Using health data for decision-making at each level of the health system to achieve universal health coverage in Ethiopia: the case of an immunization programme in a low-resource setting

Abstract Background For evidence-based decision-making, there is a need for quality, timely, relevant and accessible information at each level of the health system. Limited use of local data at each level of the health system is reported to be a main challenge for evidence-based decision-making in low- and middle-income countries. Although evidence is available on the timeliness and quality of local data, we know little about how it is used for decision-making at different levels of the health system. Therefore, this study aimed to assess the level of data use and its effect on data quality and shared accountability at different levels of the health system. Methods An implementation science study was conducted using key informants and document reviews between January and September 2017. A total of 21 key informants were selected from community representatives, data producers, data users and decision-makers from the community to the regional level. Reviewed documents include facility reports, district reports, zonal reports and feedback in supervision from the district. Thematic content analysis was performed for the qualitative data. Results Respondents reported that routine data use for routine decision-making was low. All health facilities and health offices have a performance monitoring team, but these were not always functional. Awareness gaps, lack of motivating incentives, irregularity of supportive supervision, lack of community engagement in health report verification as well as poor technical capacity of health professionals were found to be the major barriers to data use. The study also revealed that there are no institutional or national-level regulations or policies on the accountability mechanisms related to health data. The community-level Health Development Army programme was found to be a strong community engagement approach that can be leveraged for data verification at the source of community data. Conclusion The culture of using routine data for decision-making at the local level was found to be low. Strengthening the capacity of health workers and performance monitoring teams, introducing incentive mechanisms for data use, engaging the community in data verification and introducing accountability mechanisms for health data are essential to improve data use and quality.

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Individual capacities influencing uses of routine health data for decision making among health workersat Muhimbili National Hospital; Dar es Salaam – Tanzania: a quantitative study

Tanzania Journal of Health Research ◽

10.4314/thrb.v22i1.1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Salim Mpimbi ◽

Mwangu Mughwira

Keyword(s):

Decision Making ◽

Emergency Medicine ◽

Health System ◽

Health Workers ◽

Data Use ◽

Routine Data ◽

Health Data ◽

Muhimbili National Hospital ◽

National Hospital ◽

Significant Difference

Background: The availability of health workers with the capacity to read and understand statistical data and then use them for work-related decision-making, therefore, supporting their institutions or the existing health system at large in developing countries is important. However, in some countries, Tanzania inclusive, this has remained critical. This requires the capacity-building of potential users. The study aimed to assess individual capacities influencing use of routine health data for decision-making among Emergency Medicine health workers at Muhimbili National Hospital (MNH). Methods: The study design used was a descriptive cross-sectional using a quantitative approach. Stratified random sampling was used to sample Nurses, Medical officers, Residents, and Emergency medicine specialists. A semi-structured questionnaire was used to collect data. The study involved 76 health workers working in the Emergency Medicine Department (EMD) at MNH. Results: Results showed 61.6% use of routine health data for decision making. Working experience, job title, and education level had a statistically significant association with information used for decision-making. There was a statistically significant difference in routine data use between those who had poor and good knowledge to collect, analyze, interpret, and use data. Also, results showed that there was a statistically significant difference in routine data use between those who had poor and good skills to collect, analyze, interpret, and use data. Specialists had a good level of knowledge and skills on data use compared to other health workers. Conclusion: The study demonstrates partial use of routine health data for decision-making with an interplay of individual capacities. A framework for statistical capacity building in Tanzania needs to be built, by training a cadre of health workers with core competencies and skills in measuring progress in the health system that could generate sustainable demand for data use within the health systems of the country.

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Strengthening evidence-based decision-making: is it possible without improving health system stewardship?

Health Policy and Planning ◽

10.1093/heapol/czr072 ◽

2011 ◽

Vol 27 (6) ◽

pp. 499-504 ◽

Cited By ~ 17

Author(s):

R. Majdzadeh ◽

B. Yazdizadeh ◽

S. Nedjat ◽

J. Gholami ◽

S. Ahghari

Keyword(s):

Decision Making ◽

Health System ◽

Evidence Based ◽

Evidence Based Decision Making

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Commitment Levels of Health Care Providers in Using the District Health Information System and the Associated Factors for Decision Making in Resource-Limited Settings: Cross-sectional Survey Study

JMIR Medical Informatics ◽

10.2196/23951 ◽

2021 ◽

Vol 9 (3) ◽

pp. e23951

Author(s):

Shuma G Kanfe ◽

Berhanu F Endehabtu ◽

Mohammedjud H Ahmed ◽

Nebyu D Mengestie ◽

Binyam Tilahun

Keyword(s):

