Perceptions about data-informed decisions: an assessment of information-use in high HIV-prevalence settings in South Africa
Date
2017Author
Nicol, Edward
Bradshaw, Debbie
Uwimana-Nicol, Jeannine
Dudley, Lilian
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BACKGROUND: Information-use is an integral component of a routine health information system and essential to
influence policy-making, program actions and research. Despite an increased amount of routine data collected,
planning and resource-allocation decisions made by health managers for managing HIV programs are often not
based on data. This study investigated the use of information, and barriers to using routine data for monitoring the
prevention of mother-to-child transmission of HIV (PMTCT) programs in two high HIV-prevalence districts in South
Africa.
METHODS: We undertook an observational study using a multi-method approach, including an inventory of facility
records and reports. The performance of routine information systems management (PRISM) diagnostic ‘Use of
Information’ tool was used to assess the PMTCT information system for evidence of data use in 57 health facilities
in two districts. Twenty-two in-depth interviews were conducted with key informants to investigate barriers to
information use in decision-making. Participants were purposively selected based on their positions and experience
with either producing PMTCT data and/or using data for management purposes. We computed descriptive statistics
and used a general inductive approach to analyze the qualitative data.
RESULTS: Despite the availability of mechanisms and processes to facilitate information-use in about two-thirds of the
facilities, evidence of information-use (i.e., indication of some form of information-use in available RHIS reports) was
demonstrated in 53% of the facilities. Information was inadequately used at district and facility levels to inform
decisions and planning, but was selectively used for reporting and monitoring program outputs at the provincial
level. The inadequate use of information stemmed from organizational issues such as the lack of a culture of
information-use, lack of trust in the data, and the inability of program and facility managers to analyze, interpret
and use information.
CONCLCUSIONS: Managers’ inability to use information implied that decisions for program implementation and improving
service delivery were not always based on data. This lack of data use could influence the delivery of health care services
negatively. Facility and program managers should be provided with opportunities for capacity development as well as
practice-based, in-service training, and be supported to use information for planning, management and decision-making.
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