Background

Canada's Evidence-Driven Global Response

As Canadian organizations respond to the impacts of COVID-19 around the world, they are reporting a crisis within a crisis. Alongside the virus, fragile health systems, incomplete data and untrustworthy information threaten to reverse critical gains made in global health and rights and the most vulnerable have become further isolated. How will we respond? How can we do better? Here's what they told us.

As Canadian organizations respond to the impacts of COVID-19 around the world, they are reporting a crisis within a crisis. Alongside the virus, fragile health systems, incomplete data and untrustworthy information threaten to reverse critical gains made in global health and rights and the most vulnerable have become further isolated. How will we respond? How can we do better? Here's what they told us.


100 Days of a Pandemic: The Full Report

Between March and June 2020, more than 100 organizations shared their reflections on the impacts that COVID-19 has had on their work and operations, as well as recommendations on the role of data in addressing global health crises and challenges. Read the full report here.


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This report was published in partnership with Global Affairs Canada.

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BEFORE COVID-19

Prior to the onset of the pandemic, Canadian organizations and their global partners routinely navigated complex data-related challenges. As they began to design responses to COVID-19, organizations have drawn on past experiences with diverse global health crises.

December 31, 2019

Wuhan Municipal Health Commission reports cluster of pneumonia cases in Wuhan, Hubei Province. Novel coronavirus eventually identified.

Pre-COVID-19

Persistent data-related challenges in global health sector:
  1. Inconsistent or limited quality health information systems at all levels (country, region, local).
  2. Limited organizational capacity to understand and interpret data.
  3. Persistent data gaps concerning vulnerable groups (particularly gender data gaps).
  4. Government resistance to publishing data.
  5. Limited interest and funding for data, evaluation and implementation research.

January 10, 2020

WHO issues comprehensive technical guidance online with advice to countries on how to detect, test and manage potential cases based on available knowledge.

Lessons Learned

  1. Past responses we are learning from: Ebola, Zika, HIV.
    • “We need to amplify the hard-fought lessons learned.”
  2. What needs to be avoided:
    • Diverting resources (staff, equipment).
    • Rise of misinformation: reductive messaging and misleading information to justify (in)action.
    • Radicalization, clampdowns on civil society space and scapegoating/discrimination that “drives vulnerable communities underground” and away from health services.
  3. What should be repeated:
    • Prioritizing “meaningful and inclusive engagement for those at greatest risk”.
    • Don’t stop collecting data, even though there may be weaknesses or challenges with collection. Reduce the burden instead.
    • Invest in strengthening the basic scientific capacity and data literacy of stakeholders and communities.

January 30, 2020

WHO Director-General declares novel coronavirus outbreak
(2019-nCoV) a Public Health Emergency of International Concern.

February 11, 2020

Government of Canada provides $2 million to WHO to help vulnerable countries prepare and respond to COVID-19.

RESPONDING
TO COVID-19

During the first 100 days of the pandemic, there has been significant diversity in how Canadian organizations are affected by, and have responded to, the COVID-19 pandemic. Reactions were influenced by factors such as primary sources of funding, status of major project life-cycles, size of organization and human resources and the primary country of operations. Many of the data challenges faced pre-COVID-19 have been either exacerbated or have remained consistent, while others have changed radically. In some cases, data issues are no longer as relevant as they once were. The following section highlights the most common responses and observations on how staff and organizations have been affected.

March 11, 2020

WHO officially characterizes COVID-19 as a pandemic Government of Canada provides $50 million to support the efforts of international assistance partners to prevent and respond to COVID-19.

