The facilitators of the pilot Data Driven Decision Making (DDDM) workshop held in Uganda last summer felt it was a success and received positive feedback from participants. Fourteen attendees filled out evaluation forms at the close of the workshop and all agreed that that the workshop met its objectives and DDDM was relevant to their work. Also, while only one person felt ‘very comfortable’ with the topic prior to the workshop, eleven did afterwards. Still, efforts must be made to support and sustain this type of work amongst decision makers in Uganda.
Ummuro Adano, Senior HR Systems Advisor for the Capacity Project, has said DDDM is a “mental shift that can take place over time” and cannot be fully accomplished through just one workshop. One participant agreed, and explained, “We learned that data use in decision making needs to be developed. It’s about ‘how can I prove this and what is the rationale?’ It’s having the inquiring process in the thinking and decisions that we make.“ He added that by attending the workshop, participants began to realize it was a lot more risky to make decisions without the use of data, “We also learned that data can be deliberately ignored to achieve certain objectives.”
When asked how attendees will use what they learned at the workshop in the future, one participant said they will train themselves to look for evidence in all decisions that they make. “We should be able to make a reference to a source of data so that people can confirm and be certain we are using data that is authentic,” he said. He also mentioned that it is important to share current records from the various sources, “We need a system in place to maintain the databases that we are creating and maintain up to date (information) because data that is out of date, as we learned, is not very useful in decision making.”
The workshop produced several outcomes that will help participants utilize DDDM in their future work and encourage other decision makers in Uganda. One activity produced a finalized list of HR policy and management questions for the Ugandan health sector. Another result was a list of next steps and actions that included strengthening the MOH Resource Center so that it can function as the effective HRH data storage facility that collects, integrates, and provides access to the various sources of data. The Resource Center will also promote using data for decision making.
Some participants offered other suggestions for how to sustain this work. One participant said, “We need to create demand for data among policy makers and managers. We need to motivate each other in terms of further workshops to engage policy planners at the level higher than we had so in the future they may demand a certain level of quality.” Another participant agreed and added, “These kinds of trainings need to be replicated, followed up, because we are getting to a stage where we are now, that we want now to use information more.” He said they need to follow up with trainings, etc. with as many of the decision makers as possible.
A follow up to the Ugandan DDDM workshop is scheduled for this summer. Other DDDM workshops are planned for Swaziland and Rwanda this spring, where information is now becoming available from their HR Information Systems and ready to be evaluated.
Posted by
Carol Bales on 1/8/2008 • Tags: Africa, Decision-Making, HRIS, ICT4d, Information Systems, Public Health
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The DDDM workshop in Uganda this summer provided the first opportunity for many of the participants to review and discuss reports from the iHRIS Qualify system in the Nurses and Midwives Council. Dr. Pamela McQuide, HRIS leader, said she was extremely excited about participants’ reactions to seeing the reports. “When participants had actual Ugandan data, they erupted in discussion,” she said. She explained that the reports spurred lots of questions and they talked for three or more hours, showing that “they are very hungry for their own data and supporting it.”
One participant said the workshop gave meaning to the data they had been generating and built up credibility and interest in the HR information systems being established in Uganda. “It was the first attempt we had at integrating information from the various sub-systems in HRH and seeing how all these sort of fit together in order to have meaningful information.” He went on to say that the most surprising thing he realized was the amount of data already available. “It was just amazing to know there was so much data already available from different subsystems. I found that overwhelming, it was just phenomenal.” As he stated, a strong HRIS is a phenomenal tool for integrating data, where the sum becomes much more important than the parts.
Another participant said that after viewing the data he realized they already had routine information that they should start taking advantage of. He described how different the situation in Uganda was before HRIS strengthening was initiated, “We were looking at a format that was inaccessible, it was paper-based and in containers, but now that it’s in a database it’s easy to analyze.” He went on to say that the reports presented at the workshop were “able to tell us what was really happening on the ground.”
