Addressing the data deficits that hold back health care systems

By Nadi Nina Kaonga, Lauren Haynes 15 September 2016

Trócaire midwife and nurse Amran Khalif registers new mom Bishara Ali Kitnige in the beneficiary list at the Khalil hospital in Belet Xawa district, southern Somalia. Photo by: A.Gichigi / Trócaire / CC BY

This is an unprecedented time in the history of global development. We are generating more data than ever before thanks to new tools and technologies. Naturally, there is a push towards “data-driven development,” or development initiatives backed by a body of statistical evidence.

We have welcomed this emerging trend, especially through our work at HealthEnabled, where we help national governments integrate digital technology into their health systems. But at the same time we have also seen that in order for data to drive effective development at a practical level, data must exist, be accurate, accessible, and useful. Far too often, none of those requirements are met.

In particular, there are notorious deficits in civil registration and vital statistics data around the world, especially in low- and middle-income countries. A well-functioning CRVS system is an essential part of a country’s health care system; it tracks and disseminates records of births and deaths, as well as vital statistics, such as cause of death information. The lack of reliable CRVS data poses a major challenge to one of the most basic needs of functional health and social welfare systems: counting their beneficiaries.

Incomplete and inaccurate data pose significant challenges

At every stage of life — but especially the beginning and end stages — vital events are woefully under-registered. For example, on the African continent, less than half of births are properly registered, and, globally, only about one-third of all deaths are recorded. Further, fewer than 100 countries record cause of death using the World Health Organization’s International Classification of Disease system.

These data deficits adversely affect development goals by making it nearly impossible to accurately track progress on health outcomes. They also make it challenging for local governments to keep track of the size of their populations, allocate resources, and appropriately plan programs and services.

Moreover, this lack of data has significantly detrimental effects on the lives of individual citizens, impeding their ability to exercise rights or benefit from social programs such as financial or food assistance, education, and housing. For example, an unregistered citizen might not be able to attend primary school, enroll in university, inherit property from deceased parents, or be eligible for national insurance programs without a birth certificate to prove identity, age and nationality.

PPPs’ innovative solutions to the data deficit

Obtaining data that are more complete and accurate has become an international priority, and a variety of global actors have stepped up to help close the data deficit. In fact, one of the 2020 targets for Sustainable Development Goal 17 on global partnerships, is to significantly increase the availability of high-quality, timely, reliable and disaggregated data, particularly for developing countries and small island nations.

In pursuit of this SDG target, the WHO, funding partners, and local governments have engaged in specific initiatives to improve CRVS data. Most notably, these groups have leveraged information and communication technology. Specifically, in 2008, they funded a set of projects called the Monitoring of Vital Events using Information Technology initiative.

According to the 2013 progress report on MOVE-IT, country projects that were part of the initiative were able to accelerate collection, use, and dissemination of data; advocate for political and/or institutional support; and/or bolster pre-existing, in-country efforts to improve CRVS. In so doing, programs also often reduced specific gaps known to contribute to data deficits — which are primarily the result of specific gaps in data, access, governance, and usability.

Here are three examples:

The MOVE-IT project in the Philippines reduced a data gap by raising awareness among the beneficiaries, who were members of the community, about the importance of CRVS. This increased awareness helped improve coverage and support linkages between existing data systems to improve CRVS data quality.

In Bangladesh the same project reduced a governance gap by developing minimum data set standards, and reduced a vital data gap by taking advantage of free and open-source technology and streamlining data collection processes. This country project also had a unique organizational structure — a local university played a primary role in the project and was responsible for training community health workers to facilitate mobile data collection.

And in Thailand it reduced a usability gap and improved cause of death analysis by creating linkages between existing vital registration and mortality data. These steps allowed the country project to more accurately quantify the population burden of HIV and assess the effectiveness of national HIV prevention and treatment efforts.

Challenges to attaining complete, accurate, and useful data persist, but the global development community can further reduce data deficits by continuing to follow these five lessons:

• Raise awareness about the critical role that complete and accurate CRVS data play in the daily lives of individuals around the globe.

• Prioritize CRVS data quality in global development by consistently making meaningful commitments — political, financial, and human — to improving CRVS.

• Evaluate the appropriateness and sustainability of technology-based data collection methods.
• Consider data utility, timeliness of information, and eventual reporting demands, early in the design phase when developing data collection programs.

• Whenever possible and appropriate, leverage and link to existing records and systems to ensure that new technological initiatives contribute to comprehensive civil registration rather than produce more siloed data

In short, funders, implementers, and policymakers must continue to build on the legacy of initiatives such as the MOVE-IT campaign and work together to ensure that every single one of us is counted.

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About the authors

Oped nadikaonga ed
Nadi Nina Kaonga

Nadi Nina Kaonga, MHS MS, is currently serving as the interim deputy director for HealthEnabled. She has nearly a decade of experience in global health and has worked with organizations, including Columbia University, the United Nations Foundation, UNICEF and Merck for Mothers, on digital health strategies and implementations; she teaches for the Harvard Summer Program and is also completing her doctoral (MD) studies in clinical medicine. She enjoys working in her home country of Malawi and has extensive working experience in other countries throughout the African continent.


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Lauren Haynes

Lauren A. Haynes independently collaborated with HealthEnabled for this article. She has previously worked with The Global Fund and NYC Health + Hospitals and holds MPH and BS degrees from Columbia University. Lauren is based in New York City and typically writes about structural factors affecting social justice and health equity.


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