Data drives action for UHC. But whose data is it, who is in the driving seat and who is accountable?
This blog is part of a curated blog series, ‘Prioritizing Universal Health Coverage in the Political Agenda: Needs, Barriers & Opportunities’, aligned with HSR 2022 from the UHC2030 Health Systems Related Initiatives. It focuses on HSR 2022 sub-theme: Intersectoral collaboration and integrative governance on the road for health in all policies.
Authors: Craig Burgess and Mwenya Kasonde, for the Health Data Collaborative
“You cannot improve what you don’t measure”. Peter Drucker.
Data is oxygen for igniting the fire to accelerate progress for Universal Health Coverage and better-informed decisions for health outcomes. Data lies at the heart of accountability. Data needs to be governed well as an integral part of the health system (from collection to storage, sharing, analysis) so it can ultimately be used for budgets, programs and policies
The COVID 19 pandemic highlighted the need for quality data that is provided digitally in real time and responsive to local needs. Moving towards the 2030 SDGs, there is even more emphasis on disaggregated data to identify and address the needs of ‘zero dose’ populations. This will need close collaboration with non-governmental partners such as civil society and private sector.
However, all too often, parallel, fragmented approaches to collecting data are driven by the needs of bilateral donors, academic researchers and global health initiatives, rather than countries or local decision makers. Bilateral donors are accountable to politicians and voters, global health initiatives are accountable to their disease or program-specific boards and academic researchers accountable to publishers and institutional trustees.
This creates inefficiencies and skews priorities away from local needs, where data is needed for local decisions. Who is accountable for the data needs of citizens and Ministries of Low- and Middle- Income countries? What incentives are there to reduce reporting burdens of health workers and ensure data is used for local action?
All too often there is only a token ‘nod of the head’ and ‘polite smile’ to align political, technical and financial resources to country priorities (outlined in the Paris Declaration on Aid Effectiveness, Accra Agenda for Action and the work undertaken by UHC 2030’s predecessor, the International Health Partnership+). In reality, partners want their own data and the highest bidder gets what they want, perpetuating a global ‘hoover’ of data, often with scant regard for supporting capacity building or using data at local levels.
The Health Data Collaborative (HDC) and the Sustainable Development Goals Global Action Plan (Data and Digital accelerator) have measurement, partner alignment and accountability to countries at their core. The diversity of partner perspectives and alignment to common objectives within a partnership have the potential to align political, technical and financial resources for solutions to complex context-specific problems.
However, a recent study by the HDC across five countries concluded that there was very little evidence of partner alignment with country monitoring and evaluation priorities, activities or cycles.
In March 2021, Nepal’s Ministry of Health and Population presented 3 main data and digital priorities to partners, under the umbrella of the HDC. Unfortunately, none of the partners were able to align any resources to these country priorities.
In 2017, 20 organisations in Malawi mapped 83 project activities against national priorities (top priority was to reduce fragmented data sources and align indicators). As of June 2022, very little progress has been made and multiple uncoordinated data-related projects continue to overburden the ministry.
In 2018, a time and motion study in Tanzania showed 34 daily registers were used in health facilities (nine for HIV alone). This requires 65 hours for each frontline health worker to fill out – a significant burden to the HR crisis. It also results in low motivation to fill accurately or fully resulting in low quality and untimely data.
It is clear that partners and country governments often do not have the same priorities. The misalignment of financial, technical, and political resources can lead to frustrations and skews priorities in favour of partners that may not reflect local contexts or needs.
This will continue unless:
1. Health data partnerships are given more political weight and link data across sectors;
2. Structures and governance are focused on country-specific contexts and local decision-maker needs that promote strong Ministry leadership to coordinate partner actions;
3. Business and financial incentives are flipped from hoovering data for global partners to addressing the capacity needs of countries, vulnerable communities and partnering for SDG and UHC goals; and
4. Advocacy to bilateral donors, global health initiative boards and researchers for the benefits of systems approaches to achieve SDGs and UHC.