The HRIS team is in the process of implementing similar systems at the other three Uganda medical licensing bodies (the Pharmacy Council, Medical and Dental Council, and Allied Health Professional Councils). As an outcome of the workshop this summer, bi-annual HR data reports will be produced. The reports will incorporate data from all four councils and other sources, such as data from the EU and will influence annual reporting, budgeting, and strategic planning.
Once data can be integrated from various sources and reports can be generated, it is important that the information is presented in a variety of ways so that decision makers can understand and use it. Dykki Settle, HRIS leader, led a session on data quality and presentation that covered useful techniques to enable decision makers to use data. He emphasized that reports should be timely, tied to policy questions and available to the right people. Colorful reports will not be effective unless, as Ummuro Adano has stated, they are “combined with active leadership, change management, and effective professional development for key decision makers.”
Posted by
Carol Bales on 11/30/2007 • Tags: Africa, Capacity Building, Decision-Making, FOSS, FOSS4G, HRIS, ICT4d, Information Systems, Open Source, Public Health, Sustainability
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Once data is available from an HRIS, how can it be used effectively to make decisions? Part of our HRIS Strengthening process is to help managers and policy makers in the countries we work develop necessary skills and techniques for data-driven decision making (DDDM). To achieve this, the Capacity Project is planning a series of DDDM workshops. This past summer, HRIS leaders teamed up with Ummuro Adano, Senior HR Systems Advisor for the Capacity Project, to organize and facilitate the first workshop in Kampala, Uganda. The workshop was attended by 22 human resources for health (HRH) practitioners from different segments of Uganda’s national health system.
Uganda was a perfect choice for the first workshop because data was gradually becoming available from various sources, and preliminary reports were being produced by the iHRIS Qualify system at the Nurses and Midwives Council and the EU HRD project. One participant said that the workshop brought together key people for making decisions and provided the knowledge they needed to better use the information being generated. He described the workshop as timely, “We’ve been in the process of developing different Human Resources databases (and) now we’re in the stage where we should start using the information for planning, for policy making, and for evidence for decisions.”
Ummuro Adano has described DDDM as, “a journey, not a destination,” and has said that there needs to be a process in place for analyzing data and “getting it to the right decision maker at the right time with the power and resources to act on it.” To facilitate the participants’ journey from data to decisions, the workshop began with an activity that demonstrated they were already using data to make personal decisions in their own lives. Participants shared examples of encounters with data from personal or family experiences, and many felt this was a highlight of the workshop. One participant said, “it brought up that most of the time in our life we’re using evidence-based decisions. At times when we ignore it we make errors that we could have avoided.”
Some of the personal examples were about investments or businesses that failed because participants did not do the proper research or collect the right information beforehand. One participant explained his observations of how others related to the principle of the activity, “They actually found out that in our data environments -at home, our interactions with people we work with - we ought to ensure that we get good information, good data, that informs us better before we do an investment, or make decisions. It is important that in our workplace we ensure that we use information to inform ourselves better.” Emphasizing the need for concrete information about the health workforce, the participant added, “and of course get a feel of how many are leaving and for what reasons, and how we can improve on their environments so that we retain them better.” This exercise set the context for the rest of the workshop and established a shared perspective for the attendees, preparing them for the presentations and group work that followed.
Posted by
Carol Bales on 11/14/2007 • Tags: Decision-Making, HRIS, ICT4d, Information Systems
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“Am I a geek, or a suit?” I pondered, sitting in a large hall with some thousand others in Victoria, Canada, during the Free and Open Source Software for Geospatial (FOSS4G ) conference. The question was posed to me by keynote speaker Damian Conway, PERL enthusiast, frequent speaker at FOSS conferences, and management consultant. I wondered to what extent my fellow conference-goers were pondering the same question. Looking around me at the number of bearded geography types who followed his speech with open laptops running strange Unix command lines, I concluded probably not that many. As developers, most of them self-identified with the geek label by default. The exception might have been the four obvious suits who decided to check out the conference, and perhaps some boundary cases such as myself.
