Demographic and Health Surveys reemerge with Gates funds after Trump cut

For four decades, governments and global health leaders have relied on a stable backbone of surveys that collected population-level health and demographic data to understand everything from child mortality to HIV prevalence. Then, almost overnight, it was cut off. Early last year, the Trump administration abruptly terminated a $236.8 million contract that was supposed to run from 2024 to 2029 with the American global technology company ICF for the Demographic and Health Surveys program, or DHS — abruptly halting over two dozen active surveys and, more broadly, the foundation behind one of the world’s most trusted health data sources. The cancellation was part of the Trump administration’s termination of over $76.5 billion — nearly half — of the U.S. Agency for International Development multiyear foreign assistance awards early last year. The move stunned the global community, which has long relied on DHS surveys to calculate over 30 indicators tied to the Sustainable Development Goals. In some countries, they’re the only nationally representative population survey and are embedded within government statistical systems, guiding planning and investments. “Over such a long period of providing high-quality, reliable data it became a brand that has such strong support for being as close to the truth as we can get with statistics,” said Madeleine Short Fabic, senior strategy and technical adviser with the global health and development team at ICF. In the aftermath of last year’s funding cuts, there were a lot of brainstorming sessions, working groups, and meetings among DHS supporters to strategize ways to keep the program afloat. Last July, the Gates Foundation committed $39 million for three years, becoming the program’s largest donor. Countries where surveys are conducted also contribute — including through bilateral agreements and loans. Other survey funders include the The Global Fund to Fight AIDS, Tuberculosis and Malaria, World Bank, UNICEF, United Nations Population Fund, and Foreign, Commonwealth & Development Office. But even with new funding, the ICF team said the DHS program must chart a longer-term path towards sustainability. They’re working with partners to move the program from a period of rapid adjustment to one of “intentional evolution” through efficiencies, technical innovation, and diversified funding models. The ICF team said through these changes they’ll work to retain what’s made these surveys a global good: Country ownership, data quality, reliability, transparency, and the ability to use standardized data to compare across countries and within countries over time. They’ll also look to increase the funding base, so the program never finds itself heavily reliant on one donor. Cost and time effective To make the surveys more cost effective and time efficient, ICF said they’re working to streamline their work with technology. That includes streamlining the program’s data processing systems that are highly specialized to the DHS surveys. Countries have expressed the desire for more technical assistance and increased visibility into these processes. ICF said they’re also looking for ways to make this area less driven by individual expertise and more automated so countries can adopt and adapt. Another area is report writing — including reducing timelines to making data available, as well as streamlining data visualization and making data increasingly accessible for broader swaths of the population by making it easier to understand. Preventing dependency Last year’s upheaval also made the ICF team recognize vulnerabilities. Chiefly, DHS's archives — which includes final reports, standardized files, methodology, and tools — were dependent on the U.S. “The U.S. government had been such a steadfast supporter for so long, and the repository had been stable for so long, that I think the idea of instability there was not very well surfaced before 2025,” Short Fabic said. ICF used its own resources to ensure the DHS archive remained operational. Now, they’re looking to increase the partners involved in preserving the DHS archive. “We don't want to be in a situation — as with last year — where there was real uncertainty about what will become of the DHS archive,” Short Fabic said. Leaner structure Now, the DHS program team is smaller partly due to the scale of the work right now, but also because of new efficiencies, said Leo Ryan, senior vice president for global health and development at ICF. The annual operating budget is also smaller. “We have been able to bring some people back, but not everybody for sure,” he said. One critical area they’ve paused is the five-year process of revising the program’s core questionnaire — an intense process, with global community input. When changes are made, they’re rolled out in every DHS survey. At the end of 2024, ICF was embarking on the program’s ninth iteration of revisions — but this was paused. “We recognize that for DHS to still have resonance and to have a future that we need to continue to evolve, including evolving to meet emerging and new data needs, which necessitates changes to the core questionnaire,” Short Fabic said. “But we're not in a position right now to begin that type of a process.” ‘We’re here’ When USAID funded the DHS contracts, the agency’s staff in missions around the world would have frequent conversations with ministries of health and national statistics offices. Under this set-up, a ministry of health would reach out to ICF, oftentimes through USAID or other development partners, to say it’s time to plan the next survey. Following the Trump administration’s dismantling of USAID last year, ICF doesn’t currently receive U.S. funding. Without USAID, the relationship changed. Though many countries now reach out directly to ICF and the program, others have gone quiet. Some countries may not know the program has stabilized. Given this, ICF said the program is taking a more proactive approach in reaching out to countries to inquire about their plans. The DHS program is also working to directly engage with countries on envisioning the program’s future. But the withdrawal of U.S. government support has also increased resource pressures on partner countries — some have mobilized funding, some are still doing so, and others have delayed survey timelines, according to ICF. Currently, the U.S. is amid a drastic shift in how it delivers development aid. The U.S. State Department is signing bilateral health agreements with countries. But it’s still unknown if DHS will be included in those. “At least one country has reached out to talk with us about possibilities. I think it's all happening quite quickly, but there's also still a lot of unknown in that space,” Short Fabic said. “We're trying to ensure that partner countries know that we're here and that we’re contributing.” She added that she finds it personally exciting to see these bilateral agreements include strong measurement components of the results around lives saved. In the coming months, some of ICF’s priorities include spreading the word that the DHS program is continuing; deepening engagements with partner countries and other funders to better understand emerging data needs and identifying how to address gaps; and clarifying what elements of the program are essential to preserve, and where there’s room for adaptation and innovation. The program has 16 ongoing surveys. “There has been a narrative in 2025 of: ‘What is the future without the DHS program?’ And I think we have this period of stability to really outline a future that matches with the needs,” Short Fabic said. “People want the DHS program in the future.”