Feedback Loops for Health Data: Learning from Users to Inform Investments

Interest in the creation and use of citizen report cards (CRCs) is growing in many low- and middle-income countries. Bangalore has measured and reported citizens’ satisfaction with government agencies to the media; Kenya’s three largest cities have gauged citizens’ access to and use of waste management services; and townships in Myanmar have used CRCs to gather feedback on their provision of health and education services. Interest in social accountability tools is even echoed by officials at the highest levels. At a June summit on measurement and accountability in health, the World Bank, USAID, and WHO agreed to push for the increased use of citizen and community led reviews at every level of service and governance.

And yet, there is surprisingly little insight into how these report cards interact with their target audience: citizens. For instance, questions remain around what indicators are most relevant to citizens, if there is a common set of issues that could be combined into a report card, and how data should be collected and reported. Answering these questions, however, could help guide investments in and improve the development of citizen report cards.

To start filling this knowledge gap, my colleagues and I looked at the initial stages of developing a report card for primary health care facilities in rural Tajikistan—a place where there is significant opportunity for improved performance of the health care system, and where the government is interested in using incentives and information to bring about improvements. The study, recently published in Health Policy and Planning, looks at developing and selecting indicators, collecting data for the report card, and working with existing institutions and stakeholders.

Our findings indicate that better understanding how your target audience uses data may help in designing measurement strategies that are¬ relevant and effective. And by focusing on issues that are important to different communities, it may be easier for citizens to make good use of report card data. For example, we found that citizens were able to come to a consensus on which indicators to include in the report card and that they prefer an arms-length approach (e.g., phone surveys) when it comes to the collection of sensitive information. We also found some differences in citizens’ priorities across regions and genders, suggesting there may be scope for adapting report card content.

Improving health services in any country relies on accurate information on the right set of indicators, and the ability to use that data to hold service providers accountable. Instead of taking an ‘if we build it, they will come’ approach to data collection and dissemination, perhaps investments in measurement and evaluation should be guided by the intended users of the information, including their interests and abilities to interpret and use the data.