Hannu VuoriHannu Vuori

From Evidence

To Action

An international perspective

Starting pointStarting point

Own background UN/WHO orientation Information theory Focus on action rather than evidence Crisis situation Developing countries Examples

HVV/130908

ContentsContents

Basic notions of information theory Finding evidence Assessing evidence Producing evidence Using evidence Evidence and crisis situation

HVV/130908

HVV/130908

Information

Theory

From Data to KnowledgeFrom Data to Knowledge

HVV/130908

Information

Data

(Noise)

Grouping

Selection

Elimination

Adoption

Acceptance

Generation

Capture

Knowledge

From Data to ActionFrom Data to Action

Generation Capture Organization Analysis Interpretation Transmission Adoption Use

HVV/130908

From Data to ActionFrom Data to Action

Facilitators Barriers

HVV/130908

ActorsActors

Producers of data Daily activities

Researchers Analysts Intermediaries Decision makers Implementers

HVV/130908

HVV/130908

Finding

Evidence

Finding Evidence – 1 (UN)Finding Evidence – 1 (UN)

WHO World Health Report HFA Data Base Highlights on Health Health Policy Profiles

UNICEF UNHCR UNFPA WFP World Bank

HVV/130908

KOSOVO

OFFICE OF STATISTICS

INVITATIONPopulation and

Reproductive Health Survey

Presentation of the Preliminary Results

KOSOVO OFFICE OF STATISTICS

Conference Room26 April 2000, 14:00

Projected life expectancy at birth Selected sub-Saharan countries

Source: World Population Prospects: The 1996 revision, United Nations Population Division, 1996

1955 1960 1965 1970 1975 1980 1985 1990 1995 2000

years65

60

55

50

45

40

35

Zimbabwe

ZambiaUganda

Botswana

Kenya

Malawi

GE-98001/10 – 1 December 1997

10

E SI u n it

1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 199665

70

75

80 European Region

EU

CCEE

NIS

Year Source: data from the W HO Regional O ffice for Europe

L ife expectancy a t b irth in subreg iona l g roups o f countries in the European R eg ion, 1970–1996

RPF/RC48/lifex1.GRF14 : 08 : 98

Finding Evidence – 2 (other)Finding Evidence – 2 (other)

NGOs Save the Children International Planned Parenthood Federation Many others

National Development Agencies National Information Systems Ad Hoc Reports

HVV/130908

HVV/130908

Health Policy for Kosovo

Department of Health and Social Welfare

Pristina, February 2001

Provisional Institutions ofSelf-Government of Kosovo

Ministry of Health

Health And Health Care Of

Kosovo

Pristina February 2004

HVV/130908

Assessing

Evidence

Existing Data: IssuesExisting Data: Issues

Availability Existence Sensitivity

Reliability Coverage

Data Capture

Timeliness Topicality

HVV/130908

Existing Date: IssuesExisting Date: Issues

Purpose of data collection Prediction and action vs. control

Focus Infectious vs. chronic diseases Morbidity vs. system performance

Generalizability Population based vs. episodic

Time series Concept of indicator

HVV/130908

Assessing EvidenceAssessing Evidence

Factors to consider Skills and resources Mechanism of data collection Definition Purpose of data collection Purpose of data presentation Etc.

HVV/130908

Effect of war in SarajevoEffect of war in Sarajevo

Indicator 1990 1993 Change (%)

Infant mortality 15.8 26.9 + 70

Stillborn rate 7.5 12.3 + 64

Perinatal mortality

15.8 36.0 + 128

Congenital anomalies

0.4 3.0 + 650

HVV/130908

OPV Vaccination Coverage in OPV Vaccination Coverage in KosovoKosovo

Vaccination round Coverage rate

1st 87

2nd 92

3rd 95

HVV/130908

HVV/130908

Producing

Evidence

90 % perspiration, 10 % inspiration

Thomas Alva Edison

Producing Evidence: IssuesProducing Evidence: Issues

Need-to-know vs. nice-to-know Action vs. understanding Forum of presentation Style of presentation

HVV/120908

HVV/120908

Using

Evidence

Action: BarriersAction: Barriers

Ideology Preconceived ideas, prejudices Vested interests Pride Short attention span Narrow attention span Pork barrel politics Risk aversion Etc.

HVV/120908

Decision-makersDecision-makers

HVV/120908

Don’t confuse me with facts; I have made up my mind.

Decision-makersDecision-makers

HVV/130908

In politics, a day is a long time.

Action: FacilitatorsAction: Facilitators

Compatibility with ideology Compatibility with existing plans (Immediate) political gain Existing technology and know-how Existing resources Ease of implementation

HVV/130908

Politician vs. ScientistPolitician vs. Scientist

Politician Now Certainty (Single) action Understandable Easy to sell to people Resources available Easy to implement

Scientist Tomorrow Probability Options Scientifically sound True priority True priority True priority

HVV/130908

Different politiciansDifferent politicians

National level Broad picture How does my country

fare? Does it ensure my re-

election?

Local level Details How does my county

fare? Does it ensure my re-

election?

HVV/120908

Evidence

Under

Crisis

Most wars nowadays are civil wars , and in many of today’s conflicts civilians have become the main target of violence.

Kofi Anan

Today’s WarToday’s War

Health as target Public utilities as a weapon Psychological warfare Anonymity Technology Duration of impact

HVV/16 May 2003

Health Health Consequences of WarConsequences of War

Direct Biological Mental

Indirect Health infrastructure Environmental infrastucture Human resources Programme implementation Information and intelligence Economy

War and informationWar and information

Truth is the first victim of a war.

Information we get during a war is often contradictory, usually false and almost always unreliable

Clausewitz: On Warfare 1832

Why Info is NeededWhy Info is Needed

When information lacks, rumors spread – and wrong action ensues

Authorities Donors Priorities: An ounce of prevention …

HVV/120908

Crisis and Info: IssuesCrisis and Info: Issues

Denominator population Deaths, displaced, refugees

Chronic diseases often forgotten Extent of mental problems Claims vs. reality Sensitivity of information Data collection (research) Communication “Enforced health”

HVV/130908

Lessons from BosniaLessons from Bosnia

Build on the local system Support the locals, don’t do things for

them Nuts and bolts (paper and pencils) are

important Invest in communication Reporting presumes motivation: feed-

backHVV/130908