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Global health metrics and NCDs: are our perceptions years behind the data?
Editorial
Data collection is an inherent part of health care and is crucial for evaluating disease trends, planning health services, and monitoring progress. Good quality data shines a light on areas of need, success, and failure; in turn, this leads to learning, progress, and—of course—donor funding. Unfortunately, a high burden of disease comes with a high burden of data collection. This double burden is heaviest in countries that struggle both to provide health care and collect data. The requirements from each individual donor for countries to collect data specific to their programme needs only amplifies the problem. Into this arena have stepped USAID, WHO, and the World Bank with a brave strategy to streamline global health data collection. The results of their endeavours were presented at the World Bank, Washington, DC, at the Measurement and Accountability for Results in Health meeting in June, 2015. It was a breath of fresh air. Around 800 indicators that countries are currently advised to collect data for have been reduced to a recommended 100 Core Health Indicators. This reduction will both relieve countries of a huge burden of data collection and allow meaningful comparisons and opportunities for learning across countries. But can the meeting’s rhetoric be translated into results? Four key themes became clear on the first day of the 3 day meeting. First was the recognition that data needs are different at local facility, community, national, regional, and global levels. Second, that countries and users need to determine what data are useful for them to collect was mentioned several times. A third theme was the need for trust and transparency, and the use of data for audit and accountability. Fourth, quality of health indicator data must be monitored. Can all these needs be met with 100 indicators? The simple answer is no. There is clear tension between data needs for health system planning at the local level and those for accountability at a global level. The deceit in the simplicity of resolving this tension by extracting globally relevant data from local IT systems is that systems, even in high-income countries, struggle to accommodate both local and national needs. Technologies designed to leapfrog these issues have often floundered. www.thelancet.com/diabetes-endocrinology Vol 3 August 2015
There were also omissions. Non-communicable diseases (NCDs) were mostly swept under the carpet. Hans Rosling (co-founder of Gapminder) clearly showed that we are “years behind the data”; the global burden of disease has moved towards NCDs, but we—the global health community—perceive maternal and childhood mortality and infectious diseases as the major threats of today. Despite this, the latter areas got the lions’ share of air-time. Some speakers gave a nod to NCDs, but anyone new to global health would think that NCDs are not rapidly becoming the health scourges of today. NCDs are also scarce on the 100 Core Indicators list. Monitoring deaths from and risk factors for NCDs is an indicator, but there are no indicators looking at treatment coverage and success. Tuberculosis, HIV, malaria, and maternal and child health issues get more than adequate coverage in these domains. Thus, it seems the global community is content to monitor premature deaths from NCDs but is reluctant to do anything about their rapidly increasing prevalence. One could not help but wonder whether the prominence of donors like the Bill & Melinda Gates Foundation, GAVI, and UNICEF—who don’t see far beyond their traditional funding areas—at the meeting reflected their influence in the decision making for the final list of 100 Core Health Indicators. But whatever the reasons, the travesty is that NCDs will remain in the dark to quietly become the killers of those children, mothers, and people with infectious diseases who the global community are currently striving to save from an untimely death. The initiative to reduce the burden of data collection on countries is certainly to be celebrated. However, it will fail without strong leadership to resolve the tension between local and global needs, and without investment in infrastructure to aid collection of data, particularly in low-income settings. Even with this help, the relative lack of health indicators to monitor NCDs is a glaring omission that potentially makes a mockery of the process. We can only hope that countries themselves are empowered to grasp the nettle of monitoring NCDs, and in doing so, can educate the global community on the necessity of shining a light on these conditions. ■ The Lancet Diabetes & Endocrinology
Justine Davies
Global health metrics and NCDs: are our perceptions years behind the data?
