We believe that by engaging with system actors as individuals and examining the program from their unique viewpoints, we will be able to offer fresh perspectives on decades-old challenges.

Who we are
The VxData Insights study, a joint initiative between Sonder Design Collective and John Snow Inc, seeks to understand the data specific challenges that healthcare workers and managers at all levels encounter in delivering immunization services in Kenya, Mozambique and the DRC.
While much is documented about the larger barriers surrounding the collection and uptake of immunization data in African health systems, there is very limited understanding of what the barriers and drivers are for using immunization data for decision-making from the perspective of the users themselves: immunization program managers and healthcare workers at the national, district, sub-district and facility levels.

To fill this gap in knowledge, the VxData Insights global and local teams in Kenya, Mozambique and the DRC are working together with well-established national immunization programs to find the answers.
We started our journey in Kenya in early 2020, where we conducted our study in urban, peri-urban and rural areas to gain deeper understanding of the challenges for health system actors in the Immunization Program. Currently, we are kicking off field work in Mozambique and are scheduled to continue with the DRC later this year. 

The aim is that the results of this study will be used by global, local and health level actors involved in immunization programming to design innovative, user-centred interventions to address behavioral and systemic challenges to effective data collection, management and use of immunization data to improve service delivery and health outcomes.
How we work
We are using a methodology called Human-Centered Design that allows and encourages an empathetic perspective of the world, where people act as both the central source of direction and the key benchmark for the viability of a solution.
By taking a HCD approach, we seek to understand the problem by requiring actual contact with the people involved in the challenge, to understand their behaviors, motivations and hurdles. Ultimately, to be human- centered is to consider complex systems from the perspective of the people who will use or be affected by them.
By investigating the experiences, motivations, and painpoints of the individuals that make up the immunization data ecosystem, we are gaining grounded, specific insights and understanding the root causes behind their challenges. We are doing it through the following HCD techniques:

In-depth contextual interviews
Conducting individual in-depth interviews with healthcare workers and decision makers at their place of work at the facility, sub-national and national levels, allows us to understand participants’ needs, emotions, expectations, and environment, but also to reveal formal and informal networks and hidden motivators of specific actors. We not only ask questions, we engage participants with bespoke activities to solicit responses through not just storytelling, but story visualisation.
Shadowing and observation of immunization clinics and participants in their work environment allows us the unique opportunity to cross-check a participant’s words versus actions within a system. Observation gives us the lens we need to validate the findings from interviews.

Iterative and collaborative data analysis
Data that is collected during the study  is rigorously analyzed through an interactive and iterative process called ‘insight generation’. This is a HCD approach to data analysis, bringing together researchers and stakeholders to gain deeper meaning to the data that has been collected. From this analysis, themes and patterns emerge to shed light on the problem we are trying to solve.

Our focus
We are focusing on five thematic areas which were identified as gaps in immunization data knowledge through secondary research and stakeholder interviews.
Day-to-day Experiences
Gain a deeper understanding of the background, daily activities, priorities, needs, obstacles and challenges of health care workers and managers at all levels of the system.
Decision Making
Form a better understanding of the decisions (both extrinsic and intrinsic) that are currently being made at all levels of the system and the factors that influence them. We also seek to further understand what information is used both formally and informally, what information is missing, inaccessible, or not available at the right time, and what information is currently being collected but not being used.

Moments of Exchange
Mapping key interaction points across the different levels of the immunization system to better understand how actors at various levels are interacting with each other, what information is being exchanged and through what channels and how these interactions positively and negatively impact data collection and use at the various levels. 
Data Culture and Value
Identify perceptions and attitudes of immunization program actors towards data collection and use. In particular, we will explore how good quality data is defined and how much value is being placed on collecting and using good data for decision making. We also hope to gauge the confidence levels in the data for the various system actors and the various factors that influence how data is perceived. 

Identify intrinsic and extrinsic drivers of behavior that motivate health workers positively or negatively, barriers to following data-related protocols and any other areas of behavior inherent in managing, reporting and using data for immunization programs.