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Assessing Efforts to Mainstream Youth-Friendly Health Services in Madagascar, Malawi, and Mali

Assessing Efforts to Mainstream Youth-Friendly Health Services in Madagascar, Malawi, and MaliHigh fertility rates and low modern contraceptive use put African youth and adolescents at high risk for health complications, including maternal mortality. Mainstreaming youth-friendly health services (YFHS) into existing services is one approach to improve access to reproductive health services for youth and adolescents. This report details an evaluation MEASURE Evaluation conducted to assess the effects of three YFHS training packages sponsored by Population Services International (PSI) on voluntary uptake of family planning (FP) among youth and perceptions of service quality by youth and trained healthcare providers.

In 2018, a retrospective review and analysis of relevant monitoring and evaluation documents and service statistics from PSI Madagascar, PSI Malawi, and PSI Mali was conducted. Qualitative data on perceptions of service quality from Malawian youth and healthcare providers were also collected and assessed through thematic analysis.

Results show that the number of FP clients ages 15–24 increased after implementation of the YFHS training packages. Data from PSI Madagascar and PSI Malawi show that positive trends were not sustained after other YFHS components ended. Focus group discussions with youth in Malawi indicated that clinics were perceived as providing high-quality services to youth. The main barriers to accessing the services were cost and embarrassment. Malawi’s healthcare providers made many efforts to improve clinic accessibility and understood the barrier of cost and importance of outreach to youth and the broader community. The results provide evidence that provider training alone will not sustain initial increases in youth FP clients. Across the three countries, the greatest benefits of the YFHS training packages were seen when combined with demand-generation activities and increased access to peer education.

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Plan d’analyse des données de planification familiale Une évaluation des tendances de la PF pour le Mali

Plan d’analyse des données de planification familiale Une évaluation des tendances de la PF pour le MaliDans le cadre du repositionnement de la PF, le Mali participe de manière active, à l’instar des pays francophones de l’Afrique de l’Ouest à l’initiative mondiale Family Planning 2020 (FP2020) et le Partenariat de Ouagadougou afin de contribuer à la réduction des taux élevés de mortalité maternelle (325 pour 100 000 naissances vivantes), et de mortalité néonatale (33 pour 1000 naissances vivantes), selon l’EDSM-VI 2018. Ainsi, pour accompagner les différentes stratégies et initiatives des acteurs nationaux et internationaux les données sont essentielles pour prendre des décisions sur l’évolution du programme PF dont l’objectif du TPCm est de 30% dans le PANB-PF 2019–2023.

Le gouvernement du Mali, à l’aide du financement et du soutien technique de donneurs et partenaires de mise en oeuvre, s’est engagé à renforcer et à améliorer la collecte d’informations sanitaires de routine. En 2017, la plateforme du système d’information de santé DHIS2 a été lancée pour obtenir des informations sur les indicateurs clés concernant la santé à des fins de surveillance et d’évaluation. Le DHIS2 comporte un certain nombre d’indicateurs concernant la planification familiale (PF), qui sont utilisés pour évaluer les activités du programme, notamment la campagne annuelle de PF au niveau national. Ce plan d’analyse des données présente les étapes nécessaires pour utiliser les données DHIS2 concernant la PF, afin d’évaluer l’efficacité des activités de PF.

Le plan d’analyse des données ci-dessous présente des instructions étape par étape, à titre d’exemple, de l’utilisation des données DHIS2 de routine dans l’analyse des performances du programme de PF. Ces instructions sont fondées sur les données recueillies dans le DHIS2 au cours des années 2017, 2018 et 2019. En 2019, le système a été mis à niveau, et certains indicateurs de routine ont été modifiés ou ajoutés. La section portant sur les recommandations propose des analyses ultérieures pour les données provenant du système mis à niveau. Les étapes fondamentales d’analyse et les conseils d’interprétation des données présentés dans ce document peuvent être suivis pour les analyses ultérieures, y compris celles concernant les nouveaux indicateurs.

Ce plan d’analyse des données met l’accent sur l’analyse des tendances, qui permet d’examiner l’évolution des indicateurs clés de PF au cours du temps, notamment le nombre de nouveaux utilisateurs de PF, le nombre d’anciens utilisateurs qui continuent d’utiliser la PF et le nombre d’utilisateurs de PF âgés de moins de 25 ans. L’analyse de tendance proposée inclut les données recueillies en dehors des mois de la campagne nationale de PF, afin d’obtenir des informations concernant l’impact de la campagne sur les résultats de PF au Mali avec le temps.

