Identifying the Root Causes of Underutilization of Data in Immunization Programs
Exploring challenges with data to support decision making from the perspectives of system actors in Kenya, Mozambique and the DRC.
This story is part of a blog series sharing insights from a Human-Centered Design research study of the immunization program in Kenya, Mozambique and the DRC in 2020. For additional information on this work, please download the Cross-Country Brief or view the full root cause analysis here. Please read the previous stories for more context on the work as well as insights from this research.
Over the past 2 years, our team conducted research for the Vx Data Insights study, a partnership between Sonder Collective and JSI, aimed at understanding the challenges in collecting and using immunization data at all levels of the healthcare system in 3 countries in Sub-Saharan Africa: Kenya, Mozambique and the DRC. While many of these challenges are well known and are already being addressed by other projects and initiatives, this research aimed to dig deeper to uncover, humanize, and document the underlying causes and implications of these challenges from the perspective of the actors at all levels of the healthcare system.
In each of the research countries, our team met with key immunization system actors. Based on these interviews, key challenges they routinely experience in their data use were identified. Together with other insights generated through the project, these challenges were used to develop the 8 Root Causes framework.
For each of the 8 Root Causes, our team generated a fishbone diagram, which maps all of the contributing sub-causes as well as stories from the field to illustrate how actors at various levels of the system experience these issues on the ground.
Low Ability to Use Data for Decision Making
Low Ability encompasses root causes that contribute to reducing one’s ability to include or successfully utilize data in decision-making processes. These can be external factors as well as an individual’s knowledge gaps.
- Am I able to access the data I need?
- Do I have the time I need to use data?
- Do my tools and protocols support the use of data for decision making?
- Do I have the know-how (e.g. training and knowledge) to correctly interpret and act on the data I have to make decisions?
Although low data use is often attributed to a lack of skills and knowledge, we found that Access and Time were seen as the most challenging factors in preventing system actors from using data to make decisions; while Know-how was considered the least significant of these four factors.
Low Motivation to Use Data for Decision Making
Low Motivation encompasses root causes which impact one’s perceptions of data and their role within the system, as well as external demotivating factors.
- Do my working conditions provide a conducive mental and physical environment to perform the work ?
- Do I trust the accuracy of the data I have available?
- Do I feel I have the agency to make decisions?
- Do I feel like I have the influence necessary for my decisions to make a difference?
While low Trust in Data and subpar Working Conditions are well documented contributors to data underutilization, our team found that the lack of Agency to make decisions, especially at the lower levels, as well as the low Influence individuals perceive to have over the overall system are equally as important.
Based on insights from the research as well as further engagements with stakeholders in each country, the team is currently working on identifying the key causes and opportunities for interventions in each country. Check out our previous story to learn more about this process.
This story was co-written by Hannah Pick, Sarah Hassanen, and Emilia Klimiuk.
