An inflection point for country health data
Authors: Kathleen Handley, Ties Boerma, Cesar Victora, Timothy Grant Evans
Journal: The Lancet Global Health (2015)

Accurate and timely data provide the foundation on which countries base better health, wellbeing, and prosperity in a modern, highly interconnected, and global economy. Access to reliable information increases transparency and allows governments to better understand the inherent challenges to improving health and the opportunities and strategies required to address them. Rapid increases in commitments and attention by the global community over the past decade to the improvement of health outcomes has added to the already existing demand for more and better data. The advent of the post-2015 agenda and enormous resources needed to measure the Sustainable Development Goals (SDGs) represent both an opportunity and a challenge. The challenge is particularly large for virtually all of the 81 low-income and lower-middle income countries, where investments and capacity in health information systems are still inadequate. Health is a central component of the SDGs: it is a goal in and of itself with 13 targets and is recognised as being affected by, a contributor to, and an outcome measure of many of the other economic, social, and environmental SDGs. This centrality, tied to high expectations for accelerated results and accountability in the next 15 years, places an unprecedented premium on robust and reliable information systems for health in every country. To be effective in the short-term and sustainable in the long-term, we must move beyond the legacy of disintegrated data collection to a collaborative model that ensures countries have the ability to generate, collect, and use their own data to monitor programmes and policies in the context of the post-2015 SDGs, and that development partners have the necessary information to support national efforts. The costs of not making such investments are likely to be enormous, as demonstrated by events such as the Ebola epidemic in west Africa, persistent inequality within countries, absence of an appropriate and timely response to the rapidly growing non-communicable diseases, and insufficient progress towards the Millennium Development Goals (MDGs) in many countries. Most countries have made tremendous progress in monitoring health during the MDG era, but significant gaps and inefficiencies remain. Major traditional sources of health data including household surveys, birth and death registration, censuses, health facility reporting, surveillance systems, and administrative data all suffer from a host of different issues resulting in gaps in information needed by countries and development partners.1Chan M Kazatchkine M Lob-Levyt J Meeting the demand for results and accountability: a call for action on health data from eight global health agencies.PLOS Med. 2010; 7: e1000223Crossref PubMed Scopus (155) Google Scholar Lack of robust statistical capacity in countries with limited resources is well documented and typically results from funding constraints, limited autonomy for national statistical offices, and limited data use and access.2Glassman A Ezeh A Delivering on a data revolution in sub-Saharan Africa. Centre for Global Development, Washinton, DC2014http://www.cgdev.org/publication/delivering-data-revolution-sub-saharan-africaGoogle Scholar Despite major investments in data collection, development partner agencies have often compounded these problems through a fragmented approach and extensive reporting requirements not aligned with country systems. Most agree that better coordination and collaboration between countries and development partners can lead to greater efficiency of investments, leading to improved data availability, quality, and use. A quality supply of data and the demand for it must grow in tandem. There are reasons to be optimistic. Development partners are picking up the pace in their calls for stronger statistical capacity in countries. As early as 2010, leaders from UN agencies and global health partnerships called for increased levels and efficiency of investments in health information, a common data architecture, strengthened performance monitoring and evaluation, and increased data access and use. Bilateral entities, including the US government—the largest global investor in health data—are now behind, and in some cases, leading these calls. We are now at a point where we can capitalise on the momentum that has been building over the past several years. We are reaching an inflection point for country health data fuelled by several ambitious commitments to measurement.3Foreit K Moreland S LaFond A Data demand and information use in the health sector: a conceptual framework. MEASURE Evaluation, Chapel Hill2006http://www.cpc.unc.edu/measure/publications/ms-06-16aGoogle Scholar Through the production of greater volumes of data and application of new technologies and analytics, the data revolution is moving from a patchwork of pilots to innovations that are transforming health information systems. For instance, handheld devices are used in bidirectional reporting as part of disease surveillance and routine reporting systems. Household surveys can collect biological and clinical data to better assess the levels and distribution of disease and risk factors in the population and to evaluate the effective coverage of interventions. Performance monitoring to improve the quality and effectiveness of services requires accurate real-time data, often complemented by regular implementation research.4Kim JY Farmer P Redefining global health-care delivery.Lancet. 2013; 382: 1060-1069Summary Full Text Full Text PDF PubMed Scopus (205) Google Scholar The demand for data as part of accountability, defined as transparent monitoring, inclusive review, and remedial action, is greater than ever before.5Commission on Information and Accountability for Women's and Children's HealthRecommendations.http://www.who.int/woman_child_accountability/about/coia/en/index5.htmlGoogle Scholar This confluence represents a major opportunity, but requires strategic and concerted actions on the part of countries, development partners, the private sector, and civil society to reach its full potential. This month, ministers of health and leaders from the global health community are gathering in Washington, DC, USA at the Measurement and Accountability for Results in Health Summit to endorse a new way forward for improved measurement and greater accountability for post-2015. A multiagency collaboration led by USAID, the World Bank, and WHO, with input from partner organisations, countries and civil society have produced this new way forward—a Roadmap for Health Measurement and Accountability,6USAIDWorld BankWHORoadmap for health measurement and accountability.http://ma4health.hsaccess.org/roadmapGoogle Scholar offering priorities and recommendations for development partners, technical experts, implementers, and decision makers for health measurement for the next 15 years (panel).PanelHealth measurement and accountability post 2015: a call to action1)Increase the level and efficiency of investments by governments and development partners to strengthen the country health information system in line with international standards and commitments2)Strengthen country institutional capacity to collect, compile, share, disaggregate, analyse, disseminate, and use data at all levels of the health system3)Ensure that countries have well functioning sources for generating population health data, including civil registration and vital statistics systems, censuses, and health surveys tailored to country needs, in line with international standards4)Maximise effective use of the data revolution, based on open standards, to improve health facility and community information systems including disease and risk surveillance and financial and health workforce accounts, empowering decision-makers at all levels with real-time access to information5)Promote country and global governance with citizens' and communities' participation for accountability through monitoring and regular inclusive transparent reviews of progress and performance at facility, subnational, national, regional, and global levels, linked to the health-related Sustainable Development Goals 1)Increase the level and efficiency of investments by governments and development partners to strengthen the country health information system in line with international standards and commitments2)Strengthen country institutional capacity to collect, compile, share, disaggregate, analyse, disseminate, and use data at all levels of the health system3)Ensure that countries have well functioning sources for generating population health data, including civil registration and vital statistics systems, censuses, and health surveys tailored to country needs, in line with international standards4)Maximise effective use of the data revolution, based on open standards, to improve health facility and community information systems including disease and risk surveillance and financial and health workforce accounts, empowering decision-makers at all levels with real-time access to information5)Promote country and global governance with citizens' and communities' participation for accountability through monitoring and regular inclusive transparent reviews of progress and performance at facility, subnational, national, regional, and global levels, linked to the health-related Sustainable Development Goals Accountability will be built into this process. Global partners are committed to regular tracking and reviewing of progress towards the Roadmap's goal of strong health information systems in countries by 2030. This will be linked to the assessment of progress towards the health SDGs as part of the overall SDG monitoring process. The SDG agenda is more ambitious than that of the MDGs, and, by necessity, our collaboration around measurement will need to be bigger, better, and bolder. Investments need to benefit countries—not just inform donor funding choices. Common goals and a common approach are needed. This moment, at the end of the MDGs, is the right time to shift away from the old paradigms of development partners dropping in, collecting data, and departing, leaving behind little capacity. Now is the time to support low-income and middle-income countries to unlock their potential and strengthen their capacities and systems so they can play a leading part in accelerating global health impact. We declare no competing interests.