Information

Use for Action

Chapter 6
 Learning Outcomes
By the end of this session, students will be able
to:

Describe steps of information use for strategic

and operational decision making

Identify & prioritize problems and identify

solutions

Apply root-cause analysis techniques and tools

Prepare action plans and track implementations

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 Steps of Information
Use
Information use cycle (steps to be used for
information use) step

1. Problem identification - identify performance gaps

2. Prioritization of problems – prioritize

3. Investigate underlying and root causes -

investigate

4. Develop action plan/solutions - intervention

5. Implementation and follow up – implement3 the

action plan and follow up
A Cyclic Approach to
Information Use in
Decision Making

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 Step 1: Identify
Problems
The 1st step in information use is to see
whether there is a problem in performance
of the facility.

In order to know whether there is a problem or

not, we use health & health related
information that could be drawn from d/t
data sources.

In some cases, you may need to consult

multiple existing data sources for
triangulation. 5

In others, there may be a data gap, and the

 Step 1: Identify Problems
…
We may ask the following questions to identify
problems:

 Is there anything that surprises you in the data?

 Are there any highs and lows in the data?
 How does the indicator compare to other time
periods, facilities?
 How does the indicator compare to the target?
 How far from the target is the indicator?
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 Are the data consistent with data from other
sources?
 Group Work
• X woreda has a projected catchment population of
250,000 in 2016 EFY. The woreda has planned the
following targets for 2016 EFY, as described in the table
below. During the first and second quarters of 2016, the
woreda has achieved a service coverage as described in
the table below.
Indicator Pla Q1 Q2
n Achievemen Achievement
t
ANC 4 coverage 90 88% 86%
%
Deliveries attended- 75 45% 30% 7

SBA %
 Group Work …

 How do you identify problems in X woreda,

based on the case scenario above?
 Which indicators are on the right track?
 Which indicators have performance gap?
 Develop an appropriate visualization method
for the above indicators
 How do see the relationship between
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indicators?
 Step 2: Prioritize
Problems
o Itis making decisions on how limited
resources could be best allocated to priority
health problems or needs.

o Criteria for prioritization health problems

 Magnitude: this basically describes how big the
problem is.

 Severity: how serious is the condition to individuals

& the community?
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 Feasibility: is it possible or easy to implement
interventions to reverse the problem?
 Step 2: Prioritize
Problems …
o Scoring system:

1. Each member of the PMT rates each

indicator/health problem by giving a point
corresponding to the criteria for priority setting
on a scoring sheet.

2. The points given by all members to each criteria

will be summed up, and finally, the total score
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of an indicator will be obtained by adding up the

 Step 2: Prioritize
Problems …
o Take three or four health and/or health service related
problems in your area that you identified in the previous
exercise (X woreda) & prioritize the problems using the
priority setting matrix.
Type Magnit Sever Feasibil Comm. Gov’t Tot
of ude ity ity concer conce al
proble n rn
m

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Score: 1- low 2- medium 3- high

 Step 3: Investigate
the causes
o Once the problem is identified, the PMT has the
responsibility to determine the root cause of
the prioritized problem.
Root-cause analysis
o It is a systematic process for identifying “root
causes” of problems or events and an approach
for responding to them.

o Techniques & tools used for analyzing root

causes: 12

o Flowcharts
 Step 3: Investigate the
causes …
A. Fishbone diagram: is a tool that helps to
perform a cause and effect analysis for a
problem.

o This tool is also called a cause and effect

diagram or an Ishikawa diagram.

How
1. Drawto create a fish bone diagram: six
problem 1. Categorize
steps...
statement immediate causes
2. Draw major cause 2. Determine deeper
categories causes 13

3. Brainstorm
3. Identify root causes
immediate causes
 Step 3: Investigate the
causes …
o Once the problem is identified, the major
causes should be categorized.

o In the health system, the major cause

categories can be categorized based on the
building blocks of the health system.

o Selection of the categories should be done in a

participatory manner through consensus using
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prior knowledge & understanding of the

Deeper
Cause

Well
functioning
Health
System

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 Step 3: Investigate the
causes …
o The type of categories chosen depends on the context.
 Environmental - those factors outside the influence of
the organization, such as gov’tal regulations, the
economic cycle, local, national and global politics, etc.

