Latest news with #DemographicandHealthSurveys
Vox
5 days ago
- Health
- Vox
What happens when we lose global health data?
is a fellow for Future Perfect. He reports on global health, science, and biomedicine, focusing on how policies and systems shape progress. A census enumerator, right, talks with a Maasai woman during the population and housing census, the first time being conducted digitally, at a village in Engikaret on August 23, 2022. AFP via Getty Images When President Donald Trump and Elon Musk fed the US Agency for International Development into the wood chipper earlier this year, one of the lesser-known casualties was the shutdown of an obscure but crucial program that tracked public health information on about half of the world's nations. For nearly 40 years, the Demographic and Health Surveys (DHS) Program has served as the world's health report card. In that time, it has carried out over 400 nationally representative surveys in more than 90 countries, capturing a wide range of vital signs such as maternal and child health, nutrition, education levels, access to water and sanitation, and the prevalence of diseases like HIV and malaria. Taken together, it offered perhaps the clearest picture ever compiled of global health. And that clarity came from how rigorous these surveys were. Each one started with a globally vetted blueprint of questions, used by hundreds of trained local surveyors who went door-to-door, conducting face-to-face interviews in people's homes. The final, anonymized data was then processed by a single contractor ICF International, a private consulting firm based in Reston, Virginia, which made the results standardized and comparable across countries and over time. Its data powered global estimates from institutions like the Institute for Health Metrics and Evaluation, which in turn shaped public health policy, research, and funding decisions around the world. 'If DHS didn't exist, comparing anemia across countries would be a PhD thesis,' said Doug Johnson, a senior statistician at the nonprofit IDinsight. Crucially, DHS also tracked things few other systems touched, like gender-based violence, women's autonomy, and attitudes toward domestic abuse. Doctor's offices aren't representative and only capture folks who can access a formal health care system. Also, since DHS data is anonymized, unlike a police report, responders don't have to fear intervention if they don't want it. 'You can't get answers from other sources to sensitive questions like the ones DHS posed,' said Haoyi Chen from the UN Statistics Division, pointing to one example: Is a husband justified in beating his wife if she burns the food? Then, earlier this year, DHS was shut down. The decision came as part of the Rescissions Act of 2025, a bill passed in June that clawed back $9.4 billion from foreign aid and other programs. Eliminating DHS saved the government some $47 million a year — only about 0.1 percent of the total US aid budget, or half the cost of a single F-35 fighter jet. Future Perfect Explore the big, complicated problems the world faces and the most efficient ways to solve them. Sent twice a week. Email (required) Sign Up By submitting your email, you agree to our Terms and Privacy Notice . This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. That tiny budget cut has had immediate consequences. The move halted around 24 in-progress country surveys – 10 of which were just short of final publication, and three in Ethiopia, Guinea, and Uganda that were stopped mid-fieldwork. The program's public-facing website remains up, but the machinery behind it is gone. With no one to approve new applications, the process for researchers to access the underlying microdata has ground to a halt. How the DHS has saved lives The shutdown isn't just about numbers on a spreadsheet. Here's how DHS data has shaped policy and saved lives across the globe. Guinea: DHS data was used to help tailor the rollout of the new malaria vaccine India: The 2019–2021 national survey (India's version of the DHS) showed a stark gap in menstrual hygiene between urban and rural areas, which prompted a new national policy to address the disparity. Nepal: A 2016 DHS survey revealed stagnating maternal mortality rates. This spurred the government to enhance its Safe Motherhood Program , resulting in more women delivering babies in health facilities rather than homes — and fewer women dying in childbirth. Nigeria: DHS surveys showed child marriage rates as high as 76 percent in some states. Advocates used that as evidence to successfully push local governments to strengthen their laws against the practice. There will also be long-term damage. When governments or aid organizations can no longer see exactly where children are malnourished, where malaria outbreaks are quietly spreading, or where mothers are dying in childbirth, they can't effectively target life-saving interventions, leaving the most vulnerable populations to pay the price. For 24 countries, including the Democratic Republic of Congo and Mali, the DHS was the sole data source for the UN's official maternal mortality estimates. Going forward, 'it would just be basically estimates that are based on other countries' data,' says Saloni Dattani, a editor on science and global health at Works in Progress magazine and 2022 Future Perfect 50 honoree. 