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SURVEY & INTERVIEW RESPONSES ON DECISION-MAKING AND DECISION-SUPPORT TOOLS (DSTs) FOR HEALTH AND

ENVIRONMENTAL CHANGE

HEALTHY FUTURES Fifth Partners meeting, Nairobi, Kenya, 2014

Monica Coll Besa & Richard TaylorSEI Oxford Centre

HEALTHY FUTURES Fifth Partners meeting, Nairobi, Kenya, 2014

Online survey sent to s/h & HF partners

• 1 KEMRI -Kenya• 1 Ministry of Agriculture, Livestock & Fisheries• 1 University of Rwanda –College of Medicine and Health Sciences• 1 Action de Lutte contre la Malaria, A.LU.MA -Burundi• 1Ifakara Health Institute –Tanzania• 1Dept. Veterinary Services –Kenya• 1 ICTP• 1 ILRI• 1 CSAG• 1 Ministry of Health -Uganda

10 responses in total

HEALTHY FUTURES Fifth Partners meeting, Nairobi, Kenya, 2014

Important factors in decision-making

• Participatory approaches through consultation, sharing views• Environmental & socio-economic concerns• Technology, finances, audience, size of data & database• Availability of scientific data & knowledge• Improved performance of the health sector and improved service

delivery

– Other important criteria:• More cross-sectoral integration in development planning• Global trends in data mgmt, literature, environmental concerns• Individual public health experience• Information on previous performance & past achievements

HEALTHY FUTURES Fifth Partners meeting, Nairobi, Kenya, 2014

Data used in the decisions

• Surveys, feasibility studies, population dynamic data• Costs data: income, expenditure patterns (HH level)• Health mgmt information system• Data sets from clinical trials to implementation• Ecology of the area, community perception on control

and materials to be used• Sector performance reports, disease epidemics and

outbreaks, scarcity of medicines

HEALTHY FUTURES Fifth Partners meeting, Nairobi, Kenya, 2014

Challenges in the decision-making

• Domestication of integrated vector mgmt strategies at the HH level

• Sustainability of problems; relaxation when problem declines

• Taking vector surveillance as 2nd priority to disease treatment

• Timely detection of outbreaks => inadequate preparedness at lower levels

• Competing interests for funding, fear for wrong decisions

HEALTHY FUTURES Fifth Partners meeting, Nairobi, Kenya, 2014

Decision-making needs & research outputs

Needs in the decision-making:• Entire life cycle of clinical research (clinical trial to implementation)• Economic returns & savings; if preventive measures are as successful as

vector control.• Livelihood analysis• Past trends & factors influencing trends• Information on current findings wrt control of diseases, updates on current

trends, information-sharing• Forecasting & early detection• Assessment on vulnerability & impacts of diseases rather than presence

of the hazard

Endemicity level maps Socio-economic vulnerability map Cost-benefits information about options Hazard maps

HEALTHY FUTURES Fifth Partners meeting, Nairobi, Kenya, 2014

How does uncertainty complicate decision-making?

• Incomplete knowledge: when the decision-maker lacks enough knowledge about the system. This can be due to different factors, such as lack of theoretical understanding, ignorance, lack of information or data, unreliability of data describing the system, etc. e.g. the efficacy of preventive measures). 7 people mentioned it

• Multiple knowledge frames: results from having different, and sometimes conflicting views about the system (e.g. which people should be prioritised for receiving a specific health care treatment). 4 people mentioned it

• Unpredictability: when the decision-maker is not able to predict, in space or time, the behaviour of a system (e.g. the timing and extent of a malaria or RVF outbreak, e.g. longer term effects of environmental change on diseases). 3 people mentioned it

HEALTHY FUTURES Fifth Partners meeting, Nairobi, Kenya, 2014

How is uncertainty dealt with?

• Stakeholder consultation/sharing knowledge (very common)• Scenario building & analysis with key experts (Delphi method)

– If control of uncertainty: build on preventive strategies– If no control of uncertainty: ranking of strategies

• Lobbying• Use of surveillance system from the Ministry• Critical synthesis of existing data• Range or envelope of change using model agreement as providing some

confidence in at least the direction of change. Focus on the dynamics –what is behind or driving the change. (CSAG)

Time horizons of decision-making for DST tools

• Decisions that need to be made in the very near future (within weeks or months) -3 people

• Decisions in the short to medium-term (within 5 yrs) -3 people• Decisions that need to be made on annual cycles -2 people• Longer term decisions than the above -2 people

HEALTHY FUTURES Fifth Partners meeting, Nairobi, Kenya, 2014

Spatial scales of decision-making

• East Africa & neighboring countries (5)• National (5)• District/provincial (4)• Local (3)

Local

District/provincial

National

East Africa & neighboring countries

HEALTHY FUTURES Fifth Partners meeting, Nairobi, Kenya, 2014

• Uncertainty– Statistical uncertainty: main dimension taken into account. Handled by

making improvements in data collection, multiple sources of evidence, etc.

– Epistemic uncertainty (i.e. in the impact or effectiveness of preventative measures)

– No mention of ‘scenario uncertainty’ –suggesting lack of familiarity.• Relevant timeframes varied, both in terms of taking a decision and

implementing it (from days to 20/30 years for long-term planning)• Value for money of actions & stakeholder support through consultation–

most important factors in decision-making• Lack of coordination among stakeholders and more funding needed• Sequencing of decisions –based on the data collected, and the

success/failure indicators, it may prompt a new decision. If control is successful it may switch to elimination.

Summary of findings from the interviews in Nairobi