In many developing countries, true life-and-death decisions hinge on information that’s old, unreliable or both.
Without strong national capacity for data collection, health officials are left in the dark when monitoring outbreaks of diseases like Ebola or trying to improve care for cancer patients. Many countries are unable to produce an accurate picture of their progress toward universal health coverage or even assess their starting point.
Meanwhile, the global health community has rallied behind ambitious sustainable development goals for the post-2015 era, an agenda that adopts new priorities like achieving UHC and addressing noncommunicable diseases alongside updated targets for the health-related Millennium Development Goals. Delivering on the SDGs for health foresees countries’ taking increased ownership over health priority-setting and program implementation.
Inadequate health information systems stand in the way. Transforming global health by 2030, as the SDGs intend to do, will require massive scale up in country capacity to collect timely, reliable data in a way that’s sustainable and aligned with global health priorities.
If a newly launched health data initiative can win political momentum, it could help countries currently lagging to leap ahead and develop systems that meet not just today’s standards but the demands of 2030: health for all, at all ages.
A new global call to action
The new Monitoring and Accountability for Health effort comes from the World Health Organization, World Bank Group and U.S. Agency for International Development, which this month co-hosted an international summit aimed at closing global health’s data gap.
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Building on the ambition to bring better health data systems to developing countries by 2030, partners proposed a 15-year plan to boost national systems for collecting health statistics, including improved tracking of births and deaths, better risk factor and disease surveillance, engagement of civil society, and more.
The organizers are hoping the SDGs can do for health data what the MDGs did not.
The MDGs are widely credited for having accelerated increased health investments and improved health outcomes. Global initiatives organized around specific disease priorities helped drive that progress.
Yet paradoxically, those initiatives’ focus on results — specifically, their own — often undermined country systems through “a fragmented approach and extensive reporting requirements not aligned with country systems,” according to agency officials.
This insight isn’t new: As far back as 2009, a high-level Lancet commission identified national data systems as a casualty of global health programs’ failure to harmonize and invest toward sustainable, country-led approaches. (Little improvement followed.)
Indeed, the story of health in the MDG era is one of dramatic improvements around specific priorities that failed to produce strong, resilient health systems.
For post-2015 priorities like UHC and NCDs, fragmentation will not suffice: Only strong, integrated health systems can deliver meaningful progress. They require accurate, accessible data on diverse health indicators and social determinants which can be disaggregated across many population groups to detect inequity. That is, they require next-generation health information systems.
‘21st century collaboration’
For the agencies behind the data push, reconciling health programs and data systems in a practical manner is only half the challenge. They also face a dilemma of how to supply leadership and momentum behind the initiative without appearing to impose their agenda on countries and other development partners.
World Bank health chief Tim Evans described the MA4Health approach as a “21st century collaboration” without an institutional owner or coordinator. This approach precludes agency-prescribed technical solutions; instead, strategies must develop through the collaboration, defining an implementation plan extending from funding sources all the way to the needs of end users, including those collecting and interpreting data at the community level.
The collective approach might also help protect the agencies from accusations of political overreach. The World Bank-led Global Financing Facility, which launches next month, has faced criticism for bypassing existing multilateral platforms. GFF, designed to drive cutting-edge investments in maternal and child health, appears less controversial for its programmatic strategies than for its reshuffling of global health power dynamics.
The health data initiative takes a less disruptive approach. If MA4Health’s 21st century collaboration can generate enough confidence and energy, even without a clear institutional owner, it could become an important case study for future initiatives in global development: broadly inclusive and directed at systems strengthening.
Diverse starting points
Not every low-income country needs a global initiative to advance health data — some countries are ready to inform it. Take Bangladesh, which, as recently as 2008, was one of the countries “in the dark” on health information. Lack of investment showed in its infrastructure — its health information department lacked Internet connection and even reliable electricity. Once collected, data took two months to reach decision-makers in the capital city of Dhaka.
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Since then, Bangladesh has pioneered the implementation of modern health information systems in low-income settings. Small investments, including some international support, have boosted capacity and vaulted Bangladesh ahead on electronic medical records, cloud-based storage, user-friendly portals for mobile data entry and analysis, transparent citizen feedback programs and other innovations. Timely, reliable data will facilitate Bangladesh’s UHC plans.
Those improvements took national leadership, commitment, and collaboration beyond the health sector. Following his country’s playbook, Bangladesh’s director of health information says, other low-income countries can achieve the same results in just two or three years. The story may inspire other governments, even those furthest behind, to buy into the global health data agenda.
Rallying behind better data
By 2030, all people should live in countries where better health is a comprehensive agenda. Health promotion and disease prevention must be hardwired into every health system, along with quality, affordable health services across the continuum of care, with accountability at every level.
Better health information is vital to that vision. Well-functioning health systems rely on well-informed contributions, from policymakers and health officials to citizens and community representatives. We’ve all got a stake.
So as we reach the doorstep of the SDG era, leadership for better data must come from every constituency, not just agencies and governments. Citizens, civil society, the private sector and academia should step up to move this long-overdue agenda. Broad collaboration should be more than a political strategy — it should be our political demand.