'We just wouldn't know.' Without the data DHS provided, foreign aid becomes less effective, and less accountable 'We have no way of externally or objectively estimating the positive impact that those [aid] programs are having, or negative,' said Livia Montana, the former deputy director of the DHS Program, who is now a survey director for the Understanding America Study at the University of Southern California. Naturally, the global health community has been scrambling to plug the enormous gap. The Gates Foundation recently committed $25 million in emergency funding to rescue some ongoing surveys, and Bloomberg Philanthropies has also stepped in with a separate commitment to support the effort. This funding is a crucial lifeline, but only a stopgap. The search for a long-term fix has forced a reckoning with the old programs' flaws. Everyone agrees that DHS delivered high-quality, trusted data — but it wasn't perfect. Many experts have criticized it as fundamentally 'donor-driven,' with priorities that didn't always align with the national interests of the countries it surveyed. For instance, the program's historic focus on reproductive health was a direct reflection of the priorities of its primary funder, USAID, and some country officials privately felt the data served the accountability needs of international organizations better than their own immediate planning needs. This has created a central dilemma for the global development community: is it possible to build a new system that is both genuinely country-led and also globally comparable? A lifeline and a reckoning Faced with this data vacuum, an obvious question arises: Why can't other global organizations like the World Health Organization or the United Nations simply step in and take over? It's not out of the question, but it would be really, really difficult. Think of it this way: The DHS Program was like a single, powerful architecture firm that perfected a blueprint and built houses in 90 neighborhoods for 40 years. Because it was a single program managed by private contractor, ICF International, and backed by one major funder, USAID, it could enforce a standardized methodology everywhere it worked. As a for-profit firm, ICF's interest was also financial, it managed the global contract and profited from the work. The UN and WHO, by contrast, act as the global city planners: Their mandate isn't to design and build the houses themselves, but to set the building codes and safety standards for everyone. According to WHO, its role is not to 'directly fund population-based surveys,' but to provide leadership and bring the right stakeholders together. While that mandate may prevent the UN from simply inheriting the old program's work, it makes it an ideal coordinator for the path forward, says Caren Grown, a senior fellow at the Brookings Institution's Center for Sustainable Development. Grown argues that the UN is the only body that can handle the 'heavy lift' of coordinating all the different countries, donors, and organizations. And now that the DHS has been dissolved, both Grown and Chen are now part of a UN task force attempting to establish new internationally agreed-upon standards for how health data should be collected and governed. At the same time, other efforts are more focused on the practical work of implementation rather than on global governance. Montana is leading a coalition to 'rebuild elements of DHS' by creating a global consortium of research institutions that can provide technical support to countries. These efforts were catalyzed by initial conversations hosted by organizations like the Population Reference Bureau, which brought together donors, government agencies, and global data users to grapple with the shutdown's immediate aftermath. Critics argue that for every India, there are a dozen other nations where the program's sudden collapse is proof that a deep, sustainable capacity was never built. Between this mishmash, the most practical development has been a lifeline from the Gates Foundation, which announced a $25 million investment in 'bridge funding.' Separately, in a statement to Vox, Bloomberg Philanthropies confirmed its commitment to fund the completion of an additional 12-country surveys over the next eight months. A source from the Gates Foundation clarified that Bloomberg's commitment is on top of theirs, confirming the two are distinct but coordinated rescue efforts. The Gates Foundation framed its effort as a temporary, stabilizing measure designed to give the global health community a much-needed respite. 'We believe data is — and must remain — a global public good,' said Janet Zhou, a director focused on data and gender equality at the Gates Foundation. 