Trust, Quality, and Usability Challenges to Effective Data Use: Experiences Surrounding the Deployment and Use of the Bangladesh Nutrition Information System Dashboard (Preprint)

Abstract

Evidence-based decision-making is essential to improve public health benefits and resources, especially in low-middle-income countries (LMICs), but the mechanisms of its implementation remain less straightforward. The availability of high-quality, reliable, and sufficient data in LMICs can be challenging due to issues such as lack of human resource capacity and weak digital infrastructure, among others. Health information systems (HIS) have been critical for aggregating and integrating health-related data from different sources to support evidence-based decision-making. Nutrition Information Systems (NIS), which are nutrition-focused HIS, collect and report on nutrition-related indicators to improve issues related to malnutrition and food security – and can assist in improving populations’ nutritional statuses and the integration of nutrition programming into routine health services. Data visualization tools (DVT) such as dashboards have been recommended to support such evidence-based decision-making, leveraging data from HIS/NIS. The use of such DVTs to support decision-making has largely been unexplored within LMIC contexts. In Bangladesh, the Mukto dashboard was developed to display and visualize nutrition-related performance indicators at the national and sub-national levels. However, despite this effort, the current use of nutrition data to guide priorities and decisions remains relatively nascent and under-utilized.

The goal of the study is to better understand how Bangladesh’s NIS has been utilized and areas for improvement to facilitate its use for evidence-based decision-making towards ameliorating nutrition-related service delivery and health status of communities in Bangladesh.

Primary data collection was conducted through qualitative semi-structured interviews with key policy-level stakeholders (n=24). Key informants were identified through purposive sampling and were asked questions around how the experiences and challenges with the NIS and related nutrition dashboards.

Main themes such as trust, data usability, person power, and data use for decision-making emerged from the data. Trust in both data collection and quality was lacking among many stakeholders. Poor data usability stemmed from unstandardized indicators, irregular data collection, and differences between rural and urban data. Insufficient person power and staff training coupled with infrastructural challenges can negatively affect data at the input stage. While stakeholders understood and expressed the importance of evidence-based decision-making, ultimately, they noted that the data was not being utilized to its maximum potential.

Leveraging DVTs can improve the use of data for evidence-based decision-making, but decision-makers must trust that the data is believable, credible, timely, and responsive. Results support the significance of a tailored data ecosystem, which has not reached its full potential in Bangladesh. Recommendations to reach this potential include ensuring a clear intended user base, and accountable stakeholders are present. Systems should also have the capacity to ensure data credibility and support ongoing person power requirements.