Plan d’analyse des données de planification familiale Une évaluation des tendances de la PF pour le Mali

Experiences and Lessons Learned: Implementing the Ripple Effects Mapping Method

Experiences and Lessons Learned: Implementing the Ripple Effects Mapping MethodRipple effects mapping (REM) is a qualitative, participatory group method for evaluating complex programs. MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—adapted and used REM to supplement traditional evaluation methods and increase stakeholder participation. This brief shares how the application of REM  was carried out in two studies in sub-Saharan Africa and lessons learned from the experience.

Designing interventions for data demand and use

Designing interventions for data demand and useThis “decision tree” helps users identify tools that will best meet their needs when designing interventions for data demand and use.

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Facilitating Surveillance, Monitoring, and Evaluation in Malaria-Endemic Countries: A Compendium for National Malaria Programs

Facilitating Surveillance, Monitoring, and Evaluation in Malaria-Endemic Countries: A Compendium for National Malaria ProgramsConcerted efforts in malaria control have led to a significant decrease in the disease burden globally and specifically in sub-Saharan Africa (SSA). Countries there have scaled up proven malaria interventions, such as insecticide-treated nets (ITNs), indoor residual spraying (IRS), diagnostic testing, prompt and effective treatment of malaria cases, and intermittent preventive treatment in pregnancy (IPTp). A strong surveillance, monitoring, and evaluation (SME) system is needed to measure progress and achievement to inform future efforts and investments. This compendium is designed for national malaria program (NMP) personnel, who need to learn SME skills quickly and apply them immediately to their work. It is also intended to be a valuable resource for implementing partners working on malaria projects, students taking an SME course in an MPH program, and scientists interested in malaria SME. Relevant documents and guidance materials are referred to throughout the document. Readers are encouraged either to read through the compendium in its entirety or reference specific chapters, as needed.

Chapter 1 introduces the concepts of malaria SME. Chapters 2 and 3 look at the global burden of malaria and global efforts to control malaria. Chapter 4 discusses the role of data for decision making. Chapters 5 through 8 describe the development of an SME plan and a plan’s components: frameworks, indicators, and data sources. Chapter 9 discusses malaria surveillance—a concept particularly important as malaria transmission decreases and NMPs need to track each case closely. Chapter 10 describes key methods used for evaluating NMPs and provides references to key indicators, data sources, and practical examples. Chapter 11 discusses the nuts and bolts of data quality, data management, and data analysis. Chapter 12 focuses on what is needed to present, interpret, and use data correctly. Finally, Chapter 13 presents ethical concerns to think about in malaria SME.

Validating Measures of Reproductive Empowerment in Kenya

Validating Measures of Reproductive Empowerment in KenyaAlthough a substantial body of research has examined the role of empowerment in influencing reproductive outcomes, the reproductive sphere has only recently emerged as a distinct dimension of empowerment. Inconsistency in the conceptualization and measurement of reproductive empowerment (RE) has led to the use of a wide range of research measures on the determinants of reproductive behavior in relation to empowerment. We adopted the following definition of RE from a recently developed framework: “Both a transformative process and an outcome, whereby individuals expand their capacity to make informed decisions about their reproductive lives, amplify their ability to participate meaningfully in public and private discussions related to sexuality, reproductive health and fertility, and act on their preferences to achieve desired reproductive outcomes, free from violence, retribution or fear” (Edmeades, Hinson, Sebany, & Murithi, 2018).

MEASURE Evaluation—a project funded by the United States Agency for International Development—developed a draft RE scale using three steps. First, we conducted a systematic literature review to identify existing domains, subdomains, scales, and indexes related to RE. Second, through a consultative meeting, we shared our findings from the systematic review with experts in reproductive health (RH) and empowerment research and measurement, and sought their feedback on gaps and limitations in the field. Third, we conducted focus group discussions with men and women in Zambia to explore in depth the meaning of the identified domains and subdomains of RE, and to surface new domains and subdomains. At the end of this process, we prepared a draft RE scale with 44 items across five subscales. The next step in the development of the RE scale was to establish its face validity, the subject of this study. The objectives of this study were to (1) pretest the draft scale items using cognitive interviews (CIs) with women and men in Kenya to examine the items’ face validity; and (2) revise the draft RE scale based on the results of the CIs.

