Strengthening health systems by measuring what really matters

On the sidelines of the 78th World Health Assembly, a high-level Devex ecosystem event brought together representatives from Amgen, City Cancer Challenge, the Duke Global Health Innovation Center, and Ghana’s Ministry of Health to discuss the future of monitoring and evaluation, or M&E, in health care.

With noncommunicable diseases now surpassing infectious diseases as the leading cause of death globally and persistent access gaps widening, the event emphasized the urgent need to rethink traditional health metrics. The focus, speakers urged, must shift from measuring quantity of care to quality of care — in other words, from measuring how much care is delivered to understanding its impact — so that health systems can clearly identify what is and isn’t working.

The session, hosted by Devex in partnership with biotechnology company Amgen, sought to unpack the need for new metrics, locally driven and real-time data, person-centered approaches, and strengthened partnerships for systemwide improvements, particularly in low- and middle-income countries. Here are the key takeaways from the event.

1. Rethinking global health metrics

Speakers emphasized that what gets counted isn’t always what counts. “We’re here to change people’s lives, and counts don’t change people’s lives,” said Sean Lybrand, executive director of access to health care at Amgen.

While counts help measure whether activities are being implemented, they’re not telling us what change has actually occurred, emphasized Elina Urli Hodges, assistant director of programs at the Duke Global Health Innovation Center. A tally of 10,000 people screened for diabetes means little without knowing what happens to them next, she noted. “Are they being referred to care? Are they being treated? We don't get that from just looking at [screening] counts.” Metrics need to evolve to reflect not just what gets done, speakers urged, but whether lives are improved. As global health leaders look to the future, many are rethinking what “measurement” really means and who it should serve.

“We settle on outcomes, numbers, budgets … But if care is not taken, you may settle on the numbers as your end goal and lose sight of what you want to achieve,” said Dr. Philip Anderson, strategy director of access to health care at Amgen.

2. Providing real-time, locally driven data to decision-makers — not just donors

Who collects, owns, and acts on data is as important as the data itself. “We capture all this data [and] we send it off in some report never to be seen again,” said Dr. Krishna Udayakumar, director of the Duke Global Health Innovation Center.

Many global health M&E systems are still structured primarily for donor reporting — the main audience for M&E outputs is often donors, rather than the communities served or the teams delivering care. This donor-first approach can have unintended consequences: A report from the Open Society Foundations’ Economic Justice Program warned that narrow accountability frameworks may discourage transparency and distort what the data is trying to tell.

The question “How do we change that model?” increasingly shapes how global health programs think about data. Rather than measuring success solely at the end, Udayakumar emphasized the need to embed real-time data throughout implementation. “It’s not measuring after the fact how well you did,” he said. “It’s unlocking the data that’s required for decision-making today,” adding that “it's actually creating programs that can adapt along the way.”

For that to happen, local institutions — not donors — must lead research efforts. “It shouldn’t be Duke University doing this in Ghana,” Udayakumar said. “It should be the University of Ghana, which has quite strong capabilities.” Local ownership, he said, is essential to building trust across the ecosystem and ensuring data becomes a shared resource for public and private partners alike. “What we do in the second quarter should be better than what we did in the first, and the only way we’ll know that is if we actually measure how we did against some sort of targets we set.”

3. Providing contextualized, person-centered approaches

“It’s very much all about context,” Duke’s Hodges urged, emphasizing that evaluation must be tailored to — and understood within — the specific setting in which it's applied. “Every organization and every program needs to work with local partners to contextualize the metrics.”

Amgen’s Anderson highlighted how the same metric can have very different results depending on context. For example, the efficacy of one project looking to improve screening and mortality rates for cervical cancer through education was limited by different geographic realities: In cities where women had greater independence, the metrics were more accurate than in rural areas where women needed their husbands’ permission to seek care. Ultimately, he said, metrics must be grounded in local social and cultural realities to truly improve health outcomes.

Speakers stressed that designing for context and community is what turns projects into sustained progress. “We’re not there to stay forever,” said Diogo de Sousa Neves, a health systems and policy adviser with City Cancer Challenge. That means co-creating with local stakeholders — from ministries to patient groups — to define what services are needed and what quality care looks like in practice, he said.

Crucially, the patient perspective must be central. “That culture [component] definitely needs a qualitative element for measurement,” Neves added. Without understanding patient experience and satisfaction, metrics risk missing the point.

4. Promoting partnerships and sustainable financing

Dr. Hafez Adam Taher, director of technical coordination at the Ghanaian Ministry of Health, pointed to the meaningful health progress in the country resulting from cross-sector partnerships. “Health issues won’t be solved by the Ministry of Health alone,” he said, highlighting collaboration with the Ministry of Sanitation to combat waterborne diseases — but for that, “you must have the political will,” he said. Ghana’s approach includes formalized partnerships — from launching a National Vaccine Institute with private investors to training community health workers to detect and manage noncommunicable diseases.

“We want to be seen as partners, not somebody who just gives money,” said Amgen’s Anderson. While acknowledging the limitations of short-term corporate funding, he emphasized its strategic value — particularly for catalytic investments such as infrastructure and training. These, he explained, lay the groundwork for lasting system improvements.

For Duke’s Udayakumar, the challenge isn’t just about more funding — it’s about building smarter systems. “This isn’t about fancy new methods,” he said. “It’s about creating alignment.” That means agreeing on core metrics that reflect real-world conditions to strengthen both national planning and global accountability.

He cautioned against “magical thinking” that assumes training or equipment alone can drive change, stressing instead the need for a culture of accountability — with clearly defined roles, locally owned data, and shared financing plans. “If we don’t get to common understanding and common approaches,” he said, “we’re going to stay fragmented.”

Ultimately, true sustainability, he argued, depends on collaboration. “We have to better understand what we have to do together, what our part is,” he said. And that begins with “a common language — and aligning it to data.”