This document discusses the importance of using monitoring and evaluation (M&E) data to inform policy formulation, program planning, and improvement. It provides examples of how M&E data has been used in Nigeria to guide resource allocation and strengthen sub-national M&E systems. Barriers to data use include technical, organizational, individual, and political constraints. Ensuring data is effectively used requires understanding how it is produced and used, identifying and addressing barriers, and strengthening decision-making processes.

1. Using M&E Data to guide Policy formulation, programme planning and improvement Kola Oyediran and Samson Bamidele MEASURE Evaluation John Snow Incorporated

2. Presentation Outline Importance of monitoring and evaluation Possible uses of data and information Barriers to data and information use Using data to inform decision-making Examples of data use

3. Purposes of monitoring and evaluation Determine whether a plan or program is on schedule with planned activities Assess whether a policy, plan or program has produced desired impacts Generate knowledge: Identify factors (individual, community, programmatic) that influence health outcomes Inform policy, planning or program decisions: new services, resource allocation, corrections

4. Evidence-based decisions lead to better health outcomes

5. There are no enemies in M&E Policymakers, program managers and M&E specialists can be partners Strong decision-making and management relies on high quality M&E information Data quality is linked to data use

6. Inform policies and plans Advocate for additional resources, policies and programs Strengthen programs and improve results Ensure accountability and reporting Improve quality of services provided Contribute to global lessons learned We can use information to…

7. Using NNRIMS data to inform resource allocation HIV/AIDS M&E focal person for LACA in Doma, Nassarawa State, submitted NNRIMS quarterly report to LGA Chairman; 53 people in Doma tested HIV positive in the first quarter of 2006; Chairman procured 480 HIV Test Kits to be distributed through 4 local health facilities, enabling more people to get tested in Doma.

8. Strategy for Strengthen sub-national M&E system NACA in collaboration with stakeholders conducted an assessment of HIV/AIDS M&E system Relatively strong M&E system at national level but weaker at the sub-national level Develop program strategy to engage development /implementing partners on how sub-national level capacity will be strengthened.

9. What Determines Data Demand and Information Use? POLITICS CULTURE SOCIETY Decision making occurs within political, cultural, and social contexts * Based on PRISM analytical framework (LaFond, Fields et al. 2005 The PRISM: An Analytical Framework for Understanding Performance of Health Information Systems in Developing Countries. MEASURE Evaluation). SYSTEMS APPROACH TECHNICAL APPROACH INDIVIDUAL BEHAVIOR

10. Data are often underutilized because of… Technical constraints Technical skills, Availability of computers, Data system design, Definition of indicators, Lack of data quality assurance protocols Organizational Constraints Structural – roads, telecommunication Organizational – clarity of roles, support, flow of information Political interference * Based on PRISM analytical framework (LaFond, Fields et al. 2005 The PRISM: An Analytical Framework for Understanding Performance of Health Information Systems in Developing Countries. MEASURE Evaluation).

11. Data are often underutilized because of… Individual constraints Decision maker attitudes, Staff motivation, Lack of “data culture” * Based on PRISM analytical framework (LaFond, Fields et al. 2005 The PRISM: An Analytical Framework for Understanding Performance of Health Information Systems in Developing Countries. MEASURE Evaluation).

12. How to ensure that information is being used to make inform decisions? Steps include …… Understand how data are produced and used Identify and address barriers to using information Strengthen decision-making

13. Barriers …. To data use “ We are always giving patient forms and data to our M&E Unit, who then gives data to donors and the government. I am the head doctor and I never have the chance to look through the data before they go up. We just keep giving data up and up, and we never hear back about it…” Head of ART facility, Nigeria

14. Decisions Policies and plans Advocate for new policies and plans Select priorities for strategic plans Program design and planning Select messages for prevention campaigns New strategies to increase coverage Program management, improvement and operations Training and supervision of program staff Logistics and supply management

15. Different people need information for different kinds of decisions Engage in dialogue with stakeholders to fully understand the decisions they make, information they need, and best way to present that information.

16. Factors other than evidence-based information influence decisions Power relationships Timing Competing priorities Public opinion Political ideology Arbitrariness Local culture of decision-making Other information sources

17. What do they need to know? Policies and Plans (Policymakers, leaders) Population health status Principal causes of mortality Evaluation of policies Program design (Directors, Program managers) Cultural practices Population knowledge and attitudes Groups at high risk Management and Operations (Managers, service providers) Do providers have supplies they need? Are clients getting the right services? Are people being turned away?

18. In order to make information useful, we need: Understanding of how programs work, how they collect and report information. To engage others to discuss what decisions they make and what information they may find helpful Training and supervision to support reporting and documentation – including feedback. Common understanding among those who deliver services and report on them, those who analyze the data and those who need the information.

19. Decisions based on evidence lead to better health outcomes We all have a role in M&E – partners in progress Purpose of M&E is not just to produce more information but to improve action High quality information is needed for decision-making at policy, advocacy, planning, management and program levels Investments in improved information systems will be wasted if not used to inform decisions Key Messages

20. THANK YOU! Visit us online at http://www.cpc.unc.edu/measure MEASURE Evaluation is funded by the U.S. Agency for International Development (USAID) through Cooperative Agreement GHA-A-00-08-00003-00 and is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill, in partnership With Futures Group International, John Snow, Inc., Macro International Inc., Management Sciences for Health, and Tulane University. The views expressed in this presentation do not necessarily reflect the views of USAID or the United States government.