This report shares more on the work in Kenya.

Access the reproductive empowerment scale and related resources on work done in Nigeria and Zambia.

Midline Evaluation of the Tanzania Public Sector System Strengthening Program – Final Report

Midline Evaluation of the Tanzania Public Sector System Strengthening Program – Final ReportThe Public Sector System Strengthening (PS3) project, funded by the United States Agency for International Development (USAID), supports the Government of Tanzania (GOT) in strengthening the public-sector system to promote the delivery, quality and use of public services. This report presents the findings of a midline performance evaluation of PS3 conducted by MEASURE Evaluation which examined time trends and pre- and post-program inception changes in the uptake of health services as well as in financial and human resources indicators in PS3 regions and in other regions of the country. The evaluation also used qualitative methods to examine the perceptions from program implementers, community members, and other stakeholders about the adoption and performance of the PS3 intervention, its strengths and remaining challenges, and the stakeholders’ recommendations on ways to address those challenges.

PS3 works across national, regional, and local government levels. The implementation strategy seeks to strengthen each of the five component areas, while working across all sectors and levels of public governance. The expectation is that strengthening systems at all levels will result in improved service delivery at the lowest level—the service provider—which will lead to higher public service utilization by the population and better health outcomes. At the national level, emphasis is placed on providing support for key policies and strategies as well as strengthening the national system to foster improvements in service delivery at lower government levels. At the regional and LGA levels, the PS3 program facilitates the understanding and implementation of national policies and guidelines as well as providing targeted assistance to improve the management and strengthening of systems and resources.

This midline evaluation undertook an outcome evaluation to understand how system-level indicators related to human resources, financial resources, and health service utilization changed over time in PS3 and in other (non-PS3) regions of the country. Data from national routine information systems formed the basis for quantitative measurements. Adapted difference-in-differences models were used to examine time trends before PS3 and during the time PS3 has been active, changes in those trends, and to examine differences between PS3 regions and other regions of the country. Potential differences between Phase 1 and Phase 2 PS3 LGAs were also examined. In addition, qualitative methods provided a more in-depth understanding of the performance of the PS3 intervention in human resources, finance, and system strengthening, captured unintended, indirect effects of the intervention, illuminated the process of change, and examined the quality and character of the intervention implementation. The qualitative component also captured the stakeholders’ perceptions of pending challenges in system functioning and community engagement and their recommendations on how to address them.

The findings of this evaluation will contribute to USAID’s portfolio of projects focused on public-sector strengthening while informing PS3’s continued program implementation. This evaluation was performed at about the mid-point of PS3, three years after the project’s inception.

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Improving Nutrition through Community-Based Approaches in Bangladesh

Improving Nutrition through Community-Based Approaches in BangladeshThis document is the baseline survey report for the evaluation of the United States Agency for International Development (USAID)/Bangladesh’s Improving Nutrition through Community-Based Approaches (INCA) activity. The evaluation is being conducted by the USAID-funded MEASURE Evaluation project at the request of USAID/Bangladesh, and is part of a larger set of monitoring and evaluation activities for the INCA project. INCA is a three-year effort to improve the nutritional status of women and children under age two in rural areas of 11 priority upazilas in the districts of Bhola, Laxmipur, and Noakhali. Caritas Bangladesh and United Purpose are implementing the project. It started in May 2017 and will be active through April 2020. Total funding is approximately USD$4.4 million.

The 2017 baseline survey is the first of two surveys to assess the performance and impact of INCA. The overall objectives of this external evaluation are (1) to inform USAID and other stakeholders about project achievements in terms of changes in key outcomes and impact at the target population level; (2) to learn about the effectiveness of the specific INCA intervention for eventual replication in other areas of the country; and (3) to inform the follow-up of the project.

The evaluation is based on a prospective, quasi-experimental, difference-in-differences (DID) design to assess project impact using data collected through representative household surveys in INCA intervention and comparison areas in this baseline survey, and a follow-up end line survey that will be implemented by the end of 2019. MEASURE Evaluation also conducted a short community survey during this baseline assessment and will repeat it in the end line survey to assess changes in health and nutrition service availability.

