Data Review Teams: A Promising Practice to Improve Data Use and Strengthen Immunization Supply Chains

"[E]xperience shows that data review teams - equipping individuals at all levels of the supply chain to work with and improve the information that they have - can...ultimately help to ensure that we continue to close the gap on immunization coverage for the world's poorest people."

Well-performing immunisation supply chains (iSC) are critical to ensure vaccine availability, and they rely heavily on data visibility and data use to function properly. Data review teams (DRTs) provide an opportunity for stakeholders from across supply chain tiers to review key iSC performance indicators (KPIs), identify and assess performance issues, and develop actionable solutions for improving iSC and immunisation programme performance. This synthesis report offers a cross-country analysis of vaccine-related DRT interventions carried out by the Clinton Health Access Initiative (CHAI) in 7 countries, John Snow, Inc. (JSI) in 10 countries, and VillageReach in 3 countries. Because DRT interventions share characteristics that are common to many other health systems strengthening approaches - that is, they focus on instilling and institutionalising new practices and behaviours among stakeholders within the health system - lessons drawn from DRTs may be relevant to other types of interventions as well.

The issue is that data on stock levels, consumption, wastage rates, order and re-supply frequency, and stock-outs enable accurate resupply, inventory management, distribution planning, order fulfillment, and forecasting - ultimately determining whether populations have access to the vaccines they need. Although countries have taken steps like developing health logistics management information systems (LMIS) and training staff to use these systems, the increased availability of data has not necessarily led to increased use of data. DRTs are a potential solution for building a culture of data use.

To uncover insights into factors that contributed to or hindered success of DRTs in their experience, getween December 2018 and March 2019, CHAI, JSI, and VillageReach conducted in-depth interviews with DRT programme managers, reviewed programme documents, and documented practices and operational tactics. (The portfolio of cases reviewed is summarised in Figure 1 of the report. A detailed methodology, including analytical framework, primary data collection template, and interview guide, is included in Annex A.)

CHAI, JSI, and VillageReach learned that most of the DRT interventions took the form of routine meetings of multi-level and multifunctional stakeholders, who use supply chain data and improved data analysis tools to identify problems, develop solutions, and follow up on progress - with support from implementing partners. Common design elements across interventions:

• The teams typically included stakeholders from different tiers of the supply chain and actors who had different functions in the health system (e.g., Expanded Programme on Immunization (EPI) managers, logisticians, and regional health officers).
• Most teams used enhanced tools for data analysis and held structured meetings that emphasised data presentation, problem identification, and solution generation.
• Most interventions included strategies to motivate the DRT members, such as peer recognition platforms.

Recommendations for implementing DRTs are grouped under 3 programme principles:

1. Standardise the meeting structure and tools - Integrate DRTs into existing performance review and monitoring meetings; create or enhance decision support tools (e.g., data visualisation tools); and cover 4 processes during DRT meetings: KPI review, problem identification, problem cause analysis, and action planning.
2. Choose the people and orient them to their roles - "For DRTs to problem-solve effectively and take concrete action, the right people need to be in the room for the discussions. This means ensuring a mix of those close to the ground, who understand the challenges, and those in positions of authority, who can drive action. However, DRTs should be mindful to balance these two stakeholder groups to ensure that transparent and frank communication among members can take place without fear of retribution." In addition, orientation engages DRT members to ensure their full participation and sets the team up for independent operation. In Nigeria, CHAI addressed both lower-level needs (e.g., basic computer training) and higher-level needs (e.g., leadership and data-based decisionmaking skills) through at least 6 months of continuous mentorship.
3. Nurture teams' motivation and accountability - Inclusion of strategies to encourage participation and ensure sustained engagement over time can supplement official job expectations. Examples included having participants sign public declarations, which provided explicit recognition for KPI improvement, having influential conveners attend meetings, and comparing and highlighting performance across regions to introduce competition (as VillageReach is implementing in Mozambique). Support from a senior official or other champion, such as a national EPI manager or a director of public health, shows leadership and commitment to instituting data use for decisionmaking and change.

"To achieve their greatest impact, data review teams should operate at nation-wide scale, occur consistently as part of routine management processes, and be fully owned by Ministry of Health stakeholders. To achieve this, the design of the data-use team model must be paired with a strategy for effective scale-up and long-term sustainability within the government system."

Looking ahead, CHAI, JSI, and VillageReach call for robust monitoring to measure the impact of DRT interventions and to assess systematic ways to sustain and implement them at scale.