Published Online June 19, 2015 http://dx.doi.org/10.1016/ S2213-8587(15)00231-4 For more on the Measurement and Accountability for Results in Health meeting see http:// ma4health.hsaccess.org/ For the 100 Core Health Indicators see http://www.who. int/healthinfo/indicators/2015/ en/ For more on Gapminder see http://www.gapminder.org/
577
Data collection is an inherent part of health care and is crucial for evaluating disease trends, planning health services, and monitoring progress. Good quality data shines a light on areas of need, success, and failure; in turn, this leads to learning, progress, and—of course—donor funding. Unfortunately, a high burden of disease comes with a high burden of data collection. This double burden is heaviest in countries that struggle both to provide health care and collect data. The requirements from each individual donor for countries to collect data specific to their programme needs only amplifies the problem. Into this arena have stepped USAID, WHO, and the World Bank with a brave strategy to streamline global health data collection. The results of their endeavours were presented at the World Bank, Washington, DC, at the Measurement and Accountability for Results in Health meeting in June, 2015. It was a breath of fresh air. Around 800 indicators that countries are currently advised to collect data for have been reduced to a recommended 100 Core Health Indicators. This reduction will both relieve countries of a huge burden of data collection and allow meaningful comparisons and opportunities for learning across countries. But can the meeting’s rhetoric be translated into results? Four key themes became clear on the first day of the 3 day meeting. First was the recognition that data needs are different at local facility, community, national, regional, and global levels. Second, that countries and users need to determine what data are useful for them to collect was mentioned several times. A third theme was the need for trust and transparency, and the use of data for audit and accountability. Fourth, quality of health indicator data must be monitored. Can all these needs be met with 100 indicators? The simple answer is no. There is clear tension between data needs for health system planning at the local level and those for accountability at a global level. The deceit in the simplicity of resolving this tension by extracting globally relevant data from local IT systems is that systems, even in high-income countries, struggle to accommodate both local and national needs. Technologies designed to leapfrog these issues have often floundered. www.thelancet.com/diabetes-endocrinology Vol 3 August 2015
There were also omissions. Non-communicable diseases (NCDs) were mostly swept under the carpet. Hans Rosling (co-founder of Gapminder) clearly showed that we are “years behind the data”; the global burden of disease has moved towards NCDs, but we—the global health community—perceive maternal and childhood mortality and infectious diseases as the major threats of today. Despite this, the latter areas got the lions’ share of air-time. Some speakers gave a nod to NCDs, but anyone new to global health would think that NCDs are not rapidly becoming the health scourges of today. NCDs are also scarce on the 100 Core Indicators list. Monitoring deaths from and risk factors for NCDs is an indicator, but there are no indicators looking at treatment coverage and success. Tuberculosis, HIV, malaria, and maternal and child health issues get more than adequate coverage in these domains. Thus, it seems the global community is content to monitor premature deaths from NCDs but is reluctant to do anything about their rapidly increasing prevalence. One could not help but wonder whether the prominence of donors like the Bill & Melinda Gates Foundation, GAVI, and UNICEF—who don’t see far beyond their traditional funding areas—at the meeting reflected their influence in the decision making for the final list of 100 Core Health Indicators. But whatever the reasons, the travesty is that NCDs will remain in the dark to quietly become the killers of those children, mothers, and people with infectious diseases who the global community are currently striving to save from an untimely death. The initiative to reduce the burden of data collection on countries is certainly to be celebrated. However, it will fail without strong leadership to resolve the tension between local and global needs, and without investment in infrastructure to aid collection of data, particularly in low-income settings. Even with this help, the relative lack of health indicators to monitor NCDs is a glaring omission that potentially makes a mockery of the process. We can only hope that countries themselves are empowered to grasp the nettle of monitoring NCDs, and in doing so, can educate the global community on the necessity of shining a light on these conditions. ■ The Lancet Diabetes & Endocrinology
Justine Davies
Global health metrics and NCDs: are our perceptions years behind the data?
Published Online June 19, 2015 http://dx.doi.org/10.1016/ S2213-8587(15)00231-4 For more on the Measurement and Accountability for Results in Health meeting see http:// ma4health.hsaccess.org/ For the 100 Core Health Indicators see http://www.who. int/healthinfo/indicators/2015/ en/ For more on Gapminder see http://www.gapminder.org/
577