright)foraggregationandusein
reportingand,itishoped,decisionmaking.
Sharingdatathroughfeedback(asrepresentedbythepinkarrow)isan
essentialpartoftheinformationflowprocess.Feedbackensuresthat
thosewhocollectedthedatabenefitfromthecollectionasmuchas
thoserequestingthedata.Also,informationneedstobesharedregularly
andinatimelymannersothatacultureofinformationuseis
supported.Thesharingorfeedbackofinformationneedstobedone
uptheinformationhierarchy(fromthefacilitytothedistricttothe
provincetothenationallevel)butalsowithinafacilityandbetween
districtandprovince.Finally,itneedstobeshareddowntheinformation
hierarchyfromthenationalleveltotheprovincetothedistrictand
facility.Reportsproducedbythehigherlevelsshouldbesharedtolower
levelstoensurethattheyarefamiliarwithhowotherserviceproviders
areperforming.Inaddition,thehigherlevelcanprovideguidanceand
advicetofacilitiesonanindividuallevelbasedonthedatatheyreceive.
Feedbackisanessentialpartofthedataproduceranddatauser
relationship.Withoutfeedback,neitherisabletofulfilltheirrolefully.
Thesharingofdatafromthedatacollectorstothedatausersandthen
backagainalsohelpstopaveapathbetweendatacollectorsandusersat
alllevelsofthehealthsystem.
53
Whendatacollectorsunderstandandseedatasusefulness,theyare
morelikelytoappreciateandvaluethedata.Thiscantranslateinto
higherqualitydatacollectionandthecollectionofappropriateanduseful
data.Feedbackisalsoanimportantelementofthemanagementand
supervisionsystem.Effectivecommunicationhelpstoensurethat
informationisavailableandtheuseofinformationforplanningand
programmaticimprovement.Last,staffseeingtheirdataandtracking
theirprogresscanfunctionasanincentivetocontinuestrivingto
improveservicedelivery.
54
KnowledgeRecap
Question:Nationalmodelsindicatethatfordiarrhealdiseaseamong
childrentodecreasecampaignsthatpromotehandwashingwithsoapare
critical.Inresponsetothisinformation,theMOHimplementededucation
campaignsin3regionsinthecountryandsetatargettodecrease
diarrhealincidenceby25%.Allbutoneregionreducedtheincidenceof
diarrhealdiseasetothedesiredlevel.Inthelaggingregionitwas
discoveredthatseveraldistrictswereonlyreceiving3ofthe
recommended8educationcampaigns.Obviously,therewasalarge
campaigncoveragegapinthesedistrictsbutthedistrictofficeswerenot
awarethattherewasaproblem.Theyhadnotbeentoldhowtheir
diarrhealdiseaseratescomparetonationalobjectives.Howcanthis
situationbeaddressed?
a)FacilitiesshouldhirestafftoM&Estafftofollowpolicyandresearch
trends
b)Nationaltargetsshouldbeadjusted
c)Nationaltargetsshouldbecommunicatedtoalldistrictofficesthrough
routineinformationchannels
d)Thereisnothingtoaddress.Thisgapinservicecoverageistobe
expectedfromtimetotime.
e)Progresstowardmeetingnationaltargetsshouldbesharedwithin
districtsandregions.
f)B&E
g)C&E
55
Otherexamplesoffeedbackinclude:
sharinginformationwithinafacilityororganization
sharingaggregatedserviceprovisiondatafromfacilitieswithina
districtorbetweenprovinces
meetingsbetweenfacilityandsupervisingagencytoreviewand
discussdataandinformation
meetingsbetweendonorsandnongovernmentalorganizationsto
reviewdataandinformationanddiscusschallengesand
opportunities
EXAMPLES OF
FEEDBACK
56
KnowledgeRecap
Question:Aninternationaldonoragencydevelopedanationalpoverty
reductionplanthatinvolvedhundredsofpeopleincommunityfocus
groups.Thisactivitysparkedcommunityinterestinandexcitementabout
thepotentialoftheproject.Unfortunately,therewasnofeedbackto
informthefocusgroupparticipantsaboutwhattheprojecthad
discovered.Thislackoffeedbackcreatedfrustrationamongthe
community,whichmaydiscouragefutureparticipationinresearch
activities.Thisisanissueof:
a)Sharinghealthfacilitydata
b)Goodcommunication
c)Gooddatacollection
d)Poorinformationfeedback
Successfulfeedbackcontributestowhatisknownastheinformation
culture.Wheninformationbecomesavailable,itismorelikelytobeused.
Wheninformationissharedandused,it:
becomesanintegralpartofdecisionmakingprocesses,including
planning,problemsolving,choosingalternatives,andgivingor
receivingfeedback
WORKING
TOWARD A
CULTURE OF
INFORMATION
USE
57
empowerspeopletoaskquestions,seekimprovement,learn,and
improvethequalityofprograms.
KnowledgeRecap
Question:Pleaseidentifyreasonstoprovidefeedbackfromthenational
levelbackdowntotheprovinces,districtsandfacilitiesfromtheoptions
below:
a)Promotesacultureofinformationuse
b)Sodonorsdon'tstopfundingtheprogram
c)Sodistrictsandregionsunderstandhowtheireffortsarecontributing
tonationaltargets
d)Feedbackisanessentialpartofthedatauser/producerrelationship
e)Promotesdataquality
f)A,C,D&E
g)A,C&D
Feedbackcanbepresentedinmanydifferentways,suchasnarratives
(summaries,bulleteditems,graphs,andcharts),inpersondiscussion
(oneonone,staffmeetings,districtmeetings),speechestostaff,and
supervisionvisits.
VARIETY OF
FEEDBACK
FORMATS
Letstakeacloserlookatnarratives.Mostcountries/programs/facilities
haveatypeofnarrativethroughwhichtosharedata.
NARRATIVE
FEEDBACK
58