Bangladesh Maternal Mortality and Health Care Survey (BMMS) 2016: Final Report

Bangladesh Maternal Mortality and Health Care Survey (BMMS) 2016: Final ReportThe Government of Bangladesh is committed to achieving its targets for Millennium Development Goal (MDG) 5: reducing the maternal mortality ratio (MMR) to 143 deaths per 100,000 live births by 2015 and increasing skilled attendance at birth to 50 percent by 2015 (United Nations Development Program [UNDP], 2015). The decline in MMR between 2001 and 2010 indicates remarkable progress. This progress is linked to fertility reduction, access to qualified maternal health care, and overall care-seeking during the antenatal period and during delivery (UNDP, 2015).

By the end of the third sector program, a revised maternal health strategy and standard operating procedures (SOPs) for maternal and newborn health were finalized. With the MDGs phasing out and the Sustainable Development Goals (SDG) phasing in (United Nations, 2015), the Fourth Health, Population and Nutrition Sector Programme (4th HPNSP) 2017–2022 has set the target of reaching an MMR of 121 per 100,000 live births in 2022 (Ministry of Health and Family Welfare [MOHFW], 2017). Within this context, the Bangladesh Maternal Mortality and Health Care Survey (BMMS) 2016 was carried out to assess how well the country is progressing toward these targets.

The BMMS 2016 was an activity under the Operational Plan of Training, Research, and Development of the National Institute of Population Research and Training (NIPORT) under the Health, Population and Nutrition Sector Development Program (HPNSDP) 2011–2016 (MOHFW, 2014).

The major objectives of the BMMS 2016 were 1) to provide a nationally representative estimate of the maternal mortality ratio (MMR) for three years preceding the survey (approximately 2014–2016); 2) to identify the causes of maternal deaths, and 3) to assess maternal healthseeking behavior indicators and compare them with the BMMS 2010 to assess how well the country is progressing toward national and global targets for maternal health since the 2010 survey.

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Experiences and Lessons Learned: Implementing the Most Significant Change Method

Experiences and Lessons Learned: Implementing the Most Significant Change MethodThe most significant change (MSC) method is a participatory qualitative approach to monitoring and evaluation (M&E) of complex programs. MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID), has implemented this  technique in evaluations of health programs. This brief summarizes our experience and shares lessons learned in the application of MSC.

PEPFAR Local Capacity Initiative Evaluation

LCI Community Scorecard to Improve HIV Services for Key Populations in Uganda_MEval size-min

The Local Capacity Initiative (LCI) strengthened the capacity of civil society organizations (CSOs) to support policy advocacy, with the ultimate goal of improving health services for key populations affected by the HIV epidemic. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) funded the initiative from 2013–2018 to help local CSOs create an enabling environment for PEPFAR’s objectives.

Access briefs and videos sharing methods and findings from MEASURE Evaluation’s evaluation of the LCI in Uganda and Ghana.

Implementation of the Electronic Management Information System in Bangladesh: Experience and Lessons Learned

Implementation of the Electronic Management Information System in Bangladesh: Experience and Lessons LearnedIn 2015, the Ministry of Health and Family Welfare (MOHFW) of Bangladesh undertook an initiative to develop and implement an electronic management information system (eMIS) to benefit community health service delivery. The initiative was implemented through a collaborative partnership among the United States Agency for International Development (USAID)-funded MEASURE Evaluation project, the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), MaMoni Health Systems Strengthening (now MaMoni MNCSP), and SIAPS (now MTaPS) and was supported by USAID.

The intent of the initiative was to replace cumbersome paper instruments, reduce data burden for health providers, improve data-driven service delivery and quality of care, and make management of health and family planning activities at the grassroots level more efficient and effective. The resultant eMIS provides comprehensive and interlinked electronic tools for use by community-level healthcare and family planning workers (health assistants [HAs] and family welfare assistants [FWAs]), union-level service providers (family welfare visitors [FWVs], sub-assistant community medical officers [SACMOs]), their supervisors (health inspectors [HIs], assistant health inspectors [AHIs], and family planning inspectors [FPIs]), and their managers at the upazila level. Data from eMIS get linked to the mainstream reporting system for use by managers, planners, and policymakers at the directorate and ministerial levels.

All tools created for the eMIS were vetted and approved by the Directorate General of Family Planning (DGFP) and the Directorate General of Health Services (DGHS). The district and upazila managers had overall responsibility for implementing the eMIS, while technical assistance was provided by the eMIS initiative through software development, the provision of equipment, and capacity building. Systems for Improved Access to Pharmaceutical and Services (SIAPS), another USAID project (now MTaPS), contributed in the area of logistics management.