 Organizational - systems inside the organization such

as organizational strategy, human resources, resources,
policies, procedures, organizational structure, pay, etc.

 Group or departmental - work processes, group

relationships, work responsibilities, work assignments

 Individual attribute - personality, mgt style, skills,

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&
behaviors.
• Example of a fishbone diagram used to find the
causes of children not improving following malaria
treatment.

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 Step 3: Investigate the causes
…
B. The tree diagram – 5 whys (problem
tree/logic trees)
o The analysis is done by constructing a problem
tree.

o A problem tree is a set of assumptions on

causes associated with the problem & its
consequences.

o The tree diagram (chain of causes) starts with

laying down the immediate or major causes
of the effect/problem. 18
19
 Step 3: Investigate the causes
…

Steps in problem tree construction

o Start by writing the problem statement

o Write down what you think are the main

causes of the stated priority health
problem.

o For each cause, continue to ask yourself the

question “but why?” and write down one
answer.
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o Arrange the given answers under the problem

 Step 3: Investigate the
causes …
o After describing the immediate & associated
causes of a problem you then describe the possible
consequences of not addressing the problem.

o Finally, review the problem tree you have just

constructed.

o Going through each of the causes you have

identified, ask yourself “is this something we can
change in the district?”
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o We would like to focus on what is within our
control to improve, even if only in a small way.
 Example:
o Let’s say the skilled delivery coverage in X Woreda in
the two quarters of the current year has declined from the
previous year performance by 30%, and the woreda health
office PMT has identified this decline in performance as a
priority problem during the review of the second quarter
performance of the woreda.

o Apply the “five why” approach to identify the root causes

1. Why skilled delivery service has declined in this

quarter?
 B/c women are not coming to HFs for delivery service, demand
for service has declined.
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2. Why does demand for delivery service has decreased?


3. Why do women perceive that service
quality has declined?
 B/c respectfulness & caring of professionals has
decreased
 B/c care in the maternity waiting homes has
declined

4. Why respectfulness of clinicians & quality

of service at the maternity waiting homes
has declined?
 B/c staff are demotivated/dissatisfied
 Lack of cook to prepare foods & clean maternity
waiting homes.
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 Exercise
• Based on the exercise that you did in the
previous sessions, select the first two
prioritized performance gaps/problems
and do root cause analysis:

1. Use fish bone diagram for the first

prioritized performance gap

2. Use “the tree diagram– 5 whys (problem 24

tree/ logic trees” for the second

 Step 4: Intervention -
develop an action
plan/develop solutions
o Developing interventions is the process of
identifying, short-listing & deciding b/n
alternative approaches & measures to
address identified & prioritized health problems
& needs.

o Thisshould be done in a collaborative

approach with relevant stakeholders.
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o At this stage the key question to be addressed is

 Step 4: Intervention
…
o Steps of formulation of interventions
1. Identifying & short-listing gaps, threat &
opportunity.

2. Identifying additional components and

activities that are required to bring about the
desired changes.

3. Modifying proposed interventions in line with

geographical, political, climatic and socio
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cultural conditions.
 Step 4: Intervention …

4. Addressing constraints by using community

resources, modifying job responsibilities &
tasks, shifting available resources from one
activity to another & obtaining additional
resources.

5. Improving management and

administration in line with identified
interventions.
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 Prioritization Matrix for
Intervention Selection
Potenti Magnitud Feasibilit Cost Other Capacity To
al e y Resource t
Solutio Low = 4 s Needed Excellent
ns Large Highly Mediu Capacity
scale=4 feasible = m=3 Minimal = Exists = 4
Medium = 4 High = 2 4 Good = 3
3 Good = 3 Very High Few = 3 Fair = 2
Low Scale Low = 2 =1 Several = Little = 1
=2 Not at 2
Very Low = all= 1 Significant
1 =1

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 Step 4: Intervention …

Action plan
oA well prepared action plan contain the
following items:
 The identified problem  Assumptions &
 Objective(s)/ risks
interventions  Indicator
 List of activities  Output
 Inputs  Cost and
 Responsible actor  Time frame 29
 Step 5: Implementation
and Follow Up
o There are three aspects that should be kept in
mind while implementing the plan of action.

o These are effectiveness, efficiency and

timeliness.

o Proper implementation of activities requires

prior preparation in identification of
resources needed, allocation of tasks and
setting deadlines.
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