Empowering countries through the data revolution

Dr. Ariel Pablos-Mendez Healthcare NEWS & ANALYSIS

When the United States and the international community mounted a response to the Ebola outbreak in West Africa, we saw a dramatic reduction in new cases. Liberia and Sierra Leone are close to zero, and cases continue to drop in Guinea. The response was an unprecedented success, but we also underscored just how important it is for countries to quickly identify disease outbreaks to save lives and contain infections.

One of the biggest hurdles to quickly addressing a health crisis like Ebola is early warning systems that provide the kind of credible information that we have in the United States. That is why we were able to contain the outbreak rapidly when it came to our homeland. As the West African countries recover from Ebola, it is critical that we support them and other countries to strengthen local systems to monitor health threats, trace diseases and track progress toward achieving health goals around the globe.

These tools and the decision-making processes that they serve can be immeasurably strengthened if countries have the necessary capacities to collect, analyze and manage greater volumes of data. We built on historical platforms like the Demographic Health Surveys led by USAID for decades, as well as more recent National Health Accounts that allowed the world to increase access for health services. Current changes in information technology are creating a profound revolution in the way we make decisions. We need to continue to reach out and apply those lessons to the healthcare sector so that it remains at the forefront of development.

Electronic tracking systems can ensure medicines, equipment and supplies show up at the right place and at the right time. Locations of health facilities and their equipment can be mapped with GIS codes for planning and maintenance schedules. Workforce analytics can track how many healthcare workers are needed and how many a country currently employs. And there is growing momentum behind the expansion of civil registration and vital statistics systems that allow us to monitor births and deaths in real time and with greater accuracy.

In addition to saving lives and preventing disease outbreaks, continually improving the use of data will make USAID’s and partner health investments even more efficient. This collective effort will help us to direct more resources to the places US taxpayer dollars can have the greatest effect. With better measurement and more accountability, nations around the world can do better for their people and globally. Prioritizing the collection and analysis of data in countries strengthens their ability to make smart investments. Better data means better decisions for both our partner countries and for us.

Over the past week, a renewed commitment to build sustainable country information systems has been spearheaded here in Washington, DC at the Measurement and Accountability for Results in Health Summit. Fifty-six foreign governments and hundreds of global health leaders from multilaterals, academia, research institutions and civil society were brought together by USAID, the World Health Organization and the World Bank Group. Together, we discussed the Roadmap for Health Measurement and Accountability 2030, which gained overwhelming support for the Five-Point Call to Action. Country participants voiced a need for a stronger, more coordinated approach to measurement and data collection.

I am extremely proud that the international community now has a common vision with which we can drive this important agenda forward. We are creating a world where investments in measurement allow countries to fully understand and improve the health of their people.

The Five-Point Call to Action reads as follows:

Health Measurement and Accountability Post 2015: Five-Point Call to Action

We, the Leaders of Global Health Agencies and participants in the Summit on Measurement and Accountability for Health, are:

Convinced that information on citizens’ health needs, experiences, and perceptions; service provision and coverage; and outcomes is essential for the governance of responsive health systems, while ensuring equity, the safety, quality, efficiency, and effectiveness of services and value for money of health expenditure;

Recognizing the recent progress that many low- and middle-income countries, often in collaboration with development partners, have made in producing, sharing, and using health data, particularly on MDG-related health indicators;
Confronted by the evidence that despite this progress, most country health information systems cannot meet current data demands and are ill prepared to meet future data requirements in the context of the post-2015 sustainable development goals;

Concerned about insufficient and inefficient investments in health information systems by countries and development partners and the limited country capacity to produce, disseminate, and use disaggregated health data for national and subnational decision-making;

Cognizant that regular measurement of results with a focus on equity is essential for the progressive realization of Universal Health Coverage and to learn how to accelerate improvement and achievement of results;

Considering that the health SDG targets are both an opportunity and an imperative to strengthen summary measures of service coverage and systems performance that are comparable across countries;

