TY - JOUR T1 - Barriers and Facilitators to Data Use for Decision Making: The Experience of the African Health Initiative Partnerships in Ethiopia, Ghana, and Mozambique JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-21-00666 VL - 10 IS - Supplement 1 SP - e2100666 AU - African Health Initiative Partnership Collaborative for Data Use for Decision Making Y1 - 2022/09/15 UR - http://www.ghspjournal.org/content/10/Supplement_1/e2100666.abstract N2 - Key FindingsCreating regular meeting time and space for team-level capacity building through mentorship, joint analysis of data, and results sharing bolsters sustainable engagement in data use for decision making at the local level.External policy and associated incentives led to broad enthusiasm and facility-level operational challenges.Leadership engagement and available resources, at the facility and subnational levels, drove implementation readiness across projects. Performance lagged in settings where leadership felt underprepared to support state initiatives to expand health management and information systems. Where training and subsequent mentorship were farther reaching across health-system levels, impact on service delivery was greater.Key ImplicationsTo effectively implement sustained improvement interventions for data for decision making, health facility managers should create or build into existing team meeting spaces the time for capacity building through joint data sharing, analysis, and improvement programming.National and subnational managers should prioritize engagement and capacity across health systems levels through training opportunities and mentorship. Likewise, policies to improve the overall skills of the workforce should be considered at both the individual and operational levels.Background:Three African Health Initiative (AHI) partnership projects in Ethiopia, Ghana, and Mozambique implemented strategies to improve the quality and evaluation of routinely collected data at the primary health care level and stimulate its use in evidence-based decision making. We compare how these programs designed and carried out data for decision-making (DDM) strategies, elaborate on barriers and facilitators to implementation success, and offer recommendations for future DDM programming.Methods:Researchers from each project collaboratively wrote a cross-country protocol based on these objectives. By adapting the Consolidated Framework for Implementation Research (CFIR) through a qualitative theme reduction process, they harmonized lines of inquiry on the design of the respective DDM strategies and the barriers and facilitators of effective implementation. We conducted in-depth interviews and focus group discussions with stakeholders from the primary health care systems in each country, and we carried out multistage, thematic analyses using a deductive lens.Results:Effective implementation of DDM depended on whether implementers felt that DDM was adaptable to context, feasible to trial, and easy to introduce and maintain. The prevailing policy and political environment in the wider health system, learning climate and absorptive capacity for evidence-based change in DDM settings, engagement of external change agents and internal change leaders, and promotion of opportunities and means for team-based reflection and evaluations of what works influenced the success or failure of DDM strategies.Conclusion:Opportunities for team-based capacity building and individual mentorship led to effective DDM programming. External policies and associated incentives bolstered this but occasionally led to unintended consequences. Leadership engagement and availability of resources to act on recommendations; respond to capacity-building needs; and facilitate collaborations between peers, within hierarchies, and across the local health system proved crucial to DDM, as was encouraging adaptation and opportunities for iterative on-the-job learning. ER -