On September 22, 2017, a correction was made in the second paragraph of this blog post.
High-quality health data is the backbone of strong public health policies. When government officials and public health professionals understand the factors that influence health, they can make informed decisions about how and where to target public health interventions and resources. In low- and middle-income countries, noncommunicable diseases (NCDs) account for 67 percent of deaths but only 1 percent of global health funding (see page 5). As the NCD epidemic reaches all countries—regardless of income level, high-quality, quickly accessible data that provide information about NCD risk factors are the lever for action.
Bloomberg Philanthropies has an ambitious plan to address critical health data needs—with twenty low- and middle-income countries participating in our Data for Health initiative. Data for Health focuses on three broad needs at the country level: improving birth and death registration data; strengthening the link between health data and policy decisions; and exploring innovative approaches to NCD surveillance by using mobile phone surveys. The four-year initiative, a partnership with the Australian Government’s Department of Foreign Affairs and Trade, provides $100 million to partner with countries on these issues.
Mobile Phone Surveys
Because of marked increases in mobile phone ownership, tapping into this technology for survey purposes has the potential to be a resource-saving complement to the gold-standard household survey—and mobile phone surveys have the advantage of being feasible to conduct at more frequent intervals. The continuous flow of data to the public health sector allows for more rapid interventions and the early detection of new trends.
Previously, when survey data were collected by interviewers using smartphones and tablets, field workers, traveling from residence to residence, were always collecting the data. The Data for Health mobile phone survey is the first nationally representative survey in which questions are asked through cell phone networks and respondents answer by using their own mobile devices. Conducting surveys using mobile phones without visiting households allows surveys to be done more frequently and more cheaply, thus complementing detailed, in-person household surveys.
Within the Data for Health initiative, mobile phone surveys are being piloted in two countries (Zambia and Morocco) alongside the World Health Organization’s (WHO’s) NCD risk factor household survey—STEPwise—using the same standardized questions and protocols. Our program partners (the US Centers for Disease Control and Prevention, CDC Foundation, WHO, and Johns Hopkins University) will directly compare findings to quantify the bias introduced by this new mobile phone method before applying this method to additional countries.
For example, Zambia is the first country where the mobile phone survey has been rolled out nationally, beginning in July 2017, and to date, 89 percent of the needed sample size has been completed. An additional advantage of this method is that data analysis can follow quickly after the survey is completed as all data are electronically submitted.
Through several microtrials in three countries, the initiative is supporting additional research, and practical knowledge is being gained. Data for Health partners are filling research gaps on the effectiveness of incentives to increase survey completion; different modalities (such as voice versus text); and ethical, legal, and societal issues raised by the mobile phone method. These learnings will be used to improve future mobile phone surveys.
Other Data For Health Activities
In addition to our mobile-phone survey work, Data for Health partnered with Rwanda’s Ministry of Health to support its systematic collection of information on deaths outside of a hospital. This was a critical step toward understanding the leading causes of death in this country, where an estimated 95 percent of deaths occur outside of hospitals.
Data for Health has also trained more than 15,000 people to work on improving birth and death registration systems. Eight countries—Bangladesh, Brazil, Morocco, China, Solomon Islands, Tanzania, Myanmar, and Rwanda—are collecting critical information on deaths that occur outside of hospitals and, as a result, they now have data on more than 15,000 of these deaths.
Without reliable health data, we are slow and plodding, not nimble and efficient, in our response to key disease challenges such as NCDs. By closing gaps in health data, countries can react swiftly to shifting disease burdens, identify leading causes of death, and plan for the future.
The growing burden of NCDs, specifically in low- and middle-income countries, highlights a need for policy makers to access high-quality NCD risk-factor data to inform decision making and resource allocation and understand NCD trends over time. Support from the United Nations, civil society groups, nongovernmental organizations (NGOs), and the private sector is critical for countries to see these goals through.