Recognizing the opportunities to radically improve health information and statistical systems in the context of the post-2015 sustainable development goals, provided by the data revolution, the growing demand for credible health information, and the greater willingness of development partners to align their support for strengthening country health information systems;

Committed to a 15-year roadmap to improve health measurement, anchored in strong country plans and aligned investments, inclusive accountability mechanisms, and monitored by time-bound targets for performance of the information system;
Agree to the following priority actions and targets for health measurement and accountability for post-2015 in low- and middle-income countries:
1. Increase the level and efficiency of investments by governments and development partners to strengthen the country health information system in line with international standards and commitments;
 By 2030, countries are investing adequately in health information and statistical systems
 By 2020, development partner investments in health information are fully aligned with a single country platform for information and accountability.
2. Strengthen country institutional capacity to collect, compile, share, disaggregate, analyze, disseminate, and use data at all levels of the health system;
 By 2020, countries have annual transparent reviews of health progress and system performance, based on high-quality data and analyses led by country institutions
 By 2025, countries have comprehensive, disaggregated data of a high quality to review progress against their national plans and are using these data to report on progress against health-related SDGs
 By 2020, countries have health information flows that include regular feedback and local use of data locally to improve services and programs.
3. Ensure that countries have well-functioning sources for generating population health data, including civil registration and vital statistics systems, censuses, and health surveys tailored to country needs, in line with international standards;
 By 2025, countries have in place a regular, comprehensive program of health surveys and have completed the 2020 round of census, in line with agreed international standards
 By 2030, all births are registered by the civil registration system as soon as possible; 80 percent of deaths are reported, registered, medically certified, and disaggregated by age and sex; causes of death are reported using ICD by all hospitals, and verbal autopsy is used to ascertain causes of death in communities.
4. Maximize effective use of the data revolution, based on open standards, to improve health facility and community information systems including disease and risk surveillance and financial and health workforce accounts, empowering decision makers at all levels with real-time access to information;
 By 2020, countries are compliant with IHR national core functions for surveillance and response and have effective, real-time disease surveillance systems in place, including the capacity to analyze and link data using interoperable, interconnected electronic reporting systems within the country
 By 2025, countries have in place electronic systems for real-time reporting of health statistics from at least 80 percent of facilities and communities, including data quality assurance mechanisms
 By 2030, countries have regular maternal and perinatal death surveillance and response mechanisms at the national, subnational, and facility levels
 By 2030, at least 90 percent of countries are reporting data using international standards for the system of health accounts and have complete up-to-date health workforce accounts.
5. Promote country and global governance with citizens’ and community’s participation for accountability through monitoring and regular, inclusive transparent reviews of progress and performance at the facility, subnational, national, regional, and global levels, linked to the health-related SDGs;
 By 2016, a global coordination and accountability mechanism is functioning, producing regular reports and holding reviews to assess the progress of the health measurement roadmap and action plan
 By 2017, countries have established mechanisms to make health data available to users through electronic dissemination and easy access to a central data repository
 By 2020, civil society organizations in countries are actively and meaningfully participating in country reviews of progress and performance at all levels.

The 5-Point Call to Action was drafted by a team of staff at the World Bank, USAID, the World Bank Group and WHO, and benefitted from extensive inputs from partner organizations and a public web consultation. It was be endorsed at the Summit on the Measurement and Accountability for Results in Health, June 9-11, 2015, which was held at the World Bank headquarters in Washington, D.C.

Written by

Dr. Ariel Pablos-Méndez was appointed by President Barack Obama to lead the Global Health Bureau at USAID, the premier agency in international development. USAID’s vision, guided by the US Global Health Initiative, aims to end preventable child and maternal deaths, catalyze an AIDS-free generation and protect communities from infectious threats with approaches such as fostering country ownership, women’s empowerment and strengthening health systems in low-income countries.