The document summarizes survey responses from health organizations in East Africa on decision-making and decision support tools. Respondents said participatory approaches, environmental and socioeconomic factors, and available scientific data are important in decision-making. Challenges include sustaining vector control and prioritizing surveillance. Respondents need information on disease trends, costs and benefits of options, and maps of endemicity, vulnerability, and hazards. Uncertainty complicates decisions due to incomplete knowledge, conflicting views, and unpredictability. Uncertainty is addressed through stakeholder consultation, scenario analysis, and surveillance data. Decisions are needed at local to international levels over timeframes from months to decades.

1. http://www.healthyfutures.eu
SURVEY & INTERVIEW RESPONSES ON DECISION-MAKING
AND DECISION-SUPPORT TOOLS (DSTs) FOR HEALTH AND
ENVIRONMENTAL CHANGE
HEALTHY FUTURES Fifth Partners meeting,
Nairobi, Kenya, 2014
Monica Coll Besa & Richard Taylor
SEI Oxford Centre

2. HEALTHY FUTURES Fifth Partners meeting, Nairobi, Kenya, 2014
Online survey sent to s/h & HF partners
• 1 KEMRI -Kenya
• 1 Ministry of Agriculture, Livestock & Fisheries
• 1 University of Rwanda –College of Medicine and Health Sciences
• 1 Action de Lutte contre la Malaria, A.LU.MA -Burundi
• 1Ifakara Health Institute –Tanzania
• 1Dept. Veterinary Services –Kenya
• 1 ICTP
• 1 ILRI
• 1 CSAG
• 1 Ministry of Health -Uganda
10 responses in total

3. HEALTHY FUTURES Fifth Partners meeting, Nairobi, Kenya, 2014
Important factors in decision-making
• Participatory approaches through consultation, sharing views
• Environmental & socio-economic concerns
• Technology, finances, audience, size of data & database
• Availability of scientific data & knowledge
• Improved performance of the health sector and improved service
delivery
– Other important criteria:
• More cross-sectoral integration in development planning
• Global trends in data mgmt, literature, environmental concerns
• Individual public health experience
• Information on previous performance & past achievements

4. HEALTHY FUTURES Fifth Partners meeting, Nairobi, Kenya, 2014
Data used in the decisions
• Surveys, feasibility studies, population dynamic data
• Costs data: income, expenditure patterns (HH level)
• Health mgmt information system
• Data sets from clinical trials to implementation
• Ecology of the area, community perception on control
and materials to be used
• Sector performance reports, disease epidemics and
outbreaks, scarcity of medicines

5. HEALTHY FUTURES Fifth Partners meeting, Nairobi, Kenya, 2014
Challenges in the decision-making
• Domestication of integrated vector mgmt strategies at
the HH level
• Sustainability of problems; relaxation when problem
declines
• Taking vector surveillance as 2nd priority to disease
treatment
• Timely detection of outbreaks => inadequate
preparedness at lower levels
• Competing interests for funding, fear for wrong decisions

6. HEALTHY FUTURES Fifth Partners meeting, Nairobi, Kenya, 2014
Decision-making needs & research outputs
Needs in the decision-making:
• Entire life cycle of clinical research (clinical trial to implementation)
• Economic returns & savings; if preventive measures are as successful as
vector control.
• Livelihood analysis
• Past trends & factors influencing trends
• Information on current findings wrt control of diseases, updates on current
trends, information-sharing
• Forecasting & early detection
• Assessment on vulnerability & impacts of diseases rather than presence
of the hazard
 Endemicity level maps
 Socio-economic vulnerability map
 Cost-benefits information about options
 Hazard maps

7. HEALTHY FUTURES Fifth Partners meeting, Nairobi, Kenya, 2014
How does uncertainty complicate decision-making?
• Incomplete knowledge: when the decision-maker lacks enough knowledge
about the system. This can be due to different factors, such as lack of
theoretical understanding, ignorance, lack of information or data,
unreliability of data describing the system, etc. e.g. the efficacy of
preventive measures). 7 people mentioned it
• Multiple knowledge frames: results from having different, and sometimes
conflicting views about the system (e.g. which people should be prioritised
for receiving a specific health care treatment). 4 people mentioned it
• Unpredictability: when the decision-maker is not able to predict, in space
or time, the behaviour of a system (e.g. the timing and extent of a malaria or
RVF outbreak, e.g. longer term effects of environmental change on
diseases). 3 people mentioned it

8. HEALTHY FUTURES Fifth Partners meeting, Nairobi, Kenya, 2014
How is uncertainty dealt with?
• Stakeholder consultation/sharing knowledge (very common)
• Scenario building & analysis with key experts (Delphi method)
– If control of uncertainty: build on preventive strategies
– If no control of uncertainty: ranking of strategies
• Lobbying
• Use of surveillance system from the Ministry
• Critical synthesis of existing data
• Range or envelope of change using model agreement as providing some
confidence in at least the direction of change. Focus on the dynamics –what
is behind or driving the change. (CSAG)

9. Time horizons of decision-making for DST
tools
• Decisions that need to be made in the very near future (within
weeks or months) -3 people
• Decisions in the short to medium-term (within 5 yrs) -3 people
• Decisions that need to be made on annual cycles -2 people
• Longer term decisions than the above -2 people

10. HEALTHY FUTURES Fifth Partners meeting, Nairobi, Kenya, 2014
Spatial scales of decision-making
• East Africa & neighboring countries (5)
• National (5)
• District/provincial (4)
• Local (3)
Local
District/provinci
al
National
East Africa &
neighboring countries

11. HEALTHY FUTURES Fifth Partners meeting, Nairobi, Kenya, 2014
• Uncertainty
– Statistical uncertainty: main dimension taken into account. Handled by
making improvements in data collection, multiple sources of evidence,
etc.
– Epistemic uncertainty (i.e. in the impact or effectiveness of preventative
measures)
– No mention of ‘scenario uncertainty’ –suggesting lack of familiarity.
• Relevant timeframes varied, both in terms of taking a decision and
implementing it (from days to 20/30 years for long-term planning)
• Value for money of actions & stakeholder support through consultation–
most important factors in decision-making
• Lack of coordination among stakeholders and more funding needed
• Sequencing of decisions –based on the data collected, and the
success/failure indicators, it may prompt a new decision. If control is
successful it may switch to elimination.
Summary of findings from the interviews in Nairobi