UNITED NATIONS - / MaximsNews Network / 13 March 2010 - Geneva - Representatives of eight global health agencies gathered at the GAVI Alliance headquarters in Geneva, in January, and issued an important report in PLoS Medicine that calls for a concerted effort to collect better health data to improve availability, quality, timeliness, tracking and use to strengthen health systems.

The eight agencies supporting the proposal are the World Health Organization (WHO), Global Fund to Fight AIDS, Tuberculosis and Malaria; the Global Alliance for Vaccines and Immunization (GAVI); the UN Population Fund (UNFPA); the World Bank's Human Development Network; Joint United Nations Programme on HIV/AIDS/UNAIDS; United Nations Children's Fund (UNICEF); and the Global Health Program at the Bill & Melinda Gates Foundation.

The eight agencies propose four global actions to strengthen the collection, analysis, synthesis, validation, and use of health data in countries. They lay out their commitments to pursuing each of these goals: Increase levels and efficiency of investments in health information Develop a common data architecture Strengthen performance monitoring and evaluation Increase data access and use. A greater emphasis on results-based financing mechanisms by major global donors and a call for more reliable data for decision-making is also furthering these efforts as well as there importance for strategic health sector plans.  New and more systematic methods for monitoring and evaluating health progress and performance were called for to meet the Millennium Development Goals, MDGs, and other health objectives. Monitoring and evaluation (M&E) in health requires data from different sources about levels, trends and distribution in areas such as health financing, workforce, service access and quality, coverage and risks. Data from household surveys, birth and death registration, census, health facility reporting systems including surveillance systems, and administrative data needs to be more available, useful and of higher quality according to international standards and health metrics systems. Developing long-term and systematic country capacity to better collect, process, analyze, and use health data is essential to replace the fragmented situation today that is often driven by single-disease programmes. Fundamental Principles of Official Statistics are critical to increase accountability, transparency, and adherence to quality standards and to improve the capacity for analysis, synthesis, validation, and use of this data.  The eight agencies propose four global actions to support these country goals: Increase Levels and Efficiency of Investments in Health Information  Required actions include: Enhancing investments in country data sources and the systematic strengthening of information systems through global health partnerships and special disease initiatives as part of ongoing funding and through new efforts. A commonly used figure, by, for instance, the Global Fund to Fight AIDS, Tuberculosis and Malaria, is that 5% to 10% of program funds should be invested in data collection, monitoring, evaluation, and operational research; Improving the efficiency of health information investments by closer collaboration between partners in support of one strong country M&E plan that covers all major disease and health programs and all data sources. The eight agencies commit to acting upon this goal immediately by: Ensuring that funding for scaling up for the MDGs and health system strengthening include systematic funding to strengthen M&E systems in countries; Supporting countries to develop one strong M&E plan, linked to the country health sector plan and building upon existing efforts, which forms the basis for the monitoring of global goals. Develop a Common Data Architecture  Information technology applications are changing the scope and modalities of data collection, transmission, storage, analysis, dissemination, and sharing.  The UN organizations have invested much in, for instance, standards for data collection, such as the International Classification of Diseases and Related Health Problems (ICD), and, for data transmission, notably the Standard Data and Metadata eXchange (SDMX).  But the lack of a common data architecture hampers the efficient generation and use of health information. While there can be no general blueprint, it is essential to enhance interoperability between different data systems.  An explicit data architecture—describing how data are collected, stored, managed, and used, and by whom and for what purposes—is needed to ensure that the increasing diversity of actors and resources contributes evenly and sustainably to resolving the information gaps at country and global levels. The required actions include: Investing in developing norms and standards for all aspects of a common data architecture, which includes involvement of UN agencies, academia, and the private sector; Developing a global health indicator registry with standards for data, indicators, metadata, and references to analytic methods that builds upon work done in health and disease programs, promotes the implementation of the standards, and focuses on a core minimal indicator set; Developing and promoting interoperability standards for the health sector at both the level of individual and aggregate records. The eight agencies commit themselves to acting upon this goal immediately by: Working together and enhancing investments in developing a common standard for health information, including a common indicator and metadata registry and interoperable databases. Strengthen Performance Monitoring and Evaluation  There is a need for more rigorous M&E of progress and performance.  The IHP+ common evaluation strategic framework presents a set of principles to maximize country benefits, in line with the Paris Declaration on aid effectiveness.  The general principles for large-scale public health evaluation include: collective action of all major partners; alignment with country planning and reporting cycles; balance between independence and country ownership; use of internationally accepted methods and standards; strengthening of institutional capacity and health information systems as an integral part; and appropriate and timely investment in evaluation [6]. Much more can be done to reduce the reporting burden on countries and better align the monitoring of progress towards international goals—from MDGs to other international goals—with national M&E plans that are well linked to national health sector strategic plans.  Also, comparable estimates for key health indicators, such as child and maternal mortality or immunization coverage, should be made on the basis of the best possible data with the best possible methods in a comprehensible, transparent manner which allows reproduction of the estimates at country and global levels. Global technical debates are useful to improve methods and estimates but should be conducted in a manner that minimizes confusion among health planners and programmers. Required actions include: Improving coordination of monitoring progress in order to minimize the reporting burden on countries, supported by a common data architecture with a core set of indicators; Fostering methodological innovation for the collection and analysis of statistics; Ensuring that methods and data sources for estimates are transparent, objective, and available for sharing and review; Improving development of tools, software, and training programs to support country capacity building for analysis and synthesis; Supporting rigorous and independent evaluations of initiatives, programs, and interventions, implemented in line with the principles of the IHP+ common evaluation framework when working in countries.

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