Hereyouseeasimplepencilandpaperformusedbycommunitybased
programsandprimaryhealthclinicsduringregularsupervisionvisits.The
formdoesnotrequireasignificantlevelofliteracyormath,oran
understandingofhowtointerpretgraphs.Theformcontainsabar
representingtheaveragemonthlyperformanceofthemiddle80%of
communitydistributorsduringthepreviousyear.Asupervisormarksthe
distributorscurrentperformancewithanX,enablinghimorhertosee
howthiscomparestootherdistributorsintheprogramandstimulating
discussionofhowtoimproveperformance.Wherethisformhasbeen
used,ithasbeenreceivedpositivelybydistributorsandsupervisorsalike
andhassignificantlyincreasedtheamountoftimespentdiscussing
programissues.
59
SURVEILLANCE
REPORT
HereyouseeanHIVquarterlysurveillancereportfromthegovernment
ofHaiti.ItreportsonthenumberofHIVcasesbyestablishment,month,
age,andothercategories.Whatisinterestingaboutthisreportisthatit
providesfiguresandgraphics,andisnicelyorganizedsothatthereaderis
notoverwhelmedwithinformation.
60
FACILITY
REPORT
Thisexamplefromafacilityreportsonantiretroviraltherapy(ART)
servicesdeliveredforaspecificquarter.Thissimplechartisuniquein
thatitshowshowtheindicatorwascalculatedbygivingthenumerator
anddenominatortoshowthepercentageofthepopulationserved.
Providerscanthenusethisinformationbycomparingittotheirtargets
foreachservicearea.
Thissummaryprovidesaneasywaytodiscussfacilityperformance
aroundestablishedperformanceindicators.
Intheservicedeliverysetting,youmaybecalledupontoworkwith
othersinthefacilitytodevelopafeedbackmechanism.Inthiscase,there
areissuestoconsiderthatwillimprovetheusefulnessofthemechanism.
Theyincludethefollowing:
DEVELOPING A
FEEDBACK
MECHANISM
Considerthedatabeingshared.Whatisthebestwayto
summarizeandpresentthem?
61
Considerwhoorwhichstakeholderswillbenefitfromthe
informationbeingshared.Isityourfellowproviders,facility
management,districtleadership?Therecipientsofthe
informationwillaffecthowyoupackageit.
Whatisthebestformatforyourinformation?Willyourfeedback
bewrittenorverbal?Willitbeaformalorinformalfeedback
system?
Considertheforuminwhichthefeedbackwillbepresented.Will
itbepresentedatfacilitymeetings,atdistricthealthmanagement
teammeetings?
Howoftenwillthefeedbackbeprovided(e.g.,weekly,monthly,
quarterly)?
Considerhowtheinformationwillmovetothenextlevel.For
example,programmanagersalwaysshouldreviewdatabefore
sendingdatauptothenextlevel.
Documenttheprocessforimplementingandmaintainingthe
feedbackmechanismsothatitwillbestandardizedandshared
withothers.
62
KnowledgeRecap
Question:ConsidertheexampleofaVCTprogram,wheredatarevealan
increaseinthetimebetweentestingandfollowup,andadeclining
numberofclientsreceivingresults.Facilitymanagersknewthatthere
wereproblemswithproviderperformancearoundcounselingandtesting,
andthattherehadbeensomedelaysinthelab,buttheydidnotknow
howmuchtheoverallfollowuprateswerebeingaffected.Thedistrict
andregionalofficersknewfollowupratesweredeclining,butdidnot
knowwhy.Whatsolution(s)couldsolvethisseriousproblem?Please
selectallthatapply.
a)Bringstakeholdersfromclinicsandregionalofficestogethertodiscuss
theissues
b)Holddistrict/regionalstaffresponsiblefordecliningrates
c)ProvidefeedbacktoclinicsabouttheirVCTratesascomparedtoother
clinicsinthedistrict
d)Firetheclinicstaff
e)Retrainstaffoncounselingskills
f)A&C
g)A,C&E
63
Whilesharinginformationandprovidingfeedbackiscriticaltoa
providersjob,therearebarriersthatmayinhibittheabilitytodoso.
Thesebarriersinclude:
HierarchyAllprovidersreporttoafacilitymanager,adoctor,or
aprogrammanager.Providingfeedbackonclinicperformance
traditionallyisseenasaclinicmanagersjob.Othersmayfeelthat
theyaresteppingoutofplaceiftheytakeonthisresponsibility.
Whileitistruethattraditionallyitisamanagersresponsibilityto
providefeedback,otherhealthprofessionalscanfacilitatethis
process.Byregularlymonitoring,analyzing,interpreting,and
presentingdata,themanagersaccesstonecessaryinformationis
heightened.Throughdiscussionwithclinicsupervisors,ashared
responsibilitycanbeestablished.
Insomesettings,staffarededicatedtodatacaptureanddata
compilationforreportingpurposes.Inthiscase,datausersor
providerscanworkwithdataofficerstoclarifyindicators,answer
dataqueries,suggestspecificanalysesthattheproviderneedsfor
monitoringservicedelivery,interpretfindings,andcommunicate
data.
Insomesettings,theremayberestrictionsonsharingconfidential
information,requiringapprovaltodistributedataoutsideofthe
facility.Inthesecases,asolutioncanbediscussedwithclinic
management.
Last,alackofknowledgeofwhatinformationstakeholdersneed
canlimitfeedbackefforts.Discussionswithcolleagues,managers,
andthecommunitycanfacilitatethis.
POTENTIAL
BARRIERS TO
PROVIDING
FEEDBACK
Actualflowofdataandinformationcanrevealbarriersto
improvingdataqualityanduse.
Informationusemapscanhighlightinterventionpoints.
Sharinginformationwithin,between,up,anddownthehealth
system/project/organizationisessentialtoeffectivedatause.
Addressbarrierstofeedback.
KEY MESSAGES
64
Create a formal feedback mechanism.

Feedback should be timely, regular, constructive, descriptive,
helpful, and collaborative.

