5 minute read
Implementation Plans?
Review of 2020 and 2021 Kuunika District Quarterly Support Reports, training reports and District Activity Plans reveals the following:
• Very considerable inputs have been made by the project in terms of supporting data collection in Districts, through training of IDSR staff, Data Clerks and others • The post of Data Use Facilitator has been created and one such person has been working in each of the Kuunika-supported Districts • Detailed Covid-19 data have been collected • Despite such support, considerable data backlogs have occurred, due to volume of data to be entered on to OHSP (which some IDSR Focal Persons find hard to use) and lack of time for many Data Clerks. This means that major exercises in data cleaning and back data entry have had to take place, e.g. in Lilongwe • Such backlogs will of course have implications for completeness and overall quality of Covid-19 data
The Kuunika District Support Quarterly Report (for Q2 2021) states: Blantyre district accumulated a huge backlog of 31,094 COVID-19 vaccination data [as of 10th April] due to increased workload and inadequate devices to capture data. This affected the overall quality of e-vaccination data.
• Despite the considerable inputs documented in Kuunika reports, accurate knowledge of its work specific to Covid-19 response does not appear to be widespread at District or Health
Facility level (and information at second hand is that the same is true in many instances at community level). • For some District and Health Facility key informants, the Covid-19 digital data intervention appears as another vertical, data extraction exercise, whose main focus is not to support optimal and equitable service delivery or to facilitate increased access to and use of evidence.
4.3 One very practical example: has Kuunika been involved with the development of District (health) Implementation Plans?
This is a topic that receives a range of significantly differing responses. We have been prompted to consider it here because of key informants' sharply differing views of Kuunika inputs to the DIP development process. As elsewhere, the necessary caveat is that no single project can be expected to achieve all necessary change.
The evidence indicates that the project has engaged with DIP development in Zomba District; elsewhere key informants are less certain as to any involvement.
One striking finding is that there is minimal discussion of any aspect of DIP in national health or digital data for health strategies. This absence does not provide an ideal foundation for systematizing evidence-based planning at any level, but of course particularly in Districts, Health Facilities and communities.
Literature review
• New annual (2022) District (health)
Implementation Plans (DIP) are currently being developed
• Clinton Health Access Initiative (CHAI) is a major partner in support of DIP development, as is
UNICEF
• Few national strategies even refer to DIP development or implementation processes; therefore, presumably none views these as core components of effective planning + service delivery.
Key informant interviews
• 'Before 2020, DIPs were based on each program co-ordinator's degree of commitment. Districts now have a very comprehensive spreadsheet, they do bottleneck analysis. The DIP get budgeted saying what is GoM/ partner/not funded.
However, one major challenge is that the
Treasury does not disburse what is requested, plus it is always a struggle to harmonize funding coming through partners, i.e. to get them to co-ordinate. We are seeking to get those District partners involved in DIP development. ' (National level key informant)
o The sole reference in MEHIS 2017 - 2022 is discussion of work towards the achievement of the HIS Strategy 2011 - 2016 Objective 8, where HIS data are stated as having been used during DIP development
o NDHS: no reference
o The undated (but 2016 or later) MoH Data and
Digital Priorities: Digital Health for Universal
Health Coverage is similarly silent
• No information has been forthcoming as to whether the HSSP III, currently in development, will address any aspect of DIP
• Neither the Blantyre Prevention Strategy
Condensed Strategy document nor the BPS Fact
Sheet refers to the DIP as a planning tool using digital (DHIS2 + other) data, nor addresses the extent to which either the 2021 or the 2022 DIP does or does not make use of DHIS2 data +
Bottleneck Analysis to inform service delivery planning + implementation • 'Kuunika has helped, directly, to develop the new DIP, helping to capture important aspects of data, in terms of team engagement too.' (DHO staff member,
Kuunika District) • 'The DIP is renewed on an annual basis.
DHIS2 has become increasingly useful, in terms of developing targets + indicators; each co-ordinator is expected to draft indicators for his/her area. There isn't yet comprehensive use of DHIS2 data (annualised) to address gaps, etc, for the next annual plan. We use DHIS2 as the databank. DIP are not publicly available; they're working documents. We don't have enough funds to disseminate the DIP to the communities, which is a shame + means
Committees + CBOs don't get to be part of the debate. Kuunika involvement? Not sure if there is any - certainly not here, but in other Districts?' (DHO staff member, non-
Kuunika District)
Key question 1: do any DIP show evidence of DHIS2 data supporting evidence-based planning and/or better evidence use? Are Bottleneck Analysis (BNA) findings actually applied to planning for improvements in health service delivery?
One national key informant made the following points, not specific to Kuunika, but revealing about the current status of quality data availability.
'At Health Facility level data quality is a major, major issue. We have sought to use evidencebased planning and bottleneck analysis looking at both the demand and supply sides. The UNICEF Tanahashi Framework is used by one program to analyse the bottlenecks - but in Malawi the data are so lacking or so weak, the categories frequently don't make sense. Quite often the data are reported at above 100% or below 0%. The DIP process reveals that so many data sets just don't add up, in any way. In almost every District the data are so poor, it's more lip service on evidence-based planning.'
The last point is true also for Districts supported by Kuunika, according to the key informant.
Another national level key informant, also with experience of District-level data capacity, stated:
'Some data don't make sense when bottleneck analysis is done - if data are above 100%, then quality is so very poor. The DHIS2 has so many gaps, for indicators and also across time periods - so completeness of data is lacking as well as quality.'
Key question 2: do Kuunika-supported Districts provide any indications of greater engagement with evidence-based planning?
There are some indications of this. Thus the Q2 2021 Kuunika District Support Quarterly Report indicates that the Data Use Facilitator for Zomba (a post funded by Kuunika) participated in a threeday DIP consolidation meeting...supported by CHAI. The main activity was to consolidate all the programme activities into the main DIP template and fill in the performance of different indicators.