New Context

  1. Domino effect: Similar to other disasters, COVID-19 brings rising poverty and sexual and gender-based violence (SGBV) rates, food insecurity, increased transmission of other infectious diseases (such as measles), public health security challenges and governance issues in-country.
  2. No travel: COVID-19’s impact on the ability to move freely, travel and gather together raises questions about data validity, access to information and the ‘downloading’ of risk onto local partners and consultants. Several organizations have implemented travel moratoriums until December 2020, or June 2021.
  3. Differing views of risk/response: Countries and global partners hold diverse understandings of risk and best practice. Coordinating consistent responses and communicating priorities is a significant challenge.
  4. “Health systems are failing”: It is hard to plan a response when the entire infrastructure is weak. Organizations are facing supply chain and hoarding issues, alongside unreliable or unavailable health information systems.
  5. “We still haven’t figured out the gender issue”: Country/regional response plans and international templates have been criticized for being gender-blind. At the same time, organizations are not always adequately trained to use available gender data.
  6. Renewed interest in flexible, evidence-based approaches: Organizations are closely monitoring changes in research and program priorities that could impact existing work.
  7. Increased domestic engagement: Some Canadian organizations found themselves increasing their overall portfolio of work in Canada in response to COVID-19, or re-orienting their domestic work to have a COVID-19 focus.
  8. Changing relationships with funders: Overall, organizations appear to have had positive encounters with current donors and funders, many demonstrating “unprecedented flexibility”. Those currently receiving funding from the Government of Canada specifically and consistently acknowledged its transparency and accessibility, citing the following examples as helpful practice:
    • Regular virtual consultations with Minister and senior staff on a variety of platforms and topics.
    • Accessibility of desk officers and staff to answer questions directly as well as through consultation.
    • Recognition of internal delays alongside clear guidance that organizations should use their best judgment in the absence of directives.
    • Posting FAQs online.
    • Flexibility concerning activities, budget, salaries and operational concerns.

Click here for a ‘By the Numbers’ breakdown of what we heard

March 13, 2020

WHO, the United Nations Foundations and partners launch the Solidarity Response Fund to support countries with weak health systems to respond to the pandemic.

In Action

Top 3 Cited Areas of Response Programming:
  1. Water, sanitation and hygiene promotion (particular focus on communication and messaging on infection prevention).
  2. Strengthening health systems and health worker training (including personal protective equipment (PPE) distribution and building local surge capacity).
  3. Maternal, newborn and child health.
Common Areas of Response Programming:
  1. Food security and nutrition assistance.
  2. Economic support (including alternative Income).
  3. Sexual and gender-based violence programs.
Other Activities:
  1. Education support.
  2. Mental health and psychosocial support.
  3. Health infrastructure and innovation support (including remote and telemedicine).
  4. Addressing opportunistic infections for immunocompromised communities.
  5. Information, advocacy and scientific data campaigns.

March 24 – April 17, 2020

CanWaCH convenes four online dialogues to share information and resources related to the impacts of COVID-19 on partner efforts:
  1. Committed to Deliver: Global Health Programming and Operations amid COVID-19′. Forty-five organizations attend.
  2. Partnership for Strengthening Maternal, Newborn and Child Health (PSMNCH) Partners Discussion on Evaluation Approaches. Thirty-two organizations attend.
  3. Small and Medium-sized Organizations Exchange: Lessons Learned. Thirty-five organizations attend.
  4. 2020 Virtual Meeting of the Call to Action Canada-Haiti Health Network. Forty representatives attend.

Data Strategies

Respondents highlighted that COVID-19 has required them to adapt remote strategies to account for pandemic-related challenges, and/or adopt remote practices which may be new or unfamiliar. Organizations are operating in a ‘Plan B’ context: “We’re trying to figure out what’s the next best thing we can do, because the best approach isn’t an option.”

Respondents nearing the end of a project typically fell into one of several categories:

  1. Endline data collection already completed – endline evaluations possible.
  2. No endline data collected but have robust monitoring practices or midline data – endline evaluation modified.
  3. No endline data collected and have limited monitoring data and/or midline data – endline evaluation severely impacted/unfeasible.

Many organizations noted that their future evaluation practices will place greater emphasis on ongoing monitoring data collection in order to avoid similar reliance on endline data assessments.

