VxData Insights

VxData Insights

Exploring why immunization workers underutilize data in their decision-making



Congo [DRC]


Immunisation is one of the most powerful and cost-effective ways to save lives and improve economic outlooks. Yet, despite significant headway, routine immunisation and new vaccine introductions still face strong challenges related to collecting and using quality data for planning, management, and performance improvement. Prioritising and adequately addressing these challenges is difficult without understanding the full context in which they occur.

To address this need, the VxData Insights study took a Human-Centred Design (HCD) approach to gather the perspectives and data-specific challenges of actors at all levels in the expanded immunisation programs (EPI) in three countries — Kenya, the DRC and Mozambique.

Project overview

VxData Insights was a three country research study funded by the Bill & Melinda Gates Foundation. A joint effort between Sonder Collective and John Snow Inc. (JSI), the aim was to understand challenges around using data for decision-making in delivering immunisation services. The work was conducted between December 2019-December 2021 and consisted of four phases -- Planning, Discovery, Field Research, and Synthesis.


Many challenges with data use are already well-known, but often poorly understood. Without knowing exactly why problems are happening, not just what they are, prioritising and designing successful interventions can be difficult. By engaging individuals who make up the system and taking time to understand their experiences, motivations, and daily struggles, we were able to examine these challenges anew from a user-biased perspective.

Our team conducted in-depth, qualitative field research in each of the three geographies. Our 150+ participants came from all levels of the health system and included decision-makers, data collectors and data users.

Interactive mapping activities asked participants to visualise current interactions and data flows, as well as tell specific stories to help us unpack system challenges and identify their root causes.

To help us unpack how actors interact with each other, what information is exchanged between them, as well as the circumstances for these interactions, the team used an actor mapping activity. Based on expert interviews and input from John Snow Inc. (JSI) experts on the ground, the team identified key immunisation system actors at the various levels. Actor cards were printed on colour sheets to help differentiate between the various levels (National- pink, County-blue, Sub County-green, Facility-yellow).
Study participants were asked to map out who they interact with as part of their immunisation work, what information is exchanged and to identify decision-makers within their network (marked as green dots).
Each actor map was different, reflecting the various roles as well as the unique participant perspectives. Rather than focusing on capturing a comprehensive map, this method puts emphasis on accurately reflecting the participants’ mental models.


Mapping of the current system

Based on input from participants as well as local subject-matter experts, a detailed system map was created for each country. Arrows indicate bottom-up reporting lines and significant interactions. This map provides clarity on intervention entry points that are often obscured when looking at a system broadly. For each system level, actors key to the collection and utilization of EPI data were identified. Each actor profile includes a set of unique challenges, types of decisions made, data and tools used, as well as interactions with other system actors.

8 Root Causes Framework

Through roughly 200 conversations with healthcare workers and managers from Community all the way up to National levels, we gained a deeper understanding of the factors that lower participants’ ABILITY and MOTIVATION to utilize data for decision-making. These factors have been synthesized into the 8 Root Causes Framework, pictured below.

This framework was generated based on contextual interviews with healthcare workers and managers at all levels of the system in Kenya, Mozambique, and the DRC. The 8 Root Causes — Access, Time, Tools & Protocols, Know-how, Working Conditions, Trust in Data, Agency, and Influence can be further organized around two factors — Low Ability and Low Motivation for data use.

Priority Areas for intervention

The 8 Root Causes framework was shared with stakeholders in each country during a series of co-creation workshops. Based on input during these workshops, the team identified 7 Priority Areas for intervention that cut across all three geographies. The Priority Areas are made of many root and subcauses, mirroring the complexity of challenges facing the system today.

The 7 priority areas for intervention with their relative level of urgency for each of the three countries. For more information, please visit the project website.
Project website


Global health

Our services

  • Design research

  • Co-creation

  • Workshop facilitation

  • Strategy

Partner organisations

  • Bill & Melinda Gates Foundation
  • John Snow Inc.
  • Ministries of Health in Kenya, Mozambique, and the DRC


Andrew Buhayar (BMGF)

Anne LaFond (JSI)

Natasha Kanagat (JSI)

Lora Shimp (JSI)

Wendy Prosser (JSI)
Kate Bagshaw (JSI)

Hannah Pick

Isaac Mugoya (JSI, Kenya)
Andre Tonda (JSI, DRC)
Betuel Sigauque (JSI, Mozambique)

Wendi Lowe

Raquel Carrilho

Valério Govo

Celestin Nsibu

Fanny Miska

Ania Klimiuk

Lauren Gilliss (JSI)


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