Still, as a service to all of us–geeks, hybrid geek/suits, or suits–Damian Conway laid out a business case for open-source software. Contrasting the realm of the geeks with that the minds of the neoliberal “suits” (or: the ones making the actual decisions), the question Conway posed is why don’t the suits wholehearthily embrace the free software the geeks make available? Is there something fishy about open-source?
According to Conway, and taking the case of the battle of the giants, closed-source Windows operating system versus free, open-source Linux, the ten questions any open-source enthusiast geek has to come prepared with when speaking to a suit are as follows:
(Suit question 1) But SCO owns UNIX?
(Geek answer) No, that whole thing was a business play by SCO to raise the price before management dumped the stock. Oh, and if they actually did (the court said they didn’t recently) the open source community would code around it.
(Suit question 2) Open Source has a higher total cost of ownership?
(Geek answer) Yes, if you read studies funded by proprietary vendors, otherwise, it does not.
(Suit question 3) Proprietary software is easier to use.
(Geek answer) Yes, but only marginally and most of that is from familiarity.
(Suit question 4) What about compatibility/interoperability?
(Geek answer) Actually typically Open Source supports more standards and are typically better than even previous versions of proprietary software on the same document.
(Suit question 5) What about security?
(Geek answer) Open Source tends to win here because it has genetic diversity. (How many versions of UNIX are there?)
(Suit question 6) What about support?
(Geek answer) Open Source options parallel proprietary, PLUS you can have folks in house!
(Suit question 7) But what if the product goes away?
(Geek answer) There’s no single supplier, so less likely than proprietary vendors. Open Source is not cost driven and proprietary folks end products all the time.
(Suit question 8 ) Who will we sue if something goes wrong?
(Geek answer) Just like proprietary - no one. Proprietaries are too big to sue (unless you have tons of money) and with Open Source, there’s no one to sue!
(Suit question 9) How will Open Source improve customer experience?
(Geek answer) Open Source use will drop company prices, thus customer prices, scale cheaply, etc.
(Suit question 10) How will Open Source improve the company bottom line?
(Geek answer) All sorts of things will be cheaper: licensing, licensing management costs, risk, insurance, hardware, security, etc.
So, what did I learn? Governments and major corporations around the world are now moving swiftly towards wider use of Open Source software. Open Source software development and support is based on a model of collaborative interaction that is entirely different from the competitive world of commercial software. It’s not a business; it’s a culture. As a manager, to get the greatest benefit from Open Source you need to understand and engage that alien culture, to appreciate the motivations, aspirations, mindset, and limitations of its community. As a geek, you need to know how to sell it.
Alien or not, the geeks, hybrids, and four suits around me showed some serious passion to drive down the costs of software. That’s a good thing, particularly for developing nations struggling to fund their health care system. It is hard to argue with that.
Posted by
Danny de Vries on 11/6/2007 • Tags: Community, Decision-Making, Digital Divide, Events, FOSS, GIS, HRIS, Information Systems, Open Source, Software, Sustainability, Technology
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Having worked in various IT (Information Technology) departments and roles over the years, I’ve become accustomed to the point of view that IT workers are “just” overhead. In many organizations, they are considered a cost of doing business. Often the attitude is summed up in a statement like this: “We’ve got to have email, but I’ll be darned if I know what those people do all day!”
Sometimes, it is even worse and the IT department is just seen as an obstacle to work around. As the Wall Street Journal writes: “often it’s just easier to accomplish certain tasks using consumer technology than using the sometimes clunky office technology our company gives us”.
Then there are the poorly supported in-house applications that the IT department tends to throw together. If the organization is large enough, they’ll have a dedicated support team, but, again, this is seen as a cost of doing business instead of something that adds value.