Common Data Adaptation Strategies

  1. Reducing Sample Size:
    • Adopting mixed remote methods (phone, text messaging, digital surveys) to increase response numbers and triangulate findings.
    • Planning to use snowball sampling and social network analysis strategies.
    • Increasing reliance on key informant and expert interviews.
    • Increasing emphasis on meaningful incentives for participation.
  2. Upskilling and task redistribution to local staff with more mobility:
    • Having drivers undertake data collection, transcription and photography.
    • Strengthening documentation skills among all staff.
    • Asking local staff to scan or photograph paper records for remote review.
  3. Adjusting Protocols to align with safety standards:
    • Conducting in-person interviews, with enumerator and respondent remaining two metres apart.
    • Shifting to phone calls or text messaging for communication and data collection.
  4. Resourcing virtual data collection & remote visualization:
    • Zoom focus groups and interviews.
    • Zoom/Skype walkthroughs and site-visits.
    • Consulting satellite or drone imagery to monitor changes or challenges.
    • Purchasing smart phones and training for all data collectors.
    • Installing small computers for remote data collection.
    • Social media engagement including social media and social network analysis.

April 5, 2020

Canada has now allocated $159.5 million towards international efforts to fight COVID-19, with a focus on medical supplies and service, water, sanitation and hygiene services, public information on risk mitigation and strengthening local capacity.

What’s exacerbated?

  1. Increased difficulty collecting and managing data:
    • The alternative methods that organizations are adopting are more labour-intensive and time-consuming. This [burden] is becoming more pronounced as the solutions we used as work-arounds don’t hold anymore.”
    • Organizations are creating COVID-19-specific task forces and are spending significant resources to develop new checklists and protocols.
    • Respondents expressed concerns over their ability to sustain relationships with communities, particularly the most vulnerable.
    • “We are not taking a break when it comes to evaluation” but we may “narrow the scope (of our evaluation activities)”.
  2. Increase reliance on secondary data:
    • For the foreseeable future, primary data collection will be limited or cancelled. As such, organizations may need to rely on national health data systems. However, secondary data is often outdated, includes rough estimates and is not applicable to the community/geography of interest. There is little data on the COVID-19 caseload specifically, making it difficult to program.
    • Staff, and donors, lack a robust understanding of the opportunities and challenges of using secondary data.
  3. Decreased accessibility of reliable data:
    • Organizations have typically leveraged primary data to ensure a gender and rights-based lens is included in their work, as well as to supplement weak or unreliable data.
    • Access challenges are increased: paper records are stored in closed clinics, capacity of staff is limited, health workers are overstretched and communities may be less willing to participate in surveys or interviews.
    • Where staff do not have access to technology or do not understand how to enter data properly, this leads to inconsistent or low quality data.

May 4, 2020

In total, the Government of Canada has $850 million in investments to support the $8 billion goal from the Coronavirus Global Response that supports researchers and innovators.

What’s irrelevant?

  1. Many Research Projects
    • Organizations with research agendas or programs have cancelled many planned studies, particularly anything involving a mixed method data collection process. Many of these will not be restarted. Accordingly, academic institutions anticipate significant impacts on students and emerging graduates.
  2. ‘Just in case’ Data Collection
    • The COVID-19 crisis has highlighted how much collected data was ultimately not being used, despite plans for its use at the outset of project activities. Streamlining chosen indicators is imperative. To achieve this realistically, funders will need to require significantly fewer indicators and be more flexible in how they measure impact.
  3. Original Baseline, Endline and PIP Processes
    • Many baseline and endline assessments, as well as project implementation plans (PIPs), have been postponed indefinitely. Organizations are seeking guidance on timelines and are considering strategies for how to work together to fill data gaps through shared data and assessments. They are also concerned about how they can realistically deliver the programs that they proposed in this new context.
    • “Our focus on the long-term is postponed.” “Right now, it’s a matter of retaining gains and we’re focused on not losing ground (in terms of the progress we’ve made).”
  4. Exclusively Foreign Expert Evaluation
    • “We will need to rely on the intuition of local staff” to collect, interpret and respond to the data collected – and this is a good thing.
    • “We have limited control on our evaluations now.” COVID-19 has exposed a heavy reliance on external evaluation experts. Several organizations noted the need to prioritize the leadership of in-country experts and communities in regards to monitoring and evaluation (M&E).

May 6, 2020

A joint statement is released on the behalf of governments and peoples of 59 countries, including Canada, regarding the protection of sexual and reproductive health and gender-responsiveness during the COVID-19 crisis.

