DATA ACCESS AND USE
The importance of access to current, accurate data cannot be overstated. Yet, effective data usage relies on a comprehensive, accessible, and usable information pipeline.
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The importance of access to current, accurate data cannot be overstated. Yet, effective data usage relies on a comprehensive, accessible, and usable information pipeline. Prior to the start of BPS, many Blantyre District Health Coordinators could not access the data they needed to inform decision making about where to direct resources. The Data Access and Use program element of the BPS model focuses on providing access to data routinely and in a user-friendly format and supporting the use of that data for informed decision making at all levels of the district’s health system.
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BPS created two key resources to support the effort. The first is a data pipeline that brings together HIV prevention data from national data systems, census data, and other health and non-health data. The second is the Prevention Adaptive Learning and Management System, known as PALMS, which is an online dashboard through which users can access the data in the pipeline. Its design was informed by local users. Enabling users to see both HIV prevention and related data, PALMS has become the foundational platform upon which the functionality of the district’s HIV prevention response and the BPS model rests. Most importantly, it is empowering District Coordinators and health management teams, facilities, and communities to lead Blantyre’s HIV response.
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Elements of the Blantyre’s HIV data access and use approach are:
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Data pipeline linking HIV data reported through national systems with other health and non-health data.
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Use of a common data platform (PALMS) to facilitate routine access to necessary data for informed decision making by district and city health teams, facilities, partners, and others.
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Capacitated human resources at district, facility, and community levels – staff at various levels of the system have been trained in data access and use for decision making.
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Since 2021, BPS has supported the training of the Blantyre District and City health teams; public, private, and non-profit service providers; implementing partners; community organizations; and community health workers and other local structures. The capabilities built through the training have supported the implementation of the other BPS Program Elements. Expansion of training to community health teams (CHTs) and other community health structures and key informants beginning in 2024 has supported Blantyre’s active surveillance activities.
Figure 1. Data use capacitation down to community levels
“BPS has really changed the tone within the district in terms of direct usage. And as for me, as an ICT person, yeah, I feel proud to be part of it, and also to see the fruits of the trainings that we did with the teams from the facilities bearing fruits in terms of the data review meetings that they're conducting.”
Gosten Njunga
Information and Communication Technology (ICT) Programmer, Blantyre DHO
“After the coming of BPS, we started learning about how we can utilize our data to make sure that we know which areas we need to focus more and take our sources more... every month, we look at the data, and then we analyze the data, and then we take our activities there. …This has helped us to reduce or to have more outcomes based on where exactly the problem is. …PALMS and the BPS has helped Zingwangwa Health Center as a team to focus more on areas that we need to.”
Mirriam Hanjahanja
Senior Nursing Officer, Zingwangwa Health Center
BPS created the Prevention and Adaptive Learning Management System (PALMS) to pull existing and new data into user-friendly dashboards that support data-driven decision making at all levels in Malawi and Blantyre District: policy, technical leadership, implementation, and community. Enabling users to see both HIV prevention and related data, PALMS has become the foundational platform upon which the functionality of the district’s HIV prevention response and the BPS model rests. Most importantly, it is empowering District Coordinators and health management teams, facilities, and communities to lead Blantyre’s HIV response.
WHAT IS PALMS?
PALMS is being actively used by front-line health workers to enhance their ability to make decisions in everyday work (including targeting of resources and improving the uptake and quality of HIV prevention in Blantyre and now Lilongwe, where its use has expanded). In addition, data is being used outside of HIV programs as capacity has widened within facilities, e.g. MNCH, family planning, and STI programs especially as QI support teams (QISTs) have become platform for data review and decision making at facility level.
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Lessons learned:
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Use of a common data platform has been critical to rolling out and supporting HIV prevention activities and the coordination between district, facility, and community.
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Access to data is critical but insufficient on its own. Health workers need training in data interpretation and analysis to support their decision making, including understanding indicators and triangulation.
Photo 1: Quality nurse at Mpemba Health Centre expertly walking through data visualizations and describing trends and programmatic responses (Sept 2024).
Dr. Gift Kawalazira
Director of Health and Social Services,
Blantyre District Council
What is special about PALMS is that it pulls data from multiple resources automatically. It analyzes the data, gives you graphs, and red flags. If the data from a certain source or facility does not make sense, then the platform is able to point you towards the correct data source.
“I think PALMS, it's really good because the data is already there. You don't have to struggle to see how you're performing. You don't have to go through several registers.... You don't have to take a lot of time.... You just go in using your phone, check how your indicators are performing, check where you're not performing, check where you're performing well. So that also we aim to improve even more where we are performing well and where we're not performing well, we come up with change ideas. We come up with solutions. We come up with PDA circles and then we test the ideas. We see which one make better and we see which one can help us to improve the HFA outcomes in our district.”
Tamanda Nzima
Nurse, Quality Improvement Mentor, HTS Coordinator, Blantyre DHO
Chimwemwe Pinto
Statistical Officer, Blantyre DHO
Before BPS coordinators were using data for decision making, but they were still asking for help from the Health Management Information System to analyze data. So BPS came with a system called PALMS that is supporting the district with HIV data for decision-making.
“With the coming of PALMS, we can say now we are using the data. We are implementing the activities basing on the evidence. Previously, we are just doing the activities somehow. But with the use of the data, we are now using the evidence and we are really targeting those people at risk. So after identifying the people at risk, it's when we deliver the core package of HIV interventions.”
Loncy Sajeni
Deputy District Environmental Health Officer, Blantyre District
Tamanda Nzima
Nurse, Quality Improvement Mentor, HTS Coordinator, Blantyre DHO
Using data available in PALMS, District Coordinators and facilities are able to identify which communities needs prevention services, such as condoms or PrEP, and make informed resource allocation decisions. With BPS, Tamanda Nzima says “power has been given to the people”. The district and city health teams and facilities are better able to engage with communities using the data. Likewise, community members access the same data and can advocate for the resources they need for HIV prevention and other services.