Question:Pleaseselectallofthepossiblereasonstoassessinformation
flow:1)Staffturnoverratesarehigh;2)Localdataarenotbeingused
locally;3)Higherlevelinformationdoesnotreturnbacktothelocallevel;
4)Localdataarenotassessedinbroadcontext;5)Fundinghasbeencut
forprogramactivities.
CorrectAnswer:b)Localdataarenotbeingusedlocally,higherlevel
informationdoesnotreturnbacktothelocallevel,andlocaldataarenot
assessedinbroadcontext
Question:Nationalmodelsindicatethatfordiarrhealdiseaseamong
childrentodecreasecampaignsthatpromotehandwashingwithsoap
arecritical.Inresponsetothisinformation,theMOHimplemented
educationcampaignsin3regionsinthecountryandsetatargetto
decreasediarrhealincidenceby25%.Allbutoneregionreducedthe
incidenceofdiarrhealdiseasetothedesiredlevel.Inthelaggingregion
itwasdiscoveredthatseveraldistrictswereonlyreceiving3ofthe
recommended8educationcampaigns.Obviously,therewasalarge
campaigncoveragegapinthesedistrictsbutthedistrictofficeswere
notawarethattherewasaproblem.Theyhadnotbeentoldhowtheir
diarrhealdiseaseratescomparetonationalobjectives.Howcanthis
situationbeaddressed?
CorrectAnswer:g)Nationaltargetsshouldbecommunicatedtoall
districtofficesthroughroutineinformationchannelsandprogresstoward
meetingnationaltargetsshouldbesharedwithindistrictsandregions.
Sharingnationaltargetswithprovincesanddistrictsiscriticalforhealth
servicesattheselevelstoappropriatelyplanandresourcetheir
programs.Moreover,itishelpfulforfacilitieswithinadistrictoraregion
tosharetheirperformancetowardtargets.Thistypeoffeedbackfosters
understandingofperformancerelativetoneighboringfacilitatesand
encouragesdiscussionsaboutsuccessfulprogrammaticapproaches.
KNOWLEDGE
RECAP
ANSWERS
65
Question:Aninternationaldonoragencydevelopedanationalpoverty
reductionplanthatinvolvedhundredsofpeopleincommunityfocus
groups.Thisactivitysparkedcommunityinterestinandexcitementabout
thepotentialoftheproject.Unfortunately,therewasnofeedbackto
informthefocusgroupparticipantsaboutwhattheprojecthad
discovered.Thislackoffeedbackcreatedfrustrationamongthe
community,whichmaydiscouragefutureparticipationinresearch
activities.Thisisanissueof:
CorrectAnswer:d)Returninginformationbacktothosethatassistedinthe
collectionofthosedataisimportanttobuildanunderstandingofhowdata
canimprovehealthservices.Whenthisunderstandingisstrongthedata
collectionsystemsfunctionbetteranddataisofbetter.
Question:Pleaseidentifyreasonstoprovidefeedbackfromthenational
levelbackdowntotheprovinces,districtsandfacilitiesfromtheoptions
below:
CorrectAnswer:f)Feedbackfromthenationallevelbackdowntothe
provinces,districtsandfacilitiespromotesacultureofinformationuse,
allowsdistrictsandregionstounderstandhowtheireffortsare
contributingtonationaltargets,strengthensthedatauser/producer
relationship,andpromotesdataquality.
Question:ConsidertheexampleofaVCTprogram,wheredatarevealan
increaseinthetimebetweentestingandfollowup,andadeclining
numberofclientsreceivingresults.Facilitymanagersknewthatthere
wereproblemswithproviderperformancearoundcounselingand
testing,andthattherehadbeensomedelaysinthelab,buttheydidnot
knowhowmuchtheoverallfollowuprateswerebeingaffected.The
districtandregionalofficersknewfollowupratesweredeclining,butdid
notknowwhy.Whatsolution(s)couldsolvethisseriousproblem?Please
selectallthatapply.
CorrectAnswer:f)Actionshouldonlybetakenafterthetwogroupsdiscuss
thepotentialreasonsforthedecliningfollowuprates.Priortothat,any
actionwouldonlybebasedongutlevelreaction,ratherthandata
interpretation.
66
FrameworkforLinkingDatawithAction
Objectives
identifyprioritydecisionsandprogrammaticquestions
linkdecisions/questionswithpotentialdatasources
understandhowtocreateatimeboundplanforusingdatain
decisionmaking
OBJECTIVES AND
OVERVIEW
UnitOverview
decisionsandquestions
FrameworkforLinkingDatawithAction
Inthepreviousunits,wediscussedmanyoftheconceptsandtoolsthat
canimprovethedecisionmakingcontextinyoursetting.Wetalked
about:
BUILDING DATA
USE INTO YOUR
WORK
identifyingandengagingstakeholderstoparticipateinthe
decisionmakingprocess
identifyingandovercomingbarrierstodatause
mappingandimprovinginformationflowandfeedback
Nowletsdiscussthepracticalaspectofusingdatainyourwork.Howcan
youmanagetobuildregulardatauseintoyourwork?Howdoyouensure
thatdatausebecomespartandparcelofyourdaytodayduties?The
answeristoPLANforit.
MEASUREEvaluationhasdevelopedasimpletoolthatassistsusersin
identifyingdecisionsandprogrammaticquestionsfacedindaytoday
work.Thesemaybedecisionsandquestionsaround:
programmonitoring,planning,andimprovement
advocacyneeds
programmanagementoroperationsissues
strategicplanning
67
CalledFrameworkforLinkingDatawithAction,thistoolhelpsyoutolink
thedecisionsandquestionswithdataandtocreateatimeboundplan
fordecisionmaking.Itisalsocriticaltoinvolveothersinyourwork
becausethebestdecisionsaremadewithstakeholderinvolvement.You
needtounderstand:
decisionsothersmake
informationtheyneed
thebestwaytopresentthatinformation
ELEMENTS OF THE
FRAMEWORK
Theframeworkassistsyouinidentifying:
