Module 6: Macro-Level Metrics in Global Health

From The Macro-Level Perspective, How Do We Measure and Monitor Health?

Valid data on economic and social investments in health, as well as the impact of intervention programs to improve poverty, is vital for several critical processes: constructing successful health infrastructures, applying interventions, allotting funds for various research projects, and monitoring and evaluating improvement.  There are wide gaps in health information, which delays rapid responses to global health challenges. This is a reality that particularly impacts investments in diseases such as AIDS, tuberculosis and malaria.  According to Murray et al., several key changes can improve global health monitoring on a broad scale: more advanced technologies must be developed, national capacity and a “gold standard” for international reporting must be strengthened, and global health monitoring responsibilities should be expanded beyond the WHO (World Health Organization).  Currently, several interrelated attempts are being made in order to expand the accessibility of valid, reliable, and comparable health information to inform local and global decisions.(1)

In many cases, the current technologies do not provide a comprehensive assessment of how interventions are impacting poverty and disease levels.  For example, there are ways to assess child mortality through domestic surveys in certain locations, but there is still no valid method to measure adult mortality.  Similarly, HIV antibody tests have been developed so that the frequency of infection in a given area can be determined from sample surveys, yet a comparably easy and inexpensive technique has not yet been developed for diseases such as tuberculosis.  Advanced technologies and methods have made great strides in recent years, and further improvements that will assist in health monitoring must continue to be made in the decade to come.(2)

It is important to reinforce the nationwide system for data collection and analysis, an effort that may be further fueled by the Health Metrics Network.  The HMN’s current goal is to concentrate on capacity building in five to seven countries per year.  The HMN is just one example of the way in which the WHO plays a huge role in assisting the development of national health information systems.  Establishing global standards, definitions, and cataloging systems for health program evaluation is imperative for validity, reliability, and comparability in health measurement to exist.(3)

Dissemination of health information on a local, national and international scale is necessary for effective monitoring and evaluation of impact.  The global reporting system is currently weaker than it should be, and information that has the potential to significantly influence important decisions often remains idle in statistical abstracts and spreadsheets due to a lack of organization.(4)

Who Can Best Evaluate on a Macro-Level Scale?

Currently, the World Health Organization (WHO) is considered to be the gold standard of global health reporting.  WHO’s successful collection and analysis of data is uneven in different areas; for example, in terms of child and adult mortality, many systematic efforts have been made to ensure accurate numbers. However, prevalence of malaria comes from country-submitted statistics, which may be biased. WHO is responsible for serving many roles: international supporter, assistant of technology, monitor of improvements, and evaluator of how successful programs are.  Fulfilling all of these roles is a difficult task, and Murray et. al explains that the tensions between these duties cause gaps to form.  For example, when reporting the prevalence of tuberculosis, case detection rates for smear positive TB greater than 100% are accepted without scrutiny.  Additionally, since WHO is comprised of 192 member states, the dispute of a certain statistical figure from a powerful country can cause WHO to change the figure.  Due to this pressure from countries, Murray et al. have identified that monitoring and evaluation can become partial and inaccurate.(5)

Other organizations and programs suffer from similar problems.  Initiatives that focus on a certain disease can certainly be successful, but still do not solve the problem of creating a global reporting standard that is mutually used by all programs.  One proposed solution to this problem is the creation of a new independent health monitoring organization which would report frequently to the public about the amount being spent on health, public services being provided, and overall impacts on global health.  Essentially, it is necessary for all of the existing organizations to work in concert with one another and to make sure that all of the evidence being obtained is effectively collected, analyzed, and disseminated to the public in order to yield the greatest impact.  Actors such as the WHO technical programs, the Global Alliance for Vaccines and Immunizations, the Global Fund for AIDS, Tuberculosis and Malaria, and other small intervention initiatives need to make sure that their information is credible, clear, and comparable, and that it is being successfully distributed to the public.(6)

At the WHO’s World Health Assembly Meeting in May 2010, Carla Abdou-Zahr of the WHO’s Department of Health Statistics and Informatics, presented about metrics at a session on the health-related Millennium Development Goals. She explained that "reporting on MDG progress is made difficult by the paucity of reliable country data, making estimates uncertain.  Better data are key and the lack of investment in health information systems at country level is a significant problem. But even with this data gap, it is clear that the decline in maternal and child mortality is far below what is needed to achieve the targets by 2015.”(7) The information presented at this session revealed the persistent flaws in statistical information, as each year over forty million births and forty million deaths slip through the cracks and are left unrecorded.  Additionally, in 85 countries (embodying two-thirds of the world’s population), there is a lack of reliable data on causes of death.  In order to strengthen health information systems, a resolution was presented at the Assembly proposing to increase investments in financial and human resources, enabling health information systems to gather valid and timely data on the successes of the MDGs and on gender and geographical inequalities. (8)

Conclusion

In conclusion, the WHO, other governmental organizations, and NGOs must work in collaboration with one another to successfully measure and monitor global health.  Currently, vast inequities across technical and geographical areas exist in terms of data collection, analysis, and dissemination.  Efforts continue to be made in order to successfully develop a uniform system for health information distribution amongst various organizations and to the general public.  The strengthening of health information systems is a vital aspect of the larger goal of providing necessary interventions, monitoring progress, and evaluating impact in order to ensure that funds are being invested in the most effective way possible.

Footnotes

(1) Murray, C. J., Lopez, A. D., & Wibulpolprasert, S. (2004). Monitoring global health: time for new solutions. BMJ, 329(7474), 1096-1100.

(2) Ibid.

(3) Health Metrics Network.  “What is HMN?” World Health Organization (2010). 

(4) Murray, C. J., Lopez, A. D., & Wibulpolprasert, S. (2004). Monitoring global health: time for new solutions. BMJ, 329(7474), 1096-1100.

(5) Ibid.

(6) Ibid.

(7) “Better country data needed to assess progress towards health MDG targets.” (May 21, 2010). Health Metrics Network Weekly Highlight. https://www.cepal.org/cgi-bin/getProd.asp?xml=/MDG/noticias/noticias/0/39580/P39580.xml&xsl=/MDG/tpl-i/p1f.xsl&base=/mdg/tpl-i/top-bottom.xslt.

(8) Ibid.