Data to Action: A Mixed-Methods Study of Data Use Teams, Improved Availability of Contraceptives in Guinea, Indonesia, Kenya, and Myanmar.

Information Mobilized for Performance Analysis and Continuous Transformation (IMPACT) Teams routinely bring together data, people, processes, and technology, under the leadership of governments, to institute a change in culture that leads to sustained improvements in supply chain processes and outcomes. This mixed methods study examined whether IMPACT Teams were effective in improving reproductive health supply chain outcomes in Guinea, Indonesia, Kenya, and Myanmar and identified enablers and barriers to IMPACT Team success and sustainability in Indonesia and Kenya.The study design employed a pre-post intervention comparison panel design with a nonrandomized matched comparison group to examine the IMPACT Teams' effect on 2 supply chain outcomes: stocked according to plan and stock-outs. Additional key informant interviews conducted in Kenya and Indonesia explored enablers and barriers to IMPACT Team success and sustainability.For nearly all products across the 4 countries, an increase in products being stocked according to plan and a reduction in stock-outs can be attributed to the IMPACT Team intervention, demonstrating that IMPACT teams are an effective approach for improving contraceptive supply chain inventory management and availability. However, our findings do not demonstrate a clear causal pathway as theorized in our theory of change, namely that government leadership leads to the installation of a data use culture, which in turn leads to improved product availability. In both Indonesia and Kenya, though product availability improved, there was a lack of leadership and culture change. This suggests that improved product availability does not depend on establishing a data use culture or government leadership, but rather, that a data use culture-rather than product availability-is the outcome of interest for sustained change, and that understanding motivations and incentives for leadership participation may be more important for scaling, institutionalizing, and sustaining gains in supply chain outcomes.

Provider attitudes toward the voluntary medical male circumcision scale-up in Kenya, South Africa, Tanzania and Zimbabwe.

BACKGROUND: Countries participating in voluntary medical male circumcision (VMMC) scale-up have adopted most of six elements of surgical efficiency, depending on national policy. However, effective implementation of these elements largely depends on providers' attitudes and subsequent compliance. We explored the concordance between recommended practices and providers' perceptions toward the VMMC efficiency elements, in part to inform review of national policies. METHODS AND FINDINGS: As part of Systematic Monitoring of the VMMC Scale-up (SYMMACS), we conducted a survey of VMMC providers in Kenya, South Africa, Tanzania, and Zimbabwe. SYMMACS assessed providers' attitudes and perceptions toward these elements in 2011 and 2012. A restricted analysis using 2012 data to calculate unadjusted odds ratios and 95% confidence intervals for the country effect on each attitudinal outcome was done using logistic regression. As only two countries allow more than one cadre to perform the surgical procedure, odds ratios looking at country effect were adjusted for cadre effect for these two countries. Qualitative data from open-ended responses were used to triangulate with quantitative analyses. This analysis showed concordance between each country's policies and provider attitudes toward the efficiency elements. One exception was task-shifting, which is not authorized in South Africa or Zimbabwe; providers across all countries approved this practice. CONCLUSIONS: The decision to adopt efficiency elements is often based on national policies. The concordance between the policies of each country and provider attitudes bodes well for compliance and effective implementation. However, study findings suggest that there may be need to consult providers when developing national policies.