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New white paper spotlights the role of digital tools and adaptive management for navigating complex health challenges

New white paper spotlights the role of digital tools and adaptive management for navigating complex health challenges

By Celina Kareiva, Engagement Officer, PATH

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Photo: PATH/Chimwasu Njapawu. Mothers and their babies arrive early to receive growth monitoring and immunization services in Livingstone, Zambia. The BID Initiative and BID Learning Network applied principles of adaptive management from the outset.

As the world grappled with the global COVID-19 pandemic, many health professionals and health systems turned to adaptive management to respond to a rapidly evolving situation and its complex challenges. Faced with a strained workforce, supply shortages, and economic losses, adaptive management is an approach that embodies intentional testing and learning to navigate change and uncertainty. It has emerged from the interdisciplinary need and understanding that complex development issues and multi-stakeholder environments require agile solutions.

A new white paper, called “Compasses when there are no maps: The growing importance of adaptive management to the development sector and the role of real-time data,” illustrates PATH’s approach to adaptive management and points to projects that have employed adaptive management in their own project design. BID and the BID Learning Network are examples of initiatives that have adopted principles of adaptive management from the outset.

BID used real-time data to advance an adaptive management agenda both within the project and within national immunization programs. Learn fast, fail fast, share fast was a core value of BID from the earliest days. BID did not predefine solutions or demonstration countries; instead, it partnered with countries to identify the most critical routine immunization service delivery problems.

For example, BID initially used a series of “touches” or visits in either country, with BID staff leading on-the-job training to health workers. But the time-consuming strategy took between two to four months to implement and allowed for rollout in only one district at a time. Health workers passively participated in the trainings, and felt little incentive to use the system. As rollout accelerated and BID worked to scale interventions in either country, the training method also became increasingly expensive. Realizing that this method was not sustainable, BID shifted to a training strategy led by district authorities, or district data use mentors (DDUMs). DDUMs provided prompt and localized support, and reinforced behavior change by allowing health workers to see their peers using the system. Rather than forcing a method that had garnered little traction, BID evolved its training to meet health worker needs.

Furthermore, beyond the project management of BID, it hypothesized and later confirmed that person-centric data would enable a dynamic adaptive model for routine immunization programs. By capturing data at the point of care, the project team was able to develop metrics and indicators that could be aggregated and reported at varying levels, including a person, provider, health center, district, regional, and national level. Such data could then be used to drive feedback loops that support continuous quality improvement regarding person-centric care; provider and facility management; and planning and management at the district, regional, and national levels.

The white paper includes case studies from PATH projects, interdisciplinary lessons beyond the field of global health, and actionable steps for incorporating adaptive management into program design. Read the full publication here.

Original author: Celina Kareiva