Health Care ◽

Decision Making ◽

Health Care Providers ◽

Data Use ◽

Health Information System ◽

Evidence Based ◽

Care Providers ◽

District Health ◽

Cross Sectional ◽

Evidence Based Decision Making

Background Changing the culture of information use, which is one of the transformation agendas of the Ministry of Health of Ethiopia, cannot become real unless health care providers are committed to using locally collected data for evidence-based decision making. The commitment of health care providers has paramount influence on district health information system 2 (DHIS2) data utilization for decision making. Evidence is limited on health care providers’ level of commitment to using DHIS2 data in Ethiopia. Therefore, this study aims to fill this evidence gap. Objective This study aimed to assess the levels of commitment of health care providers and the factors influencing their commitment levels in using DHIS2 data for decision making at public health care facilities in the Ilu Aba Bora zone of the Oromia national regional state, Ethiopia in 2020. Methods The cross-sectional quantitative study supplemented by qualitative methods was conducted from February 26, 2020 to April 17, 2020. A total of 264 participants were approached. SPSS version 20 software was used for data entry and analysis. Descriptive and analytical statistics, including bivariable and multivariable analyses, were performed. Thematic analysis was conducted for the qualitative data. Results Of the 264 respondents, 121 (45.8%, 95% CI 40.0%-52.8%) respondents showed high commitment levels to use DHIS2 data. The variables associated with the level of commitment to use DHIS2 data were found to be provision of feedback for DHIS2 data use (adjusted odds ratio [AOR] 1.85, 95% CI 1.02-3.33), regular supervision and managerial support (AOR 2.84, 95% CI 1.50-5.37), information use culture (AOR 1.92, 95% CI 1.03-3.59), motivation to use DHIS2 data (AOR 1.80, 95% CI 1.00-3.25), health needs (AOR 3.96, 95% CI 2.11-7.41), and competency in DHIS2 tasks (AOR 2.41, 95% CI 1.27-4.55). Conclusions In general, less than half of the study participants showed high commitment levels to use DHIS2 data for decision making in health care. Providing regular supportive supervision and feedback and increasing the motivation and competency of the health care providers in performing DHIS2 data tasks will help in promoting their levels of commitment that can result in the cultural transformation of data use for evidence-based decision making in health care.

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A Framework of Evidence-Based Decision-Making in Health System Management: Applying Best-Fit Framework Synthesis

10.21203/rs.3.rs-24295/v1 ◽

2020 ◽

Author(s):

Tahereh Shafaghat ◽

Peivand Bastani ◽

Mohammad Hasan Imani Nasab ◽

Mohammad Amin Bahrami ◽

Zahra Kavosi ◽

...

Keyword(s):

Decision Making ◽

Health System ◽

Scientific Evidence ◽

Developed Countries ◽

System Management ◽

Evidence Based ◽

Systematic Map ◽

Public Health Decision ◽

Secondary Study ◽

Evidence Based Decision Making

Abstract Background: Scientific evidence is the basis for improving public health; decision-making without sufficient attention to evidence may lead to unpleasant consequences. In recent years, efforts have been made to create more comprehensive guidelines for evidence-based decision-making (EBDM), thus the purpose of the present study was developing a framework for EBDM to make the best decisions concerning to scare resources and too many needs. Methods: The present basic-applied research was a secondary study carried out using qualitative research method in 2019. A Systematic Scoping Review (SSR) was done for the comprehensive review of the existing published studies in this area. This method, according to Arksey and O’Malley approach, consists of five main stages and one optional stage. Results: Based on the SSR, 3751 studies from 7 databases were found, and due to the full-text screening of the studies, 30 final studies were selected for extracting the components and steps of EBDM in Health System Management (HSM). After collecting, synthesizing, and categorizing key information, the framework of EBDM in HSM is developed in the form of four general scopes of inquiring, inspecting, implementing and integrating, which includes 10 main steps and 56 sub-steps. Conclusions: The present framework tries to present a sequential systematic map to achieve evidence-based decision and policy making specially for under developed and developing countries which mostly suffer from applying update and applied evidences in their decision-making process. At the same time, it seems that the present framework tries to synthesize and integrate the fragmented elements of the other models and in this way can be tested by developed countries to improve their EBDM cycle.

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Improving Health Empowerment and Evidence-Based Decision-Making using Collective Intelligence and Self-management Health System

Proceedings of the 5th International Conference on Technological Ecosystems for Enhancing Multiculturality - TEEM 2017 ◽

10.1145/3144826.3149548 ◽

2017 ◽

Author(s):

Pedro Pérez-Alcántara ◽

Manuel Herrera-Usagre

Keyword(s):

Decision Making ◽

Health System ◽

Collective Intelligence ◽

Self Management ◽

Evidence Based ◽

Health Empowerment ◽

Evidence Based Decision Making

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Commitment Levels of Health Care Providers in Using the District Health Information System and the Associated Factors for Decision Making in Resource-Limited Settings: Cross-sectional Survey Study (Preprint)

10.2196/preprints.23951 ◽

2020 ◽

Author(s):