'Our interim support is helping to stabilize 14 ongoing country surveys. … This investment is designed to give global partners and national governments the time and space needed to build a more sustainable, country-led model for health data.' That support is aimed at the most urgent work: finishing surveys that were nearly complete, like in Ethiopia, and reopening the four-decade-old data archive. But rather than giving each respective country the money to complete their ongoing surveys, the Gates funding will be administered by ICF International, the same for-profit firm that ran the original DHS. The decision to work with the existing contractor, ICF International, was a pragmatic one. Continuing with the same implementer was the 'quickest, most affordable way' to prevent waste, and 'multiple host countries have shared a preference' to complete their work with the firm, said a source at the Gates Foundation. A Sudanese mother sits with her children at a shelter in the al-Qanaa village in Sudan's southern White Nile state on September 14, 2021. Ashraf Shazly/AFP via Getty Images It's a powerful argument for triage in an emergency, but it also papers over deeper flaws. Take a look at Nigeria, for example: Fieldwork for its 2023–'24 DHS finished in May 2024, and the questionnaires gathered new estimates of maternal and child deaths. Nigeria also ran a separate study to probe exactly why mothers and children are dying. In principle, the two datasets should dovetail but beyond a headline-numbers report, the full DHS micro-dataset is still in ICF's processing queue — likely frozen after DHS's shuttering. That bottleneck illustrates what critics mean by 'donor-driven.' With barely 3 percent of household surveys in low-income countries fully-financed by the local government, the WHO notes, most nations must rely on 'externally led surveys…limiting continuity and national ownership.' When the donor funding stops, so does the data pipeline. An ICF spokesperson pushed back saying survey priorities were 'primarily shaped by the participating countries.' Yet, of the $25 million that arrived from Gates, a large portion of it will go toward completing large-scale surveys in Nigeria and Kenya, two countries that also happen to be key 'geographies of interest' for the Gates Foundation's own strategic priorities, underscoring how funders still steer the spotlight. Insiders I spoke with described ICF's system as a 'black box,' with key parts of its methodology controlled by the contractor, leaving countries without the capacity to stand on their own. That matters because without home-grown statisticians and know-how, ministries can't rerun surveys or update indicators without outside help. In response, ICF stated that the program has a 'proven track record of building a long-term capacity,' noting that countries like India no longer require its assistance. But critics argue that for every India, there are a dozen other nations where the program's sudden collapse is proof that a deep, sustainable capacity was never built. This dependency creates a fragile system that can, as just happened, collapse overnight, leaving countries unable to continue that work on their own. This unresolved tension brings the debate back to a central question from the UN's Chen. 'DHS has been there for four decades,' she asks, 'and why are we still having this program doing the survey for countries?' Chen's question gets to the heart of the debate. But grappling with the flaws of the past can't get in the way of surviving the present. Existing global health data is already several years out of date due to the pandemic, while crises in maternal mortality and child nutrition continue to unfold. The need is for reliable data now, because the fundamental reality remains: You can't help people you can't see.
Time of India
14-07-2025
- Health
- Time of India
One in five women in WHO Southeast Asia region covered under health insurance, study estimates
New Delhi: About one in every five women in the WHO Southeast Asia Region , including India, are covered under a health insurance, a study published in The Lancet Regional Health Southeast Asia has estimated. One in eight women in the region - defined by the World Health Organization (WHO) - were enrolled in social security schemes. At the same time, only one in thirteen had privately purchased or commercial insurance, the analysis reveals. The 'WHO Southeast Asia Region' includes India, among other countries such as Bangladesh, Myanmar and Indonesia. Researchers from Health Systems Transformation Platform and Population Council Consulting Private Limited, New Delhi, also found that one in four men in the region had health insurance coverage, with the highest prevalence seen in Indonesia at over 56 per cent and lowest in Myanmar at about 1.5 per cent. In India, the prevalence of health insurance uptake was 53 per cent among women and 56 per cent among men, the team found. The highest levels of health insurance coverage for women and men in the region were found in Indonesia, while the lowest levels were reported in Bangladesh and Myanmar, respectively. Equity in accessing quality healthcare without experiencing financial hardship is key to achieving Universal Health Coverage (UHC) - one of the core aims of the United Nations' Sustainable Development Goals - especially in low- and middle-income countries in the WHO Southeast Asia Region, the authors of the study said. They added that healthcare demands and costs are expected to rise in the region as populations age. However, high out-of-pocket expenditures remain a barrier despite health insurance programmes in the region, they said. The study analysed socioeconomic and demographic factors to estimate coverage under any health insurance, using data from Demographic and Health Surveys (2015-2022) conducted in the WHO Southeast Asia Region every five years. "Approximately one in five women in the region were covered by any form of health insurance," the authors wrote. "In contrast, one in four men in the region had any health insurance