What’s consistent?

  1. CSOs have a role to play in strengthening country data capacity
    • Canadian civil society organizations (CSOs) have been sharing the tools they have developed on women’s needs and gaps in service: “We anticipate that these are still relevant, if not more so, in the current context and are sharing them with regional and local governments.”
    • The international development sector’s role in providing external validation of data, particularly concerning vulnerable or marginalized communities, is valued. There is a role for CSOs in enhancing government decision-making with evidence-based recommendations.
  2. Good data, M&E, and health information systems are needed before a crisis
    • Multiple organizations affirmed that the international development sector cannot and should not wait until a crisis arrives to invest in health information systems. Moreover, we cannot become complacent in the absence of a crisis. Respondents noted that a crisis is not the moment to make change: countries with robust systems continue to quality data and previously weak systems are now failing.
  3. COVID-19 is not the only crisis
    • We cannot forget about ongoing crises that COVID-19 has either exacerbated or that are emerging now as related consequences. Our response requires us to be more nuanced about the impacts of COVID-19, not just the disease itself. For instance, we need to account for the effects of social distancing in countries with no social safety nets, or where other infectious diseases and outbreaks are more prevalent and threatening.
    • “There’s the pandemic of [COVID-19], but also the pandemics that are killing us now.”
    • “We need to ask ourselves: what kind of data informs a harm reduction approach? We need to ask not just ‘why did people die?’ but ‘what could have prevented it?’. We need our data processes to move towards this approach.”

May 18, 2020

Canada’s Minister of International Development, Minister Gould, announced that Canada is providing $306 million in response to the annual humanitarian appeals to support their 2020 operations around the world.

What’s emerging?

  1. Reaffirming the commitment to ‘Do No Harm’
    • Partners reaffirmed that we must approach with a commitment to ‘do-no harm’.
    • “In an effort to be creative, we have uncovered ethical questions we didn’t expect.” Significant capacity and knowledge gaps were identified in regard to data privacy, ethics, confidentiality and security of staff and communities.
  2. Increased comfort with ambiguity sector-wide
    • Organizations are seeking clarity from funders on what they are now still required to track against contractually obligated targets set pre-COVID-19. Given that much of this will be no longer possible to collect, respondents noted that we need to get comfortable with approximates and triangulation, as well as with leveraging multiple sources of data, and recognizing that it will be difficult to maintain methodological consistency in our evaluations.
    • “We need a greater tolerance for ambiguity.”
  3. Upskilling in technology and digital approaches
    • Respondents discussed the challenges, limitations and opportunities afforded by technology and social media. Other respondents observed that community trust in technology is varied across contexts. Technology can further marginalize, be inaccessible and/or deepen data gaps on isolated communities. New and improved platforms, supplemented by user training, is essential.
  4. Improved understanding of risk
    • Partners highlighted the need for support in modifying current risk registers to address high impact potential risks such as pandemics. Within fragile contexts or humanitarian crises, there is a need to track how COVID-19 has interacted with and influenced communities using indicators relating to fragility and violence.
  5. Communicating differently
    • Dissemination and knowledge mobilization activities will need to be reimagined. Organizations discussed having to move to electronic delivery of findings, recognizing that this might not yield rich discussion and result in potentially lower uptake of results.
    • In-person connection is important for generating trust and may be new for in-country colleagues. We will need to prioritize stronger relationships with local governments and ministries of health.”

June 19, 2020

CanWaCH releases its 100 Days of the Pandemic Report, summarizing how Canadian organizations and their partners are navigating data and information-related challenges during the COVID-19 pandemic.

Looking Forward

Canadian organizations are united in their uncertainty about what the next 100 days and beyond will bring, and what the impacts and legacy of COVID-19 will have on the health and rights of the most vulnerable. However, they are also united in their agreement that our sector must think creatively, and take concrete actions, to prevent losses and protect hardfought gains. The most common data-related priorities, persistent obstacles, lingering questions and future recommendations are summarized here.

