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Barriers to and Facilitators of Sex- and Age-Disaggregated Data – Kenya

tr-17-163The availability of sex- and age-disaggregated data allows program managers and decision makers to examine service delivery, treatment, and health outcome data in depth. This helps them detect differences between the sexes, age groups, and key populations, which can lead to better understanding of the health needs of each of these groups and populations. Access to these data can also ensure that health systems do not perpetuate inequities associated with negative health outcomes. Despite the importance of examining gender and age differences, sex and age disaggregation are not always included or maintained in routine data collection practices and national HIS databases, such as the DHIS 2. Collection and use of gender-related data are increasing globally, but information gaps still prevent full understanding of the factors that facilitate or discourage helpful data disaggregation and use.

To enhance the availability and use of gender data, MEASURE Evaluation—funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—explored factors that contribute to collection and use of sex- and age-disaggregated data in Kenya. Our study used a two-pronged approach: (1) a desk review of key documents and literature, and (2) key informant interviews (KIIs) with national-level data producers and decision makers.

Many variables have an impact on when and how data are disaggregated, but we found common barriers and facilitators around the availability, production, and use of sex- and age-disaggregated data. The most common barriers to producing disaggregated data were low demand and the view that disaggregation was unnecessary. These barriers influenced data-collection tool design. We found that the availability of data by sex and age depended on the tool that was used and what type of data was collected. HIV data were generally disaggregated by sex and age, but there was variation in which age bands were used. Key informants (KIs) for this study said that registers at the facility were disaggregated by sex. This was confirmed by review of data collection tools. However, when aggregated into summary tools, the male and female fields were often aggregated into number of people, as programs did not require disaggregated summary reporting.

We also found that the production of disaggregated data was limited by the availability of resources and the added burden of reporting this type of data. Key informants strongly believed that data being collected should be used, or else it should not be collected. The KIs explored successes and challenges in analyzing and using disaggregated data. They were not sure who was responsible for ensuring disaggregation and providing technical support. Key informants working with PEPFAR data cited successes and supportive strategies more frequently than KIs in other health areas that also had implications for HIV (such as tuberculosis, malaria, and immunizations).

Our desk review revealed that a majority of Kenya’s HIV reports include sex and age disaggregation in their data presentations and discussions. Kenya’s progress in gender integration and sex and age disaggregation should be applauded. Kenya has shown substantial progress and has lessons to share with other countries, as it continues to strengthen data collection, analysis, and use of disaggregated data. Nevertheless, significant challenges remain that will require continued support to address.

At the end of this report, we offer recommendations for increased advocacy and awareness at all levels around the importance of data disaggregation by sex and age. We call for the development of guidelines, materials, and examples of how such data should be analyzed to reveal important findings. We also recommend support from gender-mainstreaming officers throughout program cycles to ensure production and use of sex- and age-disaggregated data.

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Applying User-Centered Design to Data Use Challenges: What We Learned

tr-17-161Countries are working to improve health information systems (HIS) to produce higher quality and more timely data. However, the mere existence of these data is not enough to guarantee their use in decision making for program planning and policy development. Data-informed decision making is the outcome of complex system dynamics in which technical, organizational, and behavioral factors interact to create specific facilitators or barriers to data use.

Many different types of stakeholders and individuals are involved in the production and use of data, including health workers, managers, and policymakers. Understanding their motivations, needs, internal decision-making processes, pain points, and experiences as they interact with others and complete work tasks is critical to developing innovative solutions to support the use of data for programmatic decision making at the district level.

MEASURE Evaluation implemented a user-centered design approach to understand the experiences of data users, identify current barriers facing HIS users, and develop creative solutions for tackling these issues.

The design activity followed an iterative process, from cultivating empathy with data users to developing prototypes to address critical barriers to data use. This report describes the design process, activities, and outcomes (prototypes) from a user-centered design activity in Tanzania and South Africa.

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INSP: Talleres de Evaluación 2017

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Para registrarte en los Talleres de Evaluación 2017 debes acceder al siguiente enlace: http://encuestas.insp.mx/talleres/

The Importance of Gender in Family Planning and Reproductive Health Data

gender-fprhAddressing gender when monitoring and evaluating family planning and reproductive health (FP/RH) projects and interventions helps to ensure equity in access and benefits for men and women. This brief explores the importance of gender in monitoring and evaluation (M&E) activities and suggests indicators to reveal and explain gender gaps in FP/RH outcomes.