This document describes in detail the information technology (IT) structure of the eMIS and the experience of implementing it across several upazilas and districts in Bangladesh.

Principled Health Information Systems: Ethics Beyond Data Security

Principled Health Information Systems: Ethics Beyond Data SecurityLow- and middle-income countries are creating and expanding digital data systems to monitor their health trends and guide their health programs. The construction of these systems is often regarded as purely technical, with little consideration given to ethical dimensions. Data security is a notable exception.

To identify a broader range of ethical concerns, we carried out a scoping review of the literature for sets of principles to guide the development and use of digital information systems relevant to population health. The 11 sets we identified named a total of 34 principles, of which data security was one. We organized the principles into four stages of health information system (HIS) development: HIS design, data collection, data storage, and data use. To accommodate these principles, countries must first be aware of them and identify the staff responsible for addressing them in the design of their digital data systems.

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MEASURE Evaluation’s Small Grants for Family Planning: Strengthening Research Capacity around the World

IMEASURE Evaluation’s Small Grants for Family Planning: Strengthening Research Capacity around the Worldncreasing family planning (FP) uptake in low- and middle-income countries (LMICs) requires a strong routine health information system (RHIS) and sound data. In turn, good data management can increase stakeholder ownership and subsequently increase FP uptake. Unfortunately, several knowledge gaps disrupt this virtuous cycle: how to improve the quality of FP data, address barriers to integration of FP data in RHIS, and encourage analysis and use of the data to improve FP outcomes.

Small grants to in-country research groups promote capacity and provide financial support for FP research conducted in LMICs. The small-grants model creates sustainability by working through host-country institutions to research relevant FP issues, disseminate findings to local researchers, and help develop strategies for improvements.

MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID), implemented a successful small grants program from 2014–2019. During that time, 19 subagreements were signed with research organizations from 11 USAID FP priority countries. This paper documents experience gained from the small grants program.

Capacity of Sierra Leone’s National Malaria Control Programme for Monitoring and Evaluation: Baseline Assessment

Capacity of Sierra Leone’s National Malaria Control Programme for Monitoring and Evaluation: Baseline AssessmentMEASURE Evaluation, which is funded by the United States Agency for International Development and the U.S. President’s Malaria Initiative, assessed the monitoring and evaluation (M&E) capacity of Sierra Leone’s National Malaria Control Program (NMCP). This assessment had the following specific objectives:

  • To understand the current capacity of the malaria program to conduct M&E activities
  • To assess the capabilities of individual staff members to carry out M&E functions
  • To determine gaps in malaria M&E capacity
  • To identify and prioritize interventions to strengthen M&E
  • To develop a capacity-building plan

The assessment consisted of a desk review of existing documentation and primary data collection through group assessment and individual assessment tools described in the Monitoring and Evaluation Capacity Assessment Toolkit.

Guide for Assessing the Impact of a Total Market Approach to Family Planning Programs

Guide for Assessing the Impact of a Total Market Approach to Family Planning ProgramsA Total Market Approach (TMA) is an approach to coordinating family planning (FP) services among health planners and facilities, commodity suppliers, and funders from governmental, commercial, and private or nongovernmental sectors. With a TMA, these sectors work together to increase the market for and the availability of FP services and methods. Despite the growing popularity of TMA, the development of TMA strategies and their implementation are still in their infancy. As yet, there are no studies or agreed-upon approaches to assess the medium- and long-term impact of TMA on FP outcomes. This guide will describe a step-by-step approach for evaluating the impact of FP programs that are TMA-based. As such, it is complementary to earlier guides for designing and monitoring TMA programs. The United States Agency for International Development (USAID)-funded MEASURE Evaluation project produced this guide to help TMA implementers to properly plan for evaluations of the medium- to long-term impact of their TMA programs, which will also enable them to contribute to the evidence base on the impact of TMA programs.

The objectives of this guide are fourfold: (1) to compare definitions of TMA currently being used by implementing organizations; (2) to identify objectives and components of current or past TMA implementations for FP; (3) to outline methods for an impact evaluation of TMA programs; and (4) to demonstrate how a TMA might be evaluated for impact using an example from Cambodia. To achieve these objectives, we conducted a systematic review of current and past implementations of TMA programs. To supplement the findings of this review, we followed up with authors and conducted key informant interviews with implementers and supporters of TMA projects.

