When Australia’s Foreign Minister Julie Bishop announced a $15 million contribution to Bloomberg Philanthropies’ Data for Health initiative in March 2015, the program became a key way for Australia to improve outcomes of its overseas health aid.
Two years since its launch, Data for Health is showing its worth, allowing the Department of Foreign Affairs and Trade and other partners such as the CDC Foundation and Johns Hopkins University to work with governments in developing countries on evidence-based health policies. For the first time, programs covering everything from infant mortality rates to traffic deaths can draw from a robust body of data. And the early results are impressing stakeholders.
“The initiative partners with developing countries to: strengthen their data; build their capacity to analyze and assess the quality of data collected; and improve their ability to interpret, analyze, translate and use the data,” Kathryn Elliott, director of the health program and performance section with DFAT, told Devex. “In this way, countries manage their own essential public health data collection and use it to inform program and policy decisions.”
Births, deaths and health risks are the focus of the improved data collection processes, and nearing the second anniversary of the Data for Health launch, Devex spoke with DFAT and partner organization Vital Strategies for an update on progress that has been made.
Filling in the data gaps
Data relating to births and deaths is a fundamental black spot in public health knowledge for developing countries. Dr. Philip Setel, director of civil registration and vital statistics work with Vital Strategies, called pre-existing data “sub-optimal or missing.”
“Countries have been lagging in the completeness of their birth registration coverage while for deaths the gap is even larger in terms of registering the death,” he said. “What was missing from the cause of death data, for those recorded, was a high-quality international standard definition of death. In communities, there was virtually no information about people who were dying, particularly the causes.”
Bloomberg Philanthropies is working to fill a void in cause of death data, so countries can better target resources and treatment for the health problems their citizens experience. We spoke to Kelly Henning, head of public health at the foundation, to learn more.
For Australia, the program not only aims to fill a gap in health knowledge within developing countries but specifically in the Indo-Pacific. The investment ensured Australian aid priority countries — including Bangladesh, India, Indonesia, Myanmar, the Philippines, Papua New Guinea, the Solomon Islands and Sri Lanka — were part of the 20 developing countries included in the initiative. In addition to Asia, the initiative also covers countries in Africa and Latin America.
Elliott explained accurate data on causes of death was essential to improved decision-making on public health priorities.
“In many countries, there are more deaths occurring outside of the hospital than in hospital,” she said. “Yet countries often lack the tools and techniques to accurately assign a cause of death under these circumstances. This represents a significant gap in public health data and it is an area that Data for Health is having a positive impact.” Through the support of the program, the governments of Myanmar and Rwanda are collecting data on out-of-hospital deaths for the first time and preparations are underway to do the same in the Philippines, Morocco and Tanzania.
A range of resources are being used to increase data availability, according to Setel, which he sees as important progress for the program. “In the Philippines we are helping township level medical officers greatly improve the quality of their death certification,” he said. “And in Myanmar we are enlisting the help of community midwives and female health workers to do a better job of notifying about births and deaths.”
Burden of noncommunicable diseases and impact of road traffic accidents are some of the policy-related questions developing countries can ask of their improved data, according to Setel.
At the other end of life, improved birth registration processes aim to help governments accurately assess population growth and plan for services, as well as improve opportunities for children. “If a baby’s birth is not registered, they do not receive a birth certificate,” Elliott said. “This has lasting impacts on their access to services and ability to participate in society.”
Sustainable systems are the goal of the Data for Health initiative with new technology, systems, processes and policies capturing not only new but quality health data. Local health workers are being trained to be at the center of collection processes, and policymakers are being trained on consuming data to develop policies.
It is estimated that the new birth and death certificate system will benefit an additional 250 million people.
The project’s first two years have seen great leaps in the region, according to Elliott. “Not yet two years into implementation, the Data for Health Initiative has made significant progress,” she said, with the Indo-Pacific noted as a success.
“There have been a number of early wins in the Indo-Pacific region,” Elliott said. “For example, five countries — Bangladesh, Myanmar, Philippines, Solomon Islands and Sri Lanka — have adapted their death certificates to the international standard.” And this enables causes of death to be better understood through consistent definitions and certification, enabling country comparisons and targeted health service delivery.
Additional successes have been shown in filling gaps of knowledge from remote locations through supporting countries to implement verbal autopsy, an innovative approach that allows data to be collected and cause of death to be assigned even away from a hospital or medical service provider. “Myanmar, Philippines, Solomon Islands and Sri Lanka have all made significant progress towards implementing verbal autopsy, which will greatly improve the availability and quality of cause of death data for deaths that occur outside of the hospital setting,” Elliott said.
And trials are beginning on the use of mobile technology to improve the speed of capturing data on risk factors for noncommunicable diseases, including tobacco use, exercise and obesity. “As countries institutionalize these efforts, for example on causes of death or noncommunicable disease risk factors, they can start to look for changes in disease burden over time,” Elliott said.
Overall, Elliott said progress has been steady. “It has been important for the Data for Health team to allow sufficient time to gain the necessary government approvals and secure important buy-in from key stakeholders.”
Who will benefit from the data?
Data for Health supports global experts in working closely with local partners within developing countries, including data producers and users, to improve their ability to interpret, translate, disseminate and use improved data to inform program and policy decisions.
And policymakers are one of the key beneficiaries of the Data for Health initiative. “Policymakers often have to make decisions quickly and must be able to process information rapidly,” Elliott explained. “The way in which data is presented will affect their understanding of the problems highlighted and, by extension, their commitment to addressing them.”
Of course all populations in the 20 developing countries included in the program will see improved health services and quality of life, and each country governments will determine how data can be used for other research. “Data is owned and driven by the countries,” Setel said. “It is up to national policy to decide how much data to release, to whom and under what circumstances.”
Challenges still to overcome
Even with the achievements that have been made through the Data for Health initiative, Elliott explained there are a range of barriers the program will face in the coming years to achieve systematic changes in the collection and use of health data. “Institutionalizing change is never easy, and it has been important for Data for Health to take time to secure appropriate buy-in from often multiple ministries and key stakeholders,” she said. "Without this buy-in from countries themselves, the initiative will not be sustainable.”
And there are also obstacles to overcome to safeguard the usability and usefulness of systems and strategies implemented under the Data for Health initiative. “In many low- and middle-income countries in the Indo-Pacific, barriers to the use of data abound,” Elliott said. “Insufficient attention is given to training data collators in how to interpret the data, present information, and ensure that data reach the target audiences in a timely way. Overcoming these barriers contributes to a sustained mechanism for supporting evidence-based decision-making.”
Data for Health is a four-year initiative operating until March 2019. Plans beyond the four years are not set in stone, but hopes are high for success. “DFAT prioritizes investments that work to strengthen the health systems of partner governments,” Elliott said. “Reliable, quality data is a key component of a strong and functional health system, and we look forward to seeing the significant benefits that improved data will bring to the Indo-Pacific.”
For Setel, adoption of tools, techniques or ideas beyond the participating countries would demonstrate wider success of the Data for Health initiative. “This is very much our theory of diffusion,” Setel said. “Countries that begin to demonstrate the ability to produce annual statistics reports and are able to make confident public statements and policy based on evidence from their own population get noticed regionally. If one country is inspired to seek new systems and strategies for data from their neighbors, we would be happy.”
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