decisionmakersandstakeholderswithpotentialinterestinyour
data
decisions/actionsthatastakeholdermakes(possibleusesofdata)
questionstowhichthestakeholderrequiresanswers
whenthedecisionwillbemade
indicatorsordataofinterest(torespondtostakeholderneed)
sourcesofdata
howdatawillbepresented(analyses,graphs,formats)
FRAMEWORK FOR
LINKING DATA
WITH ACTION
HereisthetemplatefortheFrameworkforLinkingDatawithAction.The
frameworkisamanagementtoolacombinationofatemplateand
processthatservesthreekeypurposes:
Theframeworkcreatesatimeboundplanforevidencebased
decisionmakingbysettingdatesbywhichdatashouldbe
68
reviewedinrelationtokeyprogrammaticquestionsand
upcomingdecisions.
Itencouragesgreateruseofexistinginformationbyidentifying
existingdataresourcesandlinkingthatinformationwiththe
programmaticquestionsthatneedanswerstosupportevidence
baseddecisionmaking.
Itprovidesyouwithanevidencebaseddecisionmakingrecord
sothatyoucanmonitortheuseofinformationindecision
making,providingatimelineforconductinganalysesandmaking
decisions.
Formoreinformationaboutthetool,pleasevisit:
http://www.cpc.unc.edu/measure/tools/datademanduse/data
demandandusestrategiesandtools.html.
KnowledgeRecap
Question:TheFrameworkforLinkingDatawithAction:
a)Createsamapofinformationflowwithinanorganization
b)Createsatimeboundplanfordatainformeddecisionmaking
c)Monitorstheuseofinformationindecisionmaking
d)Encouragesgreateruseofexistinginformation
e)B,C&D
f)Alloftheabove
g)Noneoftheabove
Answersareonpage79.
69
Letsclarifywhatwemeanbydecisions.Decisionsarechoicesthatlead
toaction.Alldecisionsareinformedbyquestions.Allquestionsshouldbe
basedondata.
WHAT ARE
DECISIONS?
Forexample,everydayyouneedtomakeadecisionaboutwhattowear
outsideofthehouse.Tomakethisdecision,youmayaskyourselfsome
ofthefollowingquestions:
Whatisthetemperature?
Isitraining?
WhateventsdoIhaveplannedfortheday?
Toanswerthesequestions,youmayconsultthethermometer,the
weatherreport,oryourdailycalendar.
Theseareexamplesofdecisionsthatmaybemadeatdifferentlevelsof
thehealthcaresystem:
DECISIONS
allocatingresourcesacrossstates/districts/facilities
revisingprogramsfororphansandothervulnerablechildren(OVC)
toemphasizechildadoptionandfostering
developingandinstitutingworkplacepoliciesonHIV/AIDS
hiringandallocatingstafftofacilities
Insomecontexts,adecisioncannotbeidentifiedbeforeakey
programmaticorpolicyquestionisanswered.Ordecisionmakersmay
haveaquestionabouttheirprogramforwhichtheyneedatimely
answer.Itistheanswertothisquestionthatmayprovidetheevidence
thatsomekindofactionneedstobetaken,eithertoimproveorrealign
services.Inthesecases,wefocusonidentifyingprogrammatic
questions,asopposedtodecisions.
DECISIONS OR
QUESTIONS
Examplesofprogrammaticquestionsincludethefollowing:
WhatpercentageofHIV+pregnantwomenincarearedelivering
inhealthfacilities?
WhatpercentageofclientsstartingARTarelosttofollowup?
Arethenumberoffamilyplanningclientsdecreasing?
PROGRAMMATIC
QUESTIONS
70
WhatpercentageofpregnantpatientswhoareHIV+arereceiving
ART?
71
KnowledgeRecap
Question1:ProgrammanagerswithinagovernmentfundedARTprogram
askedfacilitymanagersandotherstakeholderstomeettodiscusshow
theycanensurethatpatientsdonotdefaultastheprogramscalesup
servicesand,howtheycanimprovetrackingofdefaultingclientsover
time.Programmanagers,serviceproviders,supportgroupleaders,and
M&E;specialistsmettoidentifyquestionsthatwhenansweredwould
informthestrengtheningoftheirARTprograms.Whichofthefollowing
questionsisleastrelevanttoimprovingARTprograms?
a)Whatpercentageofclientsisaliveandontreatmentatthree,six,and
twelvemonthsafterinitiatingART?
b)AreweseeinganincreaseinCD4countsasclientsareontreatment
forlongerperiodsoftime?
c)Areclientsreceivingadequatecounselingandsupporttomaintain
adherencetoART?
d)Howmanyprovidersreceivedthenationalguidelinesonthenewstaff
vacationpolicy?
Question2:Programmanagerssupportingtwoclinicsareinterestedin
applyingforadditionalfundingfromadonororganizationtostrengthen
theclinics'capacitytomeettheneedsofyouthintheircatchmentareas.
First,theprogrammanagerswanttounderstandtheextenttowhichthe
clinicserviceswerealreadymeetingtheneedsofyouthintheirdistricts.
Theprogrammanagers,clinicaladvisors,andmonitoringandevaluation
(M&E)specialistsmettoidentifyquestionsthatcouldhelpthemimprove
servicesforyouth.Whichofthebelowquestionsistheleastrelevant?
a)Whatpercentageofeachclinic'sclienteleisyouthaged1524years?
b)Whatistheclinic'sperformanceagainstthetargetforthenumberof
youthaged1524yearsservedbytheclinic?
c)Howmuchmoneyisneededtoincreaseprogrammingforpregnant
women?
d)Isthenumberofyouthservedattheclinicincreasingeachmonth?
Answersareonpage79.
72
Onceyouhaveidentifiedyourprogrammaticquestionsordecisions,itis
timetoidentifythedatasourcesandspecificindicatorsnecessaryto
calculateananswertoyourprogrammaticandpolicyquestions.For
example,ifyourprogrammaticquestionis:Arewemeetingtheneedsof
pregnantwomeninDistrictXforPMTCTservices?Yourdatasourcesmay
include:
LINKING
DECISIONS AND
QUESTIONS WITH
