TechNet-21 - Forum

This forum provides a place for members to ask questions, share experiences, coordinate activities, and discuss recent developments in immunization.
  1. Wendy Prosser
  2. Service delivery
  3. Tuesday, 09 June 2020

You are invited to join an upcoming webinar:

Re-framing how we think about decision-making: 3 lessons from healthcare workers and managers in Kenya

June 18, 2020, 9:30 a.m. EST / 3:30 p.m. GMT


Join JSI and Sonder Design Collective for a first in a series of mini 30-minute webinars sharing their initial findings from The Vaccine Data Discovery Research in Kenya. This Human-Centered Design study is a joint effort between the two organizations and the Ministry of Health in Kenya, aimed at understanding the challenges around collecting and using data for decision-making in delivering immunization services. 

In this webinar, the team will deep dive into 3 insights around decision-making in the Kenya health system, covering perceptions around who is and is not a decision-maker, the context in which decisions are made, and how relevant information is accessed to inform these decisions. 

For more information about the work, you can download the initial Kenya findings report.


  • Isaac Mugoya, Senior Technical Officer, Kenya - Immunization Center, JSI. Isaac has been working in immunization for more than three decades, supporting the Kenyan Ministry of Health in monitoring immunization programs, introducing new vaccines, and applying best practices. 
  • Emilia Klimiuk, Project Lead, Sonder Design Collective. Based in Lagos, Nigeria, Emilia is a designer and researcher specializing in applying Human-Centered Design methods to the health, microfinance, and agriculture sectors in low resource settings. 
  • Sarah Hassanen, Kenya Lead, Sonder Design Collective. Based in Nairobi, Kenya, Sarah practices Human-Centred Design with a focus on health across multiple continents including Africa, Europe and the Middle East
  • Wendy Prosser, Senior Technical Officer - Supply Chain, Immunization Center, JSI. Wendy provides technical assistance and strategic guidance on the immunization supply chain across JSI’s country teams to improve the design and management of the supply chain, create processes for data use for decision making, and apply global best practices to the country context.
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Moderator Accepted Answer

You can now watch the webinar "Re-framing how we think about decision-making: 3 lessons from healthcare workers and managers in Kenya" video and download the related presentation

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  1. more than a month ago
  2. Service delivery
  3. # 1
Wendy Prosser Accepted Answer

Thank you to everyone who joined the webinar today on Reframing Decision Making. The slides that were presented can be found here. Also, any feedback or additional comments are always very welcome.

We appreciate the questions that you all posed. We didn't have time to answer all of them, so the discussion continues here with the remaining questions. 

1. Were there insights from managers on how they thought meetings could be made more effective, e.g. to have data review and discussion in those meetings?

Data review meetings were universally appreciated by all levels but there often was often not enough budget to actually conduct them regularly. If meetings did have data review, we found that the data was usually compiled, analyzed and visualised by either the Sub County or County HRIO, which also supported our insights into the concentration of data capability in those kinds of positions.

2. Did you find that HWs were empowered to make certain decisions vs. others? For example, willing to make decisions on a daily basis (microadaptations to protocols) but were hesitant to make larger decisions where they would be seen as responsible for that decision?

It seems that HWs at the facility level are very clear and feel that they have control about making the daily operational decisions at the facility such as how to organize an immunization session. However, while we saw some micro-adaptations to protocols, such as creating a separate tracking book for BCG for the maternity ward, it sought to facilitate the HW's daily operations at the facility. We tended to not see in contrast, the behaviour of or the appetite for making larger decisions that would affect broader actions. In our next webinar, we talk about the various actors in the system & the decisions they make on their own, with others, and decisions others make that impact their work. This information and further insights can also be found in our Kenya Insights report.

3. I think you said that people preferred to access data through meetings, not systems. Any thoughts about systems that can better address that point?

We found that people seemed to prefer receiving information from other actors within the system. As doctors and nurses are used to interacting with people on a daily basis, they seem to carry this preference over to higher-level positions. With many competing priorities, managers tend to have lots of trust in the people working under them to provide them with the data they need. A system is unlikely to replace this. We should look at instead, at ways that we could empower and support those that hold the data and are trusted sources of information as this human-centred layer will always be there.  

  1. Emilia Klimiuk
  2. 3 months ago
  3. #28
Thanks for the question, Isabelle. While we did not collect data specifically on tool preference, I do think our work can inform this conversation by laying out some guiding principles. Overall, we found that the current tools are rigid and only work well under ideal circumstances -- typical use cases, enough staff, uninterrupted time. Once the stress level goes up, HCWs start looking for workarounds. They revert to using palms of their hand, slips of paper, or even register margins to collect data that should be going directly into the records. To us, this is an indication that there are barriers to using current tools. We will cover this topic more in-depth in a webinar around Ad-hoc tools in a few weeks. Hope you can attend!

In the meantime, I'm happy to provide some of my personal thoughts based on what we saw in Kenya:
- Reliability/availability of tools is far more important than format (paper or digital): paper tool stock-outs as well as down time of DHIS-2 were consistently listed as one of the highest demotivators at all levels of the system and we suspect have a huge impact on data quality.
- Tools should not require HCWs full attention: we need to acknowledge that HCWs are multitasking and will always prioritize their interactions with the client. A tool that requires a nurse to stop what she is doing and focus completely on data collection for 1-2 minutes is unlikely to succeed. (think a car dashboard rather than a worksheet)
- More flexibility around what data is collected: current tools treat all data with equal importance. When nurses run out of time, they are forced to make their own decisions about which data to prioritize and which to ignore. Thinking about the order/layout/visibility of data fields to help prioritize could improve the quality of core data sets.
- Built-in decision support: we found that the current tools do not support decision-making at the facility level. They are designed with the higher system levels in mind. It might be worth exploring how small changes could make the tools more meaningful to the people interacting with them.

While it is outside the scope of our work, I think the question of why a nurse prefers to record data on her hand while standing right next to the Ledger it is supposed to go in is an important one to answer before designing any tool. Hope this helps : )
  1. Isabelle Cantin
  2. 3 months ago
  3. #26
Thank you for the presentation, it does open a whole new way of thinking about collecting data. During your study, did you hear or get a feel on how or which tool health workers would prefer using to collect data in facilities? I understand that they feel pressured between giving good services and collect data but would a new tool be well accepted instead of using a book or sheets? What would they prefer between an excel spreadsheet or a mobile app to collect data? Did they mention anything on their preference for the future?
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  1. more than a month ago
  2. Service delivery
  3. # 2

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