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'We should have access to information at our fingertips' ' results of a mixed methods study of data availability and use by decision makers for HIV programs in Blantyre, Malawi

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BACKGROUND: Timely and high-quality data are key to maximizing the efficiency of HIV programmes. Decision makers need the right data at the right time to make informed decisions. However, data use for decision making in HIV programmes is poorly understood in Blantyre. We performed a data user study in Blantyre which mapped the key decisions, data, and the information systems decision-makers use for HIV prevention.
METHODS: We drew a sample of 71 decision makers. These people leverage data for policy, management, or delivery purposes. We deployed app-based questionnaires collecting both quantitative and qualitative information. We asked about their decisions, the indicators they use, and what HIV prevention services they focus on. We generated descriptive statistics and used thematic analysis to analyze qualitative data.
RESULTS: Respondents came from civil society (42%), government (38%), and private sector (20%) and represented a variety of organizational levels including the city or district (37%), national (25%), community (23%) and facility (15%). The program areas that most frequently reported for decision making included condoms (54%), adolescent girls and young women (AGYW) (48%), and both STIs and HIV treatment (44% each). Paper based sources such as reports (54%) and registries (49%) were most commonly used while the District Health Information System (or DHIS) was the most commonly used digital data source (28%). Although over 1,000 indicators were reported as available, decision-makers reported using only 93 to support their work. Thematic analyses indicated digital literacy, access to digital systems, and availability of data are critical challenges that hinder data-driven decision making. The community-level was commonly reported as needing capacity building as a data collector as was the facility-level.
CONCLUSIONS: A diverse sample of decision makers reported a complex picture of accessing and leveraging data for decisions. Improvements are needed in digital data collection, reporting, and analysis to meet the needs of decision makers. Capacity building in data collection should prioritize the community. Future refinement of routine data collection should focus on improving alignment of data needs of decision makers with available indicators. Further inquiry into the sufficiency and value of available and future data sources is needed.