Priorities


  1. Build the expertise we need: Responding effectively to the legacy of COVID-19 will mean that development professionals are trained in the technologies and methodologies that are in demand. This will also mean prioritizing local expertise and building robust rosters of local expertise.
  2. Maintain Canada’s focus on sexual and reproductive health and rights, gender equality and health systems strengthening: Organizations were emphatic that the Canadian commitment to the health and rights of women and children, particularly sexual and reproductive health and rights and gender equality, must be sustained. The risk of losing gains made to date is high. Scaling up investments in health information systems, as well as national and local survey quality, will also be essential for future resilience.
  3. Strengthen monitoring and evaluation + research + technological partnerships: Consortiums, shared data, joint assessments and surveillance – partners are eager to explore collaborative partnerships and non-competitive programming/funding models and want to see these supported. CSO timelines, academic priorities, local partner leadership and private sector limitations can conflict – investment and a push for new thinking is required.

Obstacles


  1. New strategies require flexibility and funding: COVID-19 has highlighted a need for nimble responses but this is only possible if donors change their requirements to allow for agility in programming and reporting, more adaptive approaches, more direct support for local actors and if they fund infrastructure, personnel and capacity-strengthening. We must make the best decisions we can with the information we have now and re-evaluate as new evidence emerges.
  2. We risk regression to outcome-only measures: We must ensure that health outcomes are happening (and measured) alongside empowerment and rights-based approaches and avoid sliding back on progress made towards critical SDG targets. “Opportunities cut both ways… [crises are] an opportunity to innovate, but also an opportunity to regress.” We must compare like-with-like and remember that robust primary data collection is essential to understanding diverse communities.
  3. The lasting COVID-19 legacy: While there will be ‘the other side’ of this pandemic, COVID-19 has already irrevocably influenced health seeking behaviours, community perceptions and more. While we pursue solutions and vaccines, we must ensure that our research and evaluation approaches reflect the broad range of community needs and concerns.

Questions


  1. Can we harness the innovation mindset when it comes to data? Crises have “revolutionary potential” in that they sometimes force us to innovate.” However, to be most effective we must fund innovative thinking in data continuously, not just during a pandemic. “We need to be better at digital innovation and digital integration.”
  2. How can we do more with less (data)? As we interrogate ideas around what constitutes ‘rigour’ and when data can be ‘good enough’ for decision-making, organizations are seeking best practices for re-coding existing data and mapping on previous evidence or secondary data for baseline and endline assessments. Factor analysis approaches should be explored.
  3. How can our money and management models fit the new reality? PMFs are often burdensome – clarity and consensus is needed on whether they are meant to tell impact stories and demonstrate accountability for funders or inform decision-making and program quality. “We desperately need to rethink the goal of aggregation” and why we are collecting aggregate data in the first place.”

Recommendations


  1. Technical (Digital) Guidance and Data Literacy. Modelling, qualitative data analysis, digital focus groups, social media analysis, data visualization, digital communication, secondary data management, feminist analysis, data sharing/open data and online learning/training platforms were identified as priority areas. Alongside this, we must consider: What is the role of data in combating misinformation? We must increase our own scientific and data literacy skills so that we can better support our partners.
  2. Tell Purposeful Stories. More than ever, qualitative data is essential to understanding the crisis and its effects and yet our sector still struggles with how to collect and use this type of data. Our monitoring structures must be strengthened to better allow for the inclusion of qualitative data. This will further help us in using data for advocacy and to mobilize stakeholders to affect timely, meaningful change.
  3. Do Data Ethically. Long delays in accessing information and persistent data gaps must be addressed. As we aim to be responsive and timely, we cannot do so at the expense of community safety and rights. COVID-19 has highlighted a need for contemporary data ethics training, including data confidentiality, ethical management and dissemination of data, community engagement and data privacy. These considerations are new for many organizations and robust guidance is needed.

Resources

View the full list of resources relating to COVID-19 shared by Canadian partners.

View All COVID-19 Resources

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Special Thanks to Our Contributors

We are grateful to the multiple staff members from 102 contributing organizations for their data and reflections. Click below to learn more about these organizations and their impactful work.

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