I think part of this can be understood because much of what a savvy technology worker does is completely behind the scenes. If it is done well, the end-user sees the product of the work, but not the hours put into it. The end-user has no means of understanding the work performed.
I encountered just this sort of thinking in a conversation with my brother the other night. In May, he’ll take his boards and become a certified pharmacist. In the past, he’s worked as a lab tech at the Genome Sequencing Center at Washington University in St Louis, so he is no stranger to the value that a good IT department can add to any organization, but he was still under the impression that IT had a “neutral” economic effect.
In an attempt to illustrate just what kind of difference IT has made in the past and can make in the future, I used an example almost any American our age is familiar with: Pa Ingall’s house.
Enamored with the idea of owning his own land (and being somewhat of a loner), Pa headed west and worked and struggled to build a farm and house for his family. He worked long hours, but, at the end of the day, the best house he could build for his family still lacked some amenities like indoor plumbing and electricity that even the poorest modern day American home-owner would consider necessities today. The technology was simply not available (e.g. electricity) or was completely infeasible (e.g. indoor plumbing for prairie homes). Obviously, the creation and spread of technology has helped create a healthier and more efficient home for the modern American.
The Open Source efforts that IntraHealth’s Informatics team are pursuing could offer the same scale of benefits for health care in developing countries. As you can see from the photo to the right, many of these countries still use nineteenth century methods for organizing information about their health care workers. When there is a regional epidemic, the official in charge will have to rely on his memory or go sort through stacks of paper-based records to find the right people to send to the area.
The paper-based system lacks good reporting tools, as well. Manually compiling a list of areas with worker shortages is going to be a time-consuming, error-prone task. iHRIS puts good reporting tools at your fingertips. Reports can be created in seconds, rather than hours or days.
If iHRIS is successful to any degree, we will have a real chance of dramatically improving the health care in these countries by helping the health care workers get better access to training and by ensuring that they are deployed where they are most needed.
This, from something as mundane as providing better access to personnel records.
For someone who has been involved in IT for a few years, the chance to have this kind of impact can be intoxicating!
Posted by
Mark Hershberger on 10/29/2007 • Tags: Africa, Data Collection, Decision-Making, Digital Divide, HRIS, Information Systems, Open Source
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Well, the best answer is “not much.” As I work on an HRIS implementation in Kigali, Rwanda, this week, I have been giving the need for accurate, continuously maintained data a lot of thought. Many developing countries have embraced decentralization—the shift of decision-making authority from the central level to the regional or local level. While decentralization has many good points, it presents challenges for collecting country-wide data. Imagine a situation where every region and district used a different method for collecting and sharing data on health workers! While separate methods of data collection might work well locally, lack of consistency across the country makes collection of data for use at the government level challenging at best.
We all know databases rely on consistency of information to generate reports. To get consistent data, regional and local health managers must have a way of submitting standardized data to the central level that does not add an excessive additional burden. More importantly, local health leaders must see the benefit of providing data to the central government—access to country-wide aggregate information, increased services from the Ministry of Health or easier maintenance of their own health worker records.
Ensuring a local level commitment to share data is only half the challenge. Western culture is data oriented—we love charts, graphs and numbers. Because current data is often lacking, many health leaders in developing countries have, by necessity, learned to rely on intuitive decision making. Add this to an increasingly rapid shift from paper based systems to databases and the process can be overwhelming.
For me, this is where Pam McQuide’s stakeholder leadership group model becomes so important. Stakeholders united in a common purpose and pursuing a shared benefit can agree on appropriate, effective ways to evolve well-entrenched methods of data collection. Having seen the success of the stakeholder model time and time again, even I find myself here in Rwanda still fighting the siren song of the perfect system to focus on what is most important— local stakeholder leadership and the data itself.
Posted by
Vanessa Spann on 10/24/2007 • Tags: Data Collection, Data Quality, Decision-Making, ICT4d, Information Systems, Leadership
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