Auditing the quality of epidemic decision-making in Somalia: a pilot evaluation.

OBJECTIVE: To assess decision-making quality through piloting an audit tool among decision-makers responding to the COVID-19 epidemic in Somalia. DESIGN AND SETTING: We utilised a mixed-methods programme evaluation design comprising quantitative and qualitative methods. Decision-makers in Somalia piloted the audit tool generating a scorecard for decision-making in epidemic response. They also participated in key informant interviews discussing their experience with the audit process and results. PARTICIPANTS: A total of 18 decision-makers from two humanitarian agencies responding to COVID-19 in Somalia were recruited to pilot the audit tool. OUTCOME MEASURES AND ANALYSIS: We used thematic analysis to assess the feasibility and perceived utility of the audit tool by intended users (decision-makers). We also calculated Fleiss' Kappa to assess inter-rater agreement in the audit scorecard. RESULTS: The audit highlighted areas of improvement in decision-making among both organisations including in the dimensions of accountability and transparency. Despite the audit occurring in a highly complex operating environment, decision-makers found the process to be feasible and of high utility. The flexibility of the audit approach allowed for organisations to adapt the audit to their needs. As a result, organisation reported a high level of acceptance of the findings. CONCLUSION: Strengthening decision-making processes is key to realising the objectives of epidemic response. This pilot evaluation contributes towards this goal by the testing what, to our knowledge, may be the first tool designed specifically to assess quality of decision-making processes in epidemic response. The tool has proven feasible and acceptable in assessing decision-making quality in an ongoing response and has potential applicability in assessing decision-making in broader humanitarian response.