DATA
RHISinformationonthenumberofwomencounseled,tested,
informedoftheirtestresult,positiveandreceivingtreatment,
infantsreceivingtreatment,andfollowupofinfectedinfants
censusdatafordistrictXtocalculatetheestimatednumberof
pregnantwomen
surveydataonHIVprevalencetocalculatetheestimatednumber
ofHIV+women
Insomeinstances,youwillrealizethataneededdatasourcedoesnot
exist.Inthiscase,youhaveidentifiedadatagapthatcanbefilledwith
proxydata(ifappropriateandavailable)ornewresearchwillneedtobe
conducted.
Fortheidentifiedanalysestotakeplaceanddecisionstobemade,
specificindividualsneedtobenamedtooverseetheprocess.Thetypes
ofstakeholdersthatyoumayimplicateinaspecificdecisionmaking
processcouldincludeaprogrammanager,afacilityhead,aprovider,the
directorofanNGOorcommunityorganization.Thispersonshouldhave
theultimateauthoritytomakethedecisionandoverseethe
implementationofactivities.
IDENTIFYING
STAKEHOLDERS,
TIMELINES, AND
COMMUNICATION
CHANNELS
Linkingthedecisionmakingprocesstoatimelinealsofacilitatesthe
process.Itpresentsaconcrete,actionablescheduleofactivitiesto
addresspolicyandprogrammaticquestions,toresolveadatagap,orto
integratedataintodecisionmakingprocesses.Thespecificdatefor
conductingtheanalysisthatwillinformdecisionsshouldbeidentified,as
wellasadatebywhichthedecisionneedstobemade.
Oncethetimelineisidentified,thespecificcommunicationchannelsthat
willbeusedtocommunicatetheresultsoftheanalysisorresulting
73
decisionsshouldbespecified.Thecommunicationchannelshouldbethe
mostappropriatewaytoconveyyourmessagestotheprimarydecision
makerandotherstakeholders.Stakeholdergroupsvarybytheir
informationuse,familiaritywithM&Eterminology,andpreferencesfor
receivinginformation,resultingintheneedtotailorfindingsand
recommendationsfordifferentaudiences.Somecommunication
methodsandformatsmaybeeffectivewithmultiplestakeholdergroups.
Makingtheresultsofyouranalysesandrecommendationsavailable,
accessible,relevant,oruseful,todecisionmakersincreasestheir
applicabilityforimprovinghealthsystems.Identifyingyour
communicationchanneltoreachdifferentsegmentsofstakeholdersis
essentialtoincreasingstakeholdersresearchuptake.
TheFrameworkforLinkingDatawithActionisnotaonetimeexercise
tiedtoonespecificcalendardateordecisionpoint.Whentheframework
isintegratedintodailyandannualworkplans,itservesasaworkingtool
thatfacilitatesevidencebaseddecisionmaking.Forbestresults,thetool
shouldberegularlyreferenced,monitored,andupdated.Whenused
regularly,theframeworkalsoprovidesatimelineformonitoringprogress
inthedecisionmakingprocess,andasystematicwayofidentifyingdata
usebyprogrammanagers,donors,andconsultants.
Buildingdatauseintoyourworktakesplanninganddedicatedtime.
KEY MESSAGES
Datashouldbelinkedtospecificdecisionssoastofacilitateuse.
Relevantstakeholdersshouldbeinvolvedineachstepoftheprocess.
TheFrameworkforLinkingDatawithActioncanbeusedtocreatean
actionableplanforusingdataindecisionmaking.
TheAIDSReliefProjectbeganinRwandainJanuary2004andby
September2008wasassisting12servicesites(localpartnertreatment
facilitiesorLPTF)toprovideantiretroviraltherapyandhadtested
103,685individualsforHIV,enrolledmorethan7,840peopleincare,and
started3,852clientsonART.EachLPTFprovidesservicesatahealth
facility(eitherahospitalorhealthcenter)andsupportscommunity
CASE STUDYTEST
YOUR KNOWLEDGE
CASE STUDY:
AIDSRELIEF
RWANDA
74
outreach.AIDSReliefutilizesasystemknownasIQCharttocollectpatient
datanecessaryforitsARTprograms.IQChartisanelectronicpatient
managementandmonitoringsystemthatallowsservicesitestocollect,
store,andanalyzepatientleveldata.
InMay2008,anIQChartreportshowedthatalargenumberofclients
weremissingtheirscheduledappointmentsforantiretroviral(ARV)drug
pickup.Thecentralofficediscussedthefindingswitheachsitesclinical
team.Theinitialreactionfromtheclinicalteamswasthatthenumberof
missedappointmentswasinflated;theydidnotbelievethatsomany
patientshadmissedtheirARVappointments.Theclinicalteams
requestedaninvestigationtodetermineifthiswasadataqualityissueor
ifsomanypatientswereinfactmissingappointments.AIDSReliefhada
multifacetedproblemtosolve.Ifthequalityofdatawaspoor,the
organizationneededtoreinvestintrainingservicesitestaffindata
collectiontechniques;ifthedataqualitywassufficient,itneededto
addressthefactthatmanypeopleweremissingtheirappointments.
Usingpatientdataalreadycollectedandstored,theofficegenerateda
listofnamesandaddressesofeverypatientmarkedasmorethan20
daysoverdueforanARVpickup.Thelistsweregiventocliniciansand
communitycoordinatorsforindividualfollowupandverificationatboth
thefacilityandthepatientshome.Itwasdeterminedthatpatient
recordswereindeedcorrect.Thisresolvedtheissueofdataqualityof
existingmedicalrecords.
Asaresult,AIDSReliefRwandainstitutednewprocedurestostrengthen
supportservicestoARVpatients.Eachcommunityvolunteerwas
assignedeightARTclientsthatthevolunteerwasexpectedtovisit
weekly.Newformsweredesignedforthevolunteerstoreportontheir
clients,andmonthlymeetingswerescheduledwiththecommunity