Shuma G Kanfe ◽

Berhanu F Endehabtu ◽

Mohammedjud H Ahmed ◽

Nebyu D Mengestie ◽

Binyam Tilahun

Keyword(s):

Health Care ◽

Decision Making ◽

Health Care Providers ◽

Data Use ◽

Health Information System ◽

Evidence Based ◽

Care Providers ◽

District Health ◽

Cross Sectional ◽

Evidence Based Decision Making

BACKGROUND Changing the culture of information use, which is one of the transformation agendas of the Ministry of Health of Ethiopia, cannot become real unless health care providers are committed to using locally collected data for evidence-based decision making. The commitment of health care providers has paramount influence on district health information system 2 (DHIS2) data utilization for decision making. Evidence is limited on health care providers’ level of commitment to using DHIS2 data in Ethiopia. Therefore, this study aims to fill this evidence gap. OBJECTIVE This study aimed to assess the levels of commitment of health care providers and the factors influencing their commitment levels in using DHIS2 data for decision making at public health care facilities in the Ilu Aba Bora zone of the Oromia national regional state, Ethiopia in 2020. METHODS The cross-sectional quantitative study supplemented by qualitative methods was conducted from February 26, 2020 to April 17, 2020. A total of 264 participants were approached. SPSS version 20 software was used for data entry and analysis. Descriptive and analytical statistics, including bivariable and multivariable analyses, were performed. Thematic analysis was conducted for the qualitative data. RESULTS Of the 264 respondents, 121 (45.8%, 95% CI 40.0%-52.8%) respondents showed high commitment levels to use DHIS2 data. The variables associated with the level of commitment to use DHIS2 data were found to be provision of feedback for DHIS2 data use (adjusted odds ratio [AOR] 1.85, 95% CI 1.02-3.33), regular supervision and managerial support (AOR 2.84, 95% CI 1.50-5.37), information use culture (AOR 1.92, 95% CI 1.03-3.59), motivation to use DHIS2 data (AOR 1.80, 95% CI 1.00-3.25), health needs (AOR 3.96, 95% CI 2.11-7.41), and competency in DHIS2 tasks (AOR 2.41, 95% CI 1.27-4.55). CONCLUSIONS In general, less than half of the study participants showed high commitment levels to use DHIS2 data for decision making in health care. Providing regular supportive supervision and feedback and increasing the motivation and competency of the health care providers in performing DHIS2 data tasks will help in promoting their levels of commitment that can result in the cultural transformation of data use for evidence-based decision making in health care.

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A Framework of Evidence-Based Decision-Making in Health System Management: A Best-Fit Framework Synthesis and a Scoping Review

10.21203/rs.3.rs-24295/v2 ◽

2020 ◽

Author(s):

Tahereh Shafaghat ◽

Peivand Bastani ◽

Mohammad Hasan Imani Nasab ◽

Mohammad Amin Bahrami ◽

Zahra Kavosi ◽

...

Keyword(s):

Decision Making ◽

Health System ◽

Scoping Review ◽

Developed Countries ◽

System Management ◽

Decision Making Process ◽

Evidence Based ◽

Public Health Decision ◽

Best Fit ◽

Evidence Based Decision Making

Abstract Background: Scientific evidence is the basis for improving public health; decision-making without sufficient attention to evidence may lead to unpleasant consequences. Despite efforts to create comprehensive guidelines and models for evidence-based decision-making (EBDM), there isn`t any to make the best decisions concerning scarce resources and unlimited needs. The present study aimed to develop a comprehensive applied framework for EBDM. Methods: This was a meta-synthesis including two phases of a Scoping Review (SR) and a Best-Fit Framework (BFF) synthesis conducted in 2019. A scoping review was done for the comprehensive review of the existing published studies in this area. The six-stage approach of Arksey and O’Malley was applied. Six main databases including PUBMED, Scopus, Web of Science, Science Direct, EMBASE, and ProQuest were searched using related keywords. Data were extracted and analyzed via thematic analysis. Results of the scoping review were then synthesized to achieve the best-fit framework applying Carroll et al (2013) approach. Results: Based on the SR, 3751 studies were found, and due to the full-text screening of the studies, 30 final articles were selected for extracting the components and steps of EBDM in Health System Management (HSM). After collecting, synthesizing, and categorizing key information, the framework of EBDM in HSM was developed in the form of four general scopes. These comprised inquiring, inspecting, implementing, and integrating, which included 10 main steps and 56 sub-steps. Conclusions: The present framework provided a comprehensive guideline that can be well adapted for implementing EBDM in health systems and related organizations especially in underdeveloped and developing countries where there is usually a lag in updating and applying evidence in their decision-making process. In addition, this framework by providing a complete, well-detailed, and sequential process can be tested in the organizational decision-making process by developed countries to improve their EBDM cycle.

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