Poor decision making due to "poor data quality", meaning data that are ill-fit for the decisions that need to be made, is one of the biggest challenges we confront in our efforts to improve the health and well-being of women and children around the world. Globally, many (though not all) leaders now recognize that poor decision making and poor data quality threaten to stall the progress made over the past 20-25 years. We recognize the problem and have talked at length about it, but now we must tackle these issues with urgency and bold action. Translating current commitments in health systems strengthening and child survival improvement into more visible action presents opportunities to reimagine the future if we collectively seize those opportunities.
The challenges of achieving such transformations is formidable, however. For example, many national immunization programmes continue to struggle to ensure that information systems are appropriately resourced to provide the necessary information to best manage their programmes. Facility-based record systems are ill-suited in many places and fall short of providing data that are fit for purpose. Home-based records, perhaps one of the most under-appreciated tools within immunization delivery and primary healthcare more broadly, are often not available, not adopted and/or appropriately utilized to fulfil their intended purpose.
Unfortunately, the inefficiencies and associated costs of poor decision making — costs that exist as a result of the current state of affairs with regards to our frontline capacities (or lack thereof) for decision making and the data on which those decisions are based — are not well recognized or understood. If they were, I believe, those same global leaders mentioned above would be moving more quickly to identify solutions and mobilize necessary human and financial resources within current investment packages. Again, unfortunately, few seemingly recognize that the long-term investment costs in improving our decision making capacities and the data on which decisions are based will be far less than the costs of the status quo and existing inefficiencies. In the private sector, CEOs would be all over the inefficiencies that exist in our field.
Now, this is not to say that there necessarily needs to be a massive resource mobilization (though in some communities where the immunization information systems have been so severely neglected for years this may indeed be true). It may well be that much can be done with existing programme resources using human centered design approaches to optimize what is already in place (e.g., See phisicc.org) as well as through innovative solutions as being done with the MyChildCard approach (https://shifo.org) for which early results are promising (https://shifo.org/doc/MyChildCosts.pdf/; https://shifo.org/doc/MyChildCardEvaluationReport.pdf).
IF we maintained a greater awareness of the inefficiencies resulting from poor decision making and a desire to reduce resultant inefficiencies, I believe a common sense business case exists for national immunization programmes to more consciously invest in home-based record systems, alongside investments in the facility-based administrative recording and reporting systems, as a critical component of an immunization programme’s overall programmatic intelligence strategy.
I look forward to the views of others on the topic as we champion creative solutions to the existing challenges while ensuring that the path we are choosing will be sustainable in the long-term.