coordinatorstoshareanddiscusstheinformationcollectedandtheir
experiencesinsupportingclients.
WithimprovedincreasedavailabilityofdataonARVclientprogress,it
waspossibletoprovideahigherstandardofcare.Everysitenow
monitorsweeklyARVpickup,CD4testing,andcaresupport.With
improveddataavailableattheservicesites,cliniciansnowusethe
reportstoidentifyproblematicpatients.Communityvolunteersthen
75
followupwiththesepatientstoensurethattheycontinuewiththedrug
regimen.Asaresultoftheseprogramimprovements,thequalityoflifeof
programbeneficiarieshasimproved.Thenumberofpatientslostto
followuphasdroppedsignificantly.Anecdotalreportssuggestthat
communityvolunteershavebecomemorevisibleintheircommunities,
whichhasencouragedotherpeoplelivingwithHIVtojointheprogram
andseekHIVrelatedservices.
76
CaseStudyQuestions
Question1
Inthiscasestudy,whatpromptedtheinvestigationintoclientswhomissedARTappointments?
a)ArequestfromthenationalMOHthatallARTdatabereviewed
b)ReviewanddiscussionoftheIQChartreport
c)DrugstocksindicatedthattheARTsuppliesweretoohigh
d)Clinicalteamsverballyreportedthattheywereseeinglessclients
Question2
Whentheclinicalteamswereinformedthatthedatarevealedthatclientsweremissingappointmentstheir
initialreactionwasthatthenumberofpatientswasinflated;theydidnotbelievethatsomanypatientshad
missedtheirARVappointments.Todeterminethereasonsbehindthisfindingtheteamfirstcheckedthe
qualityofthedatabeforetheymadeanyprogrammaticdecisions.Thisactionrepresentsanunderstandingof:
a)The3determinantsofdatademandanduse:technical,organizationalandbehavioral
b)Stakeholderanalysis
c)ThegovernmentprocessforARTprocurement
d)Noneoftheabove
Question3
Inthecasestudyitstatesthat,"Asaresult,AIDSRelief/Rwandainstitutednewprocedurestostrengthen
supportservicestoARVpatients.EachcommunityvolunteerwasassignedeightARTclientswhomhe/she
wasexpectedtovisitweekly.Newformsweredesignedforthevolunteerstoreportontheirclients,and
monthlymeetingswerescheduledwiththecommunitycoordinatorstoshareanddiscusstheinformation
collectedandtheirexperiencesinsupportingclients."
a)Stakeholderengagement
b)Stakeholderanalysis
c)Evidencebaseddecisionmaking
d)Improvedinformationflow
Question4
Thenewdatacollectionformsthatwereimplementedtodocumenttheweeklyvisitsfromtheprogram
coordinatorsresultedinincreasedavailabilityofdataonARVclientprogress.AIDSReliefalsoconvened
regularmeetingswithcoordinatorstodiscussthefindingstomakedecisionsonclientcare.Theseactivities
areanexampleof:
a)Barrierstodatause
b)Thecycleofevidencebaseddecisionmaking
c)NationalM&Epolicy
d)Applicationofthestakeholderengagementtool
Answersareonthenextpage(78).
77
CaseStudyAnswers
Question1
Inthiscasestudy,whatpromptedtheinvestigationintoclientswhomissedARTappointments?
Thecorrectansweris"b."AIDSReliefhadastrongM&Esysteminplaceaswellasacommitmenttoregular
reviewofmonthlytrendsinthedata.Itwasthroughtheregularreviewanddiscussionofdatathatthedrop
inclientcontactswasnoted.Usingdatatomonitorprogramactivitiesisakeystepindatause.
Question2
Whentheclinicalteamswereinformedthatthedatarevealedthatclientsweremissingappointmentstheir
initialreactionwasthatthenumberofpatientswasinflated;theydidnotbelievethatsomanypatients
hadmissedtheirARVappointments.Todeterminethereasonsbehindthisfindingtheteamfirstchecked
thequalityofthedatabeforetheymadeanyprogrammaticdecisions.Thisactionrepresentsan
understandingof:
Thecorrectansweris"a."Thesystemsthatareinplacetoensurethequalityofdataareakeytechnical
determinantofdatause.Theclinicalteamknewthatdataqualityhadbeenanissueinthepastandwere
doingtheirduediligencetofirstensurethatthedatareflectedthetruesituationintheprogrambefore
embarkingonacostlyintervention.
Question3
Inthecasestudyitstatesthat,"Asaresult,AIDSRelief/Rwandainstitutednewprocedurestostrengthen
supportservicestoARVpatients.EachcommunityvolunteerwasassignedeightARTclientswhomhe/she
wasexpectedtovisitweekly.Newformsweredesignedforthevolunteerstoreportontheirclients,and
monthlymeetingswerescheduledwiththecommunitycoordinatorstoshareanddiscusstheinformation
collectedandtheirexperiencesinsupportingclients."Thisisanexampleof:
Thecorrectanswerisc.Evidencebaseddecisionmaking.
Question4
Thenewdatacollectionformsthatwereimplementedtodocumenttheweeklyvisitsfromtheprogram
coordinatorsresultedinincreasedavailabilityofdataonARVclientprogress.AIDSReliefalsoconvened
regularmeetingswithcoordinatorstodiscussthefindingstomakedecisionsonclientcare.Theseactivities
areanexampleof:
Thecorrectansweris"b."Thecycleofevidencebaseddecisionrepresentshowdatacollection,availability,
useanddemandareinterlinked.Whenthereisademandfordatathenecessaryresourcesareinvestedto
collectthatdata.Oncethedataarecollected,theywillbeanalyzedandsynthesizedintoaformatthatmakes
thedataavailablefordecisionmaking.Oncetheyareavailable,thedatacanbeusedtoinformhealth
programs.TheAIDSReliefstoryillustratesthatpositiveexperiencesusinginformationtosupportadecision
resultsinastrongercommitmenttoimprovingdatacollectionsystemsandcontinuingtousetheinformation
theygenerate.
78