The Global Evaluation and Monitoring Network for Health (GEMNet-Health): An Institutional Partnership as a Vehicle for Capacity Building

The Global Evaluation and Monitoring Network for Health (GEMNet-Health): An Institutional Partnership as a Vehicle for Capacity BuildingThe purposes of this paper are to (1) describe how GEMNet-Health has served as a global resource for teaching and training, research, and technical assistance while also strengthening the capacity of individual network members; (2) document the technical activities and materials that have been produced to date; and (3) explore how GEMNet-Health has added to the global knowledge base on partnership networks as vehicles for capacity building in the field of public health.

Lessons in Health Information System Strengthening: What Worked in Mali

Lessons in Health Information System Strengthening: What Worked in MaliSince 2010, MEASURE Evaluation has worked with the United States Agency for International Development (USAID) mission in Mali to strengthen national- and community-level health information systems (HIS), with an emphasis on malaria monitoring and evaluation (M&E).

In collaboration with units and programs of the Mali Ministry of Public Health and Hygiene (MOH), MEASURE Evaluation streamlined data collection systems and strengthened governance and leadership and HIS management, to improve quality and use of health data. MEASURE Evaluation supported HIS strengthening by partnering with the MOH and working closely with United States Government (USG) implementing partners (IPs) and non-USG partners. The project also built MOH capacity to use and manage the HIS and use HIS data for decision making, by customizing electronic platforms, providing necessary hardware and software, and training and mentoring MOH staff. These approaches yielded the following gains:

  • Nine parallel systems (on non-web-based platforms that were previously only available in electronic version above the site level) were combined into one streamlined system that is available at all levels of the health system on the DHIS 2 platform.
  • HIS management and governance tools, resources, and coordinating bodies were established that have standard operating procedures, guides, steering committees, and technical working groups.
  • More than 2,200 staff members and providers at all levels of the health system were trained in DHIS 2 use, data use, and other relevant topics through training of trainers and cascade trainings. Select staff at the central level were also trained in the customization of DHIS 2.
  • One hundred percent of regional hospitals, 100 percent of district health facilities, and 98 percent of community health facilities reported in DHIS 2.
  • Mechanisms for data monitoring (e.g., data review meetings, data competitions, a quarterly health management information system bulletin, and supportive supervision visits) were established.

These accomplishments can be quantified, but it is also important to understand HIS users’ experiences and the context in which the system was strengthened and improved. To do so, in 2019, we conducted stakeholder interviews to capture perceptions and experiences of MOH staff who interact with Mali’s HIS. An analysis of these interviews yielded common themes of what worked in HIS strengthening in Mali. The objective of this document is to summarize lessons learned and highlight effective HIS strengthening approaches and interventions and their outcomes.

Improved Reporting of Performance Data Supports Health Decision Making in Bangladesh

Improved Reporting of Performance Data Supports Health Decision Making in BangladeshMEASURE Evaluation contributed to institutionalizing regular health-sector performance reviews by the Ministry of Health and Family Welfare of Bangladesh and helped promote data use for program and policy decisions.

This brief shares more.

Snowball Effect of Data Competition in Mali

Snowball Effect of Data Competition in MaliIn 2018, Mali held a friendly competition among health facilities to motivate all levels of the health system to improve the quality of health data and to make strategic use of those data. The first competition came as Mali had successfully adopted and deployed the District Health Information Software, version 2 (DHIS2) platform for management of health data across the health system.

What began in 2018 as a data quality incentive designed by the Mali Ministry of Health (MOH) has won enthusiastic adoption by health providers across the health system. Not only has it attracted more competitors (from 2018 to the second competition in 2019), it also has demonstrably improved the quality of health data across the board. The MOH intends to institutionalize the competition, has included it in its priority health management information system (HMIS) activities, and is planning a third competition in 2020.

In 2018, the competition rewarded eight health facilities (five community health centers [CSCom], two health districts [CSRef], and one hospital) for improving their data quality from 2017 to 2018. In 2019, the MOH rewarded 16 health facilities (10 CSCom, four CSRef, and two hospitals). Achievement in meeting the criteria for judging data quality (100% data completeness and 80% timeliness) improved significantly from the 2018 competition to the 2019 competition and the number of facilities competing grew from 65 in 2018 to 308 in 2019 (an almost fivefold increase). This brief shares more.