Health data are essential to understanding what is working in a health system and what is not. Data alone, however, are just numbers, unless transformed into compelling information products that communicate and lead to action to improve health care.
For the past year, MEASURE Evaluation, a $180 million program housed in the Carolina Population Center at the University of North Carolina at Chapel Hill and funded by the U.S. Agency for International Development (USAID), has provided technical assistance to 14 health professionals from Zambia’s Ministry of Health, the National AIDS Council, the Ministry of Community Development and the University of Zambia. They spent three weeks last fall in Chapel Hill working on data products, such as posters, data dashboards and trend lines, and then flew home, certificates of achievement in their baggage and a vetted health communication product on their laptops.
Take, for instance, Boyd Kaliki, a provincial monitoring and evaluation (M&E) officer with the health ministry in Lusaka, Zambia’s capital. He supports programs to prevent HIV transmission and uses the country’s data software to generate visuals that illustrate what health data are saying. For this training, he focused on merging data sets to discover why only 37 percent of HIV-positive women of childbearing age are using modern contraceptives.
He compared women living with HIV, who do use contraceptives, with other data and discovered that HIV-positive women with more education were more likely to use contraceptives, and that rural women were less likely to use them. His analysis led to three conclusions:
- The government should offer HIV testing, counseling and treatment, along with family-planning services and incentives in rural and urban areas.
- The government should improve health education so women living with HIV understand how to take precautions for their health during and after pregnancy.
- The government should help families keep their girls in school, because education correlates with contraceptive use and delayed childbearing.
Katongo Mumbi looked, instead, at the issue of childhood growth stunting. She is the research M&E coordinator for the National AIDS Council in Zambia and the mother of two young children. She went beyond growth data and looked at the age of the mother at childbirth, her HIV status, the child’s birth weight, gender, and the family’s economic situation, especially access to clean water and sanitation. The lack of clean water can lead to enteropathy, an inflammation of the digestive system that leads to nutrients not being absorbed.
The window of most concern for child growth stunting is between the ages of 1 and 3. “Many children in this age group in urban settings go to play school and are not the focus of family attention,” she says.
But that is the time period when parents, health workers and the health system should be vigilant, Mumbi emphasizes. As many as 40 percent of children in Zambia have some effects of stunting. The upshot of her analysis is that she needs to generate interest within the health ministry to probe more deeply into the causes.
“Maybe we focus too much on HIV status, but what about thereafter? Stunting lasts a lifetime, leading to lower cognitive development, school dropout and lower incomes,” she says.
Trust Mfune works in M&E for the Zambian health ministry. He focused on antenatal care and skilled birth assistance to look at why the number of women choosing to give birth in a skilled facility was low. Four antenatal visits during pregnancy are recommended, but many women do not come back after their first clinic visit.
“In a facility, the equipment is there [if there is a problem], providing better survival for mother and baby,” he says.
He discovered that health data scored antenatal care as “covered” after even one visit. This gave the country a high rate, but neglected the fact that many women came only once to the clinic.
The data also told him that geography was a factor because women in rural areas were less likely to give birth in a facility if it was far from home. Another chief factor was the woman’s education level. The longer she attended school, the more likely she was to understand the value in having the full complement of four antenatal care visits. He decided upon three recommendations:
- The country should focus on increasing the number of antenatal visits to increase the number of skilled facility deliveries.
- The government should increase the number of health facilities in rural areas to reduce distances.
- The health and education ministries should work together to encourage education for girls and to get very young mothers back into school.
The point of the workshop in Chapel Hill, says Andrew Banda, is that people are more likely to use complex data if it is easy to understand. For a researcher at the University of Zambia like himself, that begins with the basics of analyzing data.
“For me, I have improved my research skills in generating an objective, doing the analysis, and presenting the facts,” he says. “I can teach my students better skills.”
Banda worked on what determines when children get treatment for illness, specifically the two most common contributors to deaths among children under age 5 , diarrhea and acute respiratory infections.
In looking at routine health data, he saw that about 30 percent of children with sniffles, diarrhea or a fever not been taken to a clinic, and he wondered why. The ensuing data triangulation and secondary research he did led to his conclusion that household decisions were the key, alongside factors such as distance, lack of knowledge, or age of the child, because often only the youngest child is worried about. Banda proposed two recommendations:
- The government should help mothers know that diarrhea or respiratory illness should not be ignored.
- The government should improve health care and medical supplies in rural areas, closer to families.
UNC’s MEASURE Evaluation is working in more than 40 low-resource countries to improve the use of data for better health. In its 25th year, the program has improved the use of data to address such health issues as HIV transmission, malaria, tuberculosis, capacity for rigorous research, health information systems and, recently, helped in the global response to the Ebola virus outbreak.