Question:TheFrameworkforLinkingDatawithAction:
CorrectAnswer:e)TheFrameworkforLinkingDatawithActioncreatesa
timeboundplanfordatainformeddecisionmaking,helpsmonitorthe
useofinformationindecisionmaking,andencouragesgreateruseof
existinginformation.
Question1:ProgrammanagerswithinagovernmentfundedART
programaskedfacilitymanagersandotherstakeholderstomeetto
discusshowtheycanensurethatpatientsdonotdefaultasthe
programscalesupservicesand,howtheycanimprovetrackingof
defaultingclientsovertime.Programmanagers,serviceproviders,
supportgroupleaders,andM&E;specialistsmettoidentifyquestions
thatwhenansweredwouldinformthestrengtheningoftheirART
programs.Whichofthefollowingquestionsisleastrelevantto
improvingARTprograms?
CorrectAnswer:d)TheFrameworkforLinkingDatawithActioncreatesa
timeboundplanfordatainformeddecisionmaking,helpsmonitorthe
useofinformationindecisionmaking,andencouragesgreateruseof
existinginformation
Question2:Programmanagerssupportingtwoclinicsareinterestedin
applyingforadditionalfundingfromadonororganizationtostrengthen
theclinics'capacitytomeettheneedsofyouthintheircatchment
areas.First,theprogrammanagerswanttounderstandtheextentto
whichtheclinicserviceswerealreadymeetingtheneedsofyouthin
theirdistricts.Theprogrammanagers,clinicaladvisors,andmonitoring
andevaluation(M&E)specialistsmettoidentifyquestionsthatcould
helpthemimproveservicesforyouth.Whichofthebelowquestionsis
theleastrelevant
CorrectAnswer:c)Whilebudgetingconcernsareimportantinimproving
servicesforpregnantwomen,thedecisionmakersfirstobjectiveisto
determinehowthetwoclinicsarecurrentlymeetingtheneedsofyouth.
Oncethisisdeterminedandtheservicesthatneedtobeaddedor
improvedareidentified,thendecisionscanbemadeaboutwhereto
investadditionalresources.Also,theneedsofpregnantwomenare
relevanttowomenolderthan24.Ifthedecisionmakerswanttofocuson
servicesforyouth,theywillneedtolookspecificallyatprenatalservices
forwomen1524.
KNOWLEDGE
RECAP ANSWERS
79
FINALEXAM
Congratulationsyouhavenearlycompletedthiscourse!
Thefinalexamwilltestyourunderstandingofthematerialpresented.
AnswerthefollowingquestionstoseehowmuchyouknowaboutData
DemandandUse.Gotopages8485toseetheanswers.
1. Datademandanduse:
a)functionsasareinforcingcycle
b)involvesonlyoneperson
c)reliesonthecollectionandavailabilityofdata
d)happensnaturallyinalldecisionmakingprocesses
e)a&c
f)b&c
2.Basedoninformationfromahealthfacilityassessmentsurvey,a
ministryofhealthfoundthatthenumberofemergencyobstetriccare
facilitiesabletoprovideemergencyobstetriccarewaslowerthanthe
recommendedstandard.Thegovernmentusedthisinformationtoincrease
thecapacityoffacilitiestoprovideemergencyobstetricservices.Trueor
False:Inthiscase,thepurposeofinformationfromthehealthfacility
assessmentsurveywasusedtomakeaninformeddecisionabout
expandingthetypeofservicesofferedathealthcarefacilities.
a)true
b)false
3.Pleaseselectthecomponentsofthedatauseconceptualframework
fromthefollowingchoices:Collection,Supervision,Demand,Utilization,
FundingandAvailability.
a)supervision,demand,fundingandavailability
b)supervision,demand,utilizationandavailability
c)collection,utilization,fundingandavailability
d)collection,demand,utilizationandavailability
80
4. Alackofdataqualityassuranceprotocolsisa/an______________
barriertodataandinformationuse.
a)individualorbehavioral
b)technical
c)organizationalorsystemic
d)noneoftheabove
5.Alowlevelofstaffmotivationisa/an______________barriertodata
andinformationuse.
a)behavioral
b)technical
c)organizational
d)noneoftheabove
6.Datausersareindividualsororganizationswho:
a)makedecisions
b)provideservicesormanageprograms
c)developpoliciesorplans
d)alloftheabove
Chartforquestion7:
81
7.Theabovechartisanexampleofa/an__________feedbackform.
a)narrative
b)inpersondiscussion
c)supervisionvisitform
d)facilityreport
Chartforquestion8:
a)narrative
b)inpersondiscussion
c)supervisionvisitchecklist
d)facilityreport
9.Pleasechoosetheissue/issuesthatis/arepotentialbarrierstoproviding
feedback.
a)lackofcommunicationaboutdataneeds
b)strictorganizationalhierarchy
c)narrowrolesandresponsibilities
d)confidentiality
e)alloftheabove
82
10.Agovernmentisdevelopingitsannualhealthplanandbudget,andhas
includedabroadrangeofstakeholdersintheplanningprocess.Thereisa
needformoreinformationaboutthehealthstatusofkeypopulationsand
healthprogramsbeingimplementedbythegovernmentaswellasother
donorfundednongovernmentalorganizations.Thesedatahavebeen
collectedbyhealthsurveysandsurveillancesystemsbuthavenotbeen
synthesizedinoneaccessibleformatforusebyprogramplanners.Thisis
anissueof:
a)informationavailability
b)informationflow
c)dataproducererror
d)feedback
e)a,b&d
f)noneoftheabove
11.Achoicebetweentwoormorealternativesis:
a)information
b)astakeholder
c)adecision
12.Whyisitimportanttoconsiderhowyouwillcommunicatedatavia
feedbackmechanisms?
a)differentstakeholdershavedifferentdegreesofunderstandingabout
thetopicbeingcommunicated
b)differentstakeholdersneed/wantdifferentinformation
c)differentstakeholdersneedinformationatdifferentlevelsofcomplexity
d)differentstakeholdershavedifferentintensitiesofinterestinthetopic
beingcommunicated
e)alloftheabove
83
FinalExamAnswers
1.Datademandanduse:
e)a&c
2.Basedoninformationfromahealthfacilityassessmentsurvey,a
ministryofhealthfoundthatthenumberofemergencyobstetriccare
facilitiesabletoprovideemergencyobstetriccarewaslowerthanthe
recommendedstandard.Thegovernmentusedthisinformationto
increasethecapacityoffacilitiestoprovideemergencyobstetricservices.
TrueorFalse:Inthiscase,thepurposeofinformationfromthehealth
facilityassessmentsurveywasusedtomakeaninformeddecisionabout
expandingthetypeofservicesofferedathealthcarefacilities..
a)True
3.Pleaseselectthecomponentsofthedatauseconceptualframework
fromthefollowingchoices:Collection,Supervision,Demand,Utilization,
FundingandAvailability.
d)collection,demand,utilizationandavailability
4.Alackofdataqualityassuranceprotocolsisa/an______________
barriertodataandinformationuse.
b)technical
5.Alowlevelofstaffmotivationisa/an______________barriertodata
andinformationuse.
a)behavioral
6.Datausersareindividualsororganizationswho:
d)alloftheabove
a)narrative
d)facilityreport
84
9.Pleasechoosetheissue/issuesthatis/arepotentialbarriersto
providingfeedback.
e)alloftheabove
10.Agovernmentisdevelopingitsannualhealthplanandbudget,and
hasincludedabroadrangeofstakeholdersintheplanningprocess.There
isaneedformoreinformationaboutthehealthstatusofkeypopulations
andhealthprogramsbeingimplementedbythegovernmentaswellas
otherdonorfundednongovernmentalorganizations.Thesedatahave
beencollectedbyhealthsurveysandsurveillancesystemsbuthavenot
