| How Exemplars used data and evidence for decision-making | Detailed strategies | Country examples and links to more detail |
|---|---|---|
|
Invest in data systems and foster a culture of data use |
Foster a culture of data use through regular integration of M&E into program operations and at all levels of government |
Senegal had quarterly data review meetings at health post/CHW level, including subsequent regional meetings (Senegal narrative) To address national goals for PMTCT, Rwanda's MOH created a new health-information management system called TRACnet, which consolidated mobile phone reports submitted by CHWs to provide timely data on HIV cases .1 (Rwanda narrative) |
| Invest in data systems and the human resource capacity necessary to operate them |
Bangladesh established an HMIS unit at the Directorate General of Health Services and divisional training centers (Bangladesh narrative) Rwanda supported master's degree training for department heads within the MOH to build capacity for data use (Rwanda narrative) |
|
| Use multiple data sources |
Leverage the strengths and weaknesses of:
|
To prepare for Maternal and Neonatal Tetanus Elimination, Senegal reviewed subnational tetanus case data and also supplemented this with field visits (Senegal narrative) Senegal used multiple data sources to inform Intermittent Preventive Treatment (IPT) delivery (Senegal narrative) |
| Identify program areas of need |
Use national and sub-national data to determine program areas with low coverage | Based on a study of treatment-seeking, Peru identified inconsistent progress in care-seeking (Peru narrative) In Peru, local estimates identified low NICU coverage, led to new MoH policy to improve intensive care (Peru narrative) |
| Use national and sub-national data to understand disease burden |
Bangladesh designed Integrated Management of Childhood Illness (IMCI) to focus on the most common causes of death (Bangladesh narrative) Nepal used the Health Management Information System (HMIS) and DHS to monitor causes of under-five mortality, including measles and malaria (Nepal narrative) |
|
| Use existing research to identify effective solutions |
Bangladesh introduced community-based treatment of neonatal sepsis based on a study in India (Bangladesh narrative) |
|
| Pilot at small scale when necessary |
Select pilot sites based on goal of the pilot. To ensure implementation plans are designed to serve the communities with the highest need, pilot in areas of highest need. To determine effectiveness of an intervention, pilot in areas of highest likelihood of success. | In Senegal, a pilot of facility-based IMCI in one district identified a supervision gap. (Senegal narrative) Bangladesh piloted the community-based skilled birth attendants (SBA) program in six districts. Based on high satisfaction surveys among women who used their services and also high retention of skills among the SBAs, the government scaled up the program using a phased approach, adding an average of 10 districts per year (with support from WHO and UNFPA). (Bangladesh narrative) |
| When considering pilot testing, consider impact of potential delayed introduction of evidence-based intervention | In Nepal, the practice of requiring pilot testing by local researchers and implementing partners led to delays of PCV and rotavirus. (Nepal narrative) | |
| Customize how interventions are implemented |
Prioritize interventions geographically based on local data on burden of disease |
In Peru, ITN distribution and IRS targeted in high-transmission areas. (Peru narrative) |
| Assess local need when implementing with an equity lens |
Bangladesh decided to implement IMCI at the community level, reflecting the needs of a predominantly rural country. (Bangladesh narrative) |
|
| Use data to evaluate impact of system constraints | Bangladesh selected PCV-10 instead of PCV-13 due to evidence of similar effectiveness but lower cold-chain requirements. (Bangladesh narrative) | |
| Adjust continuously |
During implementation, use routine program monitoring data, evaluations, and other available data sources. After implementation and during adaptation, reassess program areas of need, including adaptations to interventions and/or implementation strategies |
In Peru, subnational surveillance on artemisinin resistance led to early adoption of differentiated ACT regimens. (Peru narrative) Senegal conducted evaluations post-PCV introduction and post-rotavirus vaccine introduction (Senegal narrative) |
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1
Nsanzimana, S., Prabhu, K., McDermott, H. et al. Improving health outcomes through concurrent HIV program scale-up and health system development in Rwanda: 20 years of experience. BMC Med 13, 216; 2015. https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0443-z. Accessed Apr 21, 2020.