The Data-to-Action Continuum (D2AC) Toolkit

The conceptual framework shown here describes organizational, human, technology, and process-related factors affecting data use capabilities. The framework highlights an interlinked and cyclical evolution of the health information system involving tuberculosis data collection and reporting, analysis, use and dissemination-related interventions that build on the leadership and governance and capacity building efforts of a given NTP. The framework shows that the interlinked interventions follow a continuous improvement approach to achieve the advanced maturity levels (often identified by a descriptor such as nascent, defined, established, institutionalized, and optimized) which are associated with an improvement of NTP performance in terms of using data for proactive and responsive clinical, programmatic, managerial, and policy decision making.

The TB Data-to-Action Continuum (D2AC) Toolkit measures countries’ progress towards improving their TB monitoring and evaluation (M&E) and surveillance systems and provides information to guide their continued efforts. The D2AC defines five possible levels of system development—ranging from “nascent” to “optimized”—and allows national TB programs (NTPs) to precisely gauge the barriers to data use and assess the decision-making capabilities of different actors across their health systems. It also helps NTPs select appropriate interventions within the context of their health systems and develop implementation plans to apply them.

The D2AC Toolkit, validated by an expert advisory group and field tested, includes:

1) The Excel-based D2AC Data Collection Tool for collecting individual responses with:

  • Five defined continuum levels
  • A country profile template to collect socio-economic, demographic, and epidemiological indicators
  • A D2AC scale, with capability statements organized into five domains and 17 sub-domains for each of the five continuum levels
  • Key user roles and decisions organized according to USAID’s TB objectives of reach, cure, prevent, and sustain
  • A data collection instrument
  • An analysis matrix
  • An analysis dashboard

2) The Excel-based D2AC Data Analysis Tool that automatically aggregates responses from all completed data collection instruments and generates data visualizations and recommended priority actions. This enables decision makers to make sense of and apply the findings and develop an implementation plan using the template provided by D2AC.

3) A D2AC User Guide to facilitate the use of both tools.

D2AC Publications

The TB DIAH team is publishing a series of articles describing the process of developing the D2AC Toolkit. The process is divided into three phases, and each phase will be documented in its own article:

  1. Research gaps in transforming tuberculosis data to action for better health outcomes: A systematic literature review, in the Journal of Global Health, describes the theory behind the D2AC approach and the systematic review undertaken to develop the framework.
  2. “Data-to-Action Continuum: How to measure and advance data use capabilities of the national tuberculosis program?” describes the phases ranging from the creation and validation of the D2AC Data Collection Tool to the pretest of the D2AC Toolkit. The article is currently under review.
  3. A final article will reflect on the field test processes and learnings from Ghana and Nigeria that preceded D2AC’s first implementations. This article is currently in development.

More information on the D2AC is available in English, French, Portuguese and Russian.

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