beensynthesizedinoneaccessibleformatforusebyprogramplanners.
Thisisanissueof:
e)informationavailability,flow,andfeedback
11.Achoicebetweentwoormorealternativesis:
c)adecision
12.Whyisitimportanttoconsiderhowyouwillcommunicatedatavia
feedbackmechanisms?
e)alloftheabove
85
GLOSSARY
Aggregation:Acollectionofdatacombinedforaspecifictypeofanalysis.
Analysis:Turningrawdataintoinformationtoassistinunderstandingaphenomenon.
ART:Antiretroviraltherapy;strategiesformedicinaltreatmentofinfectionsbyretrovirus,suchasHIV.
Behavioraldeterminants:Determiningfactorstiedtothebehaviorofindividualswhoproduceanduse
data.Thiswouldcovertheirattitudes,values,andmotivation.
Causalelement:Anelementorfactordirectlyresponsiblefororaspecificoutcome.
Cultureofdatause:Whenasystemororganization,andtheindividualsthatarepartofthe
system/organization,routinelypracticetheuseofdataindecisionmaking
Data:Referstoraw,unprocessednumbers,measurements,ortext.
Datademandanduse:Asystematicapproachthatappliesbestpracticesandappropriatetoolswith
thegoalofincreasingdemandforqualityhealthrelateddataandensuringthattheresulting
informationisusedinanevidencebaseddecisionmakingprocess.
Dataproducers:Individualsororganizationswhoconductresearch;collectprimarydatainthecourse
ofprovidingaspecificserviceordeliveringaprogramintervention;orcompile,analyze,interpret,or
communicatedataandinformation.Adatauserandadataproducermaybethesameindividual.
Datausers:Individualsororganizationsthatusedatatomakedecisions,developpoliciesandplans,
formulateadvocacymessages,provideservices,ormanageprograms.Adatauserandadataproducer
maybethesameindividual.
Decision:Achoicethatleadstoaction(orpurposefulinaction),ideallyinformedbyquestionsand
basedondata.
Denominator:Thepartofafractionthatisbelowtheline(thedivisorofthenumerator).
Determinants:Adeterminingorcausalelementorfactordirectlylinkedtodatause.
Evidencebaseddecisionmaking:Inthiscourse,evidencebaseddecisionmakingreferstousingdata
orinformationtoinformadecision.
Evaluation:Anactivity(suchasastudy)thatattributesprogramoutcomestotheircauses.
86
Feedbackmechanisms:Asysteminwhichinformationaboutreportsandperformanceissentbackto
theoriginaldatacollectorsorproducerswithinaroutinehealthinformationsysteminordertogive
comments,advice,correction,orencouragementtotheoriginalcollectorsorprogrammanagers
Impact:Apositiveornegative,primaryorsecondarylongtermeffectproducedbyaprogram
intervention,directlyorindirectly,intendedorunintended.
Indicator:Aquantitativeorqualitativefactororvariablethatprovidesasimpleandreliablemeansto
measureachievement,toreflectthechangesconnectedtoaprojectintervention,ortohelpassessthe
performanceofthoseofinteresttotheintervention.
Information:Referstoprocesseddata,orcombineddatapresentedinaspecificcontext.
Informationflow:Thepaththatinformationtravelsthroughanorganization,program,government,or
system.
Interpretation:Theprocessbywhichfindingsofananalysisareunderstoodwithinthecontextofa
program.
M&Esystems:Theprocessbywhichdataarecollected,analyzed,andcommunicatedtoprovide
informationtopolicymakersandotherstakeholdersforuseinmakingdecisions,diagnosingproblems
orconcerns,andansweringprogrammaticquestions.
Monitor:Totrackchangesinprogramperformanceovertimetoknowwhethertheprogramisbeing
truetoitsstatedgoalsandobjectives;continuedanalysisandinterpretationofkeyindicators.
Numerator:Thepartofafractionthatisabovethelineandsignifiesthenumbertobedividedbythe
denominator.
Organizationaldeterminants:Determiningfactorstiedtotheorganizationalcontextthatsupportdata
collection,availability,anduse,suchastheidentifiedproceduresandtherolesandresponsibilitiesof
thosewhocollect,analyze,disseminate,andusedata.
Outcome:Thelikelyorachievedshorttermandmediumtermeffectsofaprograminterventions
outputs.
Percentage:Expressesafractionofatotalonthebasisofthetotalbeingdividedinto100parts(e.g.,
50%representshalfofthetotal).
PMTCT:PreventionofmothertochildtransmissionofHIVtypicallyinvolvespProgramsintendedto
preventinfectionofHIVfromanHIV+mothertoherchildduringpregnancy,labor,delivery,or
breastfeeding.
87
PRISM:PerformanceofRoutineInformationSystemManagement,aconceptualframework
developedbyMEASUREEvaluationtoevaluateroutinehealthinformationsystems(RHIS).More
informationcanbefoundat:http://www.cpc.unc.edu/measure/publications/ms0934
Proxydata:Indirectmeasuresofaprogramtarget.
Routinehealthinformationsystems:Systemsthattrackandutilizedatathatarecollectedona
continuousbasis,suchaspatientregisters.
Stakeholder:Anyonewhohasastakeorinterestinyourprogram.Thiscanincludegovernment
agencies,policymakers,fundingagencies,andevenimplementersorproviders.Inaddition,the
beneficiariesofhealthprogramsarestakeholders.
Target:Aprogramgoalorindicatorgoal.
Technicaldeterminants:Determiningfactorstiedtothetechnicalaspectsofdatacollectionprocesses
andtools,suchasthedatacollectionprocesses,methods,andforms.
Vitalevents:Arecordofbirthsanddeathsamongapopulation.
88
MEASURE Evaluation
University of North Carolina at Chapel Hill
400 Meadowmont Village Circle, 3rd Floor
Chapel Hill NC 27517 USA
P: +1 919-445-9350
F: +1 919-445-9353
E: measure@unc.edu
www.measureevaluation.org
eCourse available for download:
http://www.measureevaluation.org/resources/
publications/ms-12-54
MEASURE Evaluation is funded by the U.S. Agency for

International Development (USAID) through Cooperative Agreement
GHA-A-00-08-00003-00 and is implemented by the Carolina Population
Center at the University of North Carolina at Chapel Hill, in partnership
with ICF International, John Snow, Inc., Management Sciences for
Health, Palladium, and Tulane University. The views expressed in this
publication do not necessarily reflect the views of USAID or the United
States government. MS-12-54

Data Demand and Use

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Data Demand and Use

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2012

Data Demand and Use:

understand the importance of improving datainformed decision

There is evidence to suggest that the global HIV epidemic is stabilizing,

Approximately 1.7 million people died from tuberculosis (TB) in 2009.

The importance of evidencebased decision making is expressed by a

without information, things are done arbitrarily and one becomes

A 2008 international survey conducted by the Overseas Development

Specifically, we see that 42% of policy makers, 60% intermediary

CASE STUDY: TEST

Create a formal feedback mechanism.

helpful, and collaborative.

MEASURE Evaluation is funded by the U.S. Agency for

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