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Equity Trends in Ownership of Insecticide-Treated Nets in 19 sub-Saharan African Countries

ja-17-224Malaria disproportionately affects poor, rural populations, with pregnant women and young children at highest risk. The Roll Back Malaria Partnership, together with the Secretary-General of the United Nations, launched the initiative Cover The Bed Net Gap to achieve the goal of universal bed-net coverage by December 2010.

Finding that previous distribution strategies had led to inequity in insecticide-treated net (ITN) ownership among subgroups, particularly between socioeconomic subgroups, the Cover the Bed Net Gap initiative shifted the distribution of ITNs from targeted distribution to mass distribution campaigns, which aim to provide one ITN for every two household members.

This study assessed the level of equity in bed net ownership before and after the widespread implementation of national ITN distribution strategies in 19 malaria-endemic countries in sub-Saharan Africa.

The study used data from Demographic and Health Surveys as well as Malaria Indicator Surveys. Surveys conducted prior to the launch of the initiative in 2009 were assigned as baseline surveys, and those conducted between 2009 and 2014 were considered endpoint surveys. The study used both country-level and pooled multicountry analyses. Pooled analyses based on malaria transmission risk, were done by dividing geographical zones into either low- and intermediate-risk or high-risk. A calculation of the Lorenz concentration curve and concentration index (C-index) assessed changes in equity.

Out of the 19 countries this study assessed, 13 showed improved equity between the baseline and endpoint surveys, and two countries showed no change. Four countries had worsened equity, with two showing greater increases in coverage of poorer households and two showing greater increases in coverage of richer households.

Findings indicate that bed net distribution campaigns linked to the launch of the Cover The Bed Net Gap initiative, have led to improvement in coverage of ITN ownership across sub-Saharan Africa, with a significant reduction in inequity.

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Assessment of Mali’s 2016 National Campaign for the Promotion of Family Planning

tr-17-162The Republic of Mali has one of the world’s lowest modern contraceptive prevalence rates, at 9.9% according to the 2012–2013 Mali Demographic and Health Survey. Nevertheless, the government of Mali is making strides to reposition family planning (FP) as an essential public health and development intervention. As part of a national strategic plan, a promotional FP campaign is organized each year.

This report presents an assessment of Mali’s 2016 national FP campaign. The long-term goals of the 2016 campaign were to: (1) increase the number of FP users, and (2) reduce the maternal and infant mortality rate in Mali. The purpose of the assessment—a post-intervention process evaluation—was to identify how well the campaign’s activities were implemented and whether adjustments should be made to improve future FP campaigns and interventions. The assessment focused on the national level and five health districts targeted by intensive intervention: Diéma, Bougouni, San, Koro, and Nara.

The assessment used three types of data:

1) A document review of campaign planning, implementation, and results was conducted. Twenty-four indicators were chosen through a review of anticipated campaign activities. Materials reviewed include the campaign action plan, the campaign final report, records of campaign activities and events occurring in intensive intervention districts, information collected during the campaign, and materials produced and distributed by the campaign.

2) Twenty-one key informant interviews were conducted to collect information on perceptions of the effectiveness of campaign activities, barriers to implementation, and the identification of strengths and weaknesses.

3) Six focus group discussions (FGDs) were held with women ages 18–24 living in communities in intensive intervention districts (Diéma, San, and Bougouni) to gauge exposure to the campaign, attitudes about the annual campaign and campaign messages, and common barriers to the use of FP.

Assessment results suggest a number of recommendations, including that the country improve logistics management to ensure that contraceptive methods and services are available at all distribution points, and strengthen information systems so that validated information on FP service delivery is available on an ongoing basis.

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The Importance of Gender in Emerging Infectious Diseases Data

gender-eidAddressing gender when monitoring and evaluating emerging infectious disease (ID) interventions and programs helps to ensure equity in access and benefits for men and women. This brief explores the importance of gender in monitoring and evaluation (M&E) activities and suggests indicators to reveal and explain gender gaps in emerging ID outcomes.

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