coverage, with the highest prevalence observed in Indonesia (56.6 per cent) and the lowest in Myanmar (1.4 per cent)," they wrote. Older age, higher education levels, and higher exposure to media were found to positively influence insurance coverage for both men and women in India, Indonesia, Nepal, Bangladesh and Myanmar. Further, beyond individual factors, contextual ones such as government commitment, design and implementation of insurance schemes and economic conditions are crucial in determining health insurance coverage, the authors said. Traditional beliefs and a lack of trust in formal financial systems can hinder insurance adoption among South Asian communities, they added. Evidence suggests that in rural areas of India, Nepal and Bangladesh, people relied on community-based informal support systems over formal insurance, reflecting cultural preferences that affect enrolment rates, the team said. The study's findings, therefore, highlight that country-specific contexts need to be addressed to effectively expand health insurance coverage, the authors said. They suggested policies should prioritise building sustainable health financing systems, making healthcare infrastructures more resilient, and fostering widespread awareness in the community about the benefits of health insurance. Further, strategies aimed at resolving socioeconomic disparities and for the underinsured populations are vital in advancing equitable health insurance access and accelerating progress towards UHC, the team said. PTI
The Hindu
14-07-2025
- Health
- The Hindu
One in five women in WHO Southeast Asia region covered under health insurance, study estimates
About one in every five women in the WHO Southeast Asia Region, including India, are covered under a health insurance, a study published in The Lancet Regional Health Southeast Asia has estimated. One in eight women in the region — defined by the World Health Organization (WHO) — were enrolled in social security schemes. At the same time, only one in thirteen had privately purchased or commercial insurance, the analysis reveals. The 'WHO Southeast Asia Region' includes India, among other countries such as Bangladesh, Myanmar and Indonesia. Researchers from Health Systems Transformation Platform and Population Council Consulting Private Limited, New Delhi, also found that one in four men in the region had health insurance coverage, with the highest prevalence seen in Indonesia at over 56 per cent and lowest in Myanmar at about 1.5 per cent. In India, the prevalence of health insurance uptake was 53 per cent among women and 56 per cent among men, the team found. The highest levels of health insurance coverage for women and men in the region were found in Indonesia, while the lowest levels were reported in Bangladesh and Myanmar, respectively. Addressing limited health insurance coverage Equity in accessing quality healthcare without experiencing financial hardship is key to achieving Universal Health Coverage (UHC) — one of the core aims of the United Nations' Sustainable Development Goals — especially in low- and middle-income countries in the WHO Southeast Asia Region, the authors of the study said. They added that healthcare demands and costs are expected to rise in the region as populations age. However, high out-of-pocket expenditures remain a barrier despite health insurance programmes in the region, they said. The study analysed socioeconomic and demographic factors to estimate coverage under any health insurance, using data from Demographic and Health Surveys (2015-2022) conducted in the WHO Southeast Asia Region every five years. "Approximately one in five women in the region were covered by any form of health insurance," the authors wrote. "In contrast, one in four men in the region had any health insurance coverage, with the highest prevalence observed in Indonesia (56.6 per cent) and the lowest in Myanmar (1.4 per cent)," they wrote. Older age, higher education levels, and higher exposure to media were found to positively influence insurance coverage for both men and women in India, Indonesia, Nepal, Bangladesh and Myanmar. Beyond individual factors Further, beyond individual factors, contextual ones such as government commitment, design and implementation of insurance schemes and economic conditions are crucial in determining health insurance coverage, the authors said. Traditional beliefs and a lack of trust in formal financial systems can hinder insurance adoption among South Asian communities, they added. Evidence suggests that in rural areas of India, Nepal and Bangladesh, people relied on community-based informal support systems over formal insurance, reflecting cultural preferences that affect enrolment rates, the team said. Bridging the health coverage gap The study's findings, therefore, highlight that country-specific contexts need to be addressed to effectively expand health insurance coverage, the authors said. They suggested policies should prioritise building sustainable health financing systems, making healthcare infrastructures more resilient, and fostering widespread awareness in the community about the benefits of health insurance. Further, strategies aimed at resolving socioeconomic disparities and for the underinsured populations are vital in advancing equitable health insurance access and accelerating progress towards UHC, the team said.
Daily Maverick
06-07-2025
- Health
- Daily Maverick
Free education benefits poorest girls most, Burundi study shows
New research in Burundi shows that scrapping primary school fees lifts all boats – but it's the poorest who benefit most in reproductive choices, literacy and income. Teenage pregnancy rates remain high across many parts of the developing world. In Africa, on average, about one in 10 girls between the ages of 15 and 19 has already given birth. These early pregnancies often come with serious consequences for young mothers and their children. They are linked to lower education levels, poorer health outcomes and reduced economic opportunities. Scientists, development agencies and NGOs have long heralded education as a powerful tool to reduce early childbearing. Education may directly influence women's reproductive behaviour, but it can also improve their employment and income-generating opportunities, leading them to postpone pregnancy. But does access to basic education for young girls result in such successes uniformly across population groups? We are economists who conducted a study to explore the effect of primary school education on fertility and its related outcomes in Burundi. A bold education reform took place in that country in 2005: the government abolished formal school fees for primary education. As a result, many children who had been excluded from school by cost were able to get a basic education. The free primary education policy displays a natural experiment for researchers interested in the effects of education. Because the reform applied only to children young enough to be in school, we could compare girls who were eligible for free schooling with those who were just too old to be eligible (but similar in other ways). This allowed us to track the policy's direct and causal effects. Indeed, we see that Burundi's free primary education policy increased educational attainment of women by 1.22 years on average. Our findings also provide new, robust evidence that education can reduce downstream effects, as we see teenage childbearing reducing by as much as 6.9 percentage points. In other words, whereas about 37% of teenage women who did not benefit from free primary education had given birth before the age of 20, only 30% of those eligible for free primary education had done so. Importantly, and new in our findings, education conferred the greatest benefit to girls from the poorest segment of society. Our study thereby underscores an important lesson for policymakers: education policies can be highly effective, but not necessarily for everyone in the same way. A natural experiment in Burundi We used nationally representative data from Burundi's Demographic and Health Surveys to establish the effects of education. We compared women born between 1987 and 1991 with those born between 1992 and 1996 – aged 14 to 18 and nine to 13, respectively, when the free school policy took effect. We applied modern econometric techniques to identify the increase in years of schooling induced by the policy. We then examined the effect of this increase in schooling on girls' outcomes, including teenage pregnancy, literacy and the likelihood of working for cash income, among other outcomes. The results were striking. Girls who had been young enough to benefit from free schooling gained, on average, 1.22 more years of education thanks to the programme. That corresponds to a 34% increase in the years of education compared with similar women who missed out on the policy. Crucially, this increase occurred across the board – both poor and wealthier women gained more education. But there was a twist: only young women from poor backgrounds seemed to reap broader benefits from that extra schooling. For girls from very low-income households, one additional year of schooling reduced the likelihood of becoming a teenage mother by nearly seven percentage points. It also decreased their desired number of children and boosted their literacy and chances of working for a cash income outside their own home. These are all powerful indicators of women gaining autonomy and making more informed reproductive choices. Although girls from wealthier households experienced an increase in education too, this additional schooling showed no measurable effect on fertility, literacy or employment outcomes for them. Thus, we did not find any statistically significant impact of increased schooling for these girls. In other words, the free primary education programme in Burundi increased the number of years of education for girls in general, but the downstream effects of that education appear to have materialised only for the very poor. Why does household wealth matter? Why would women from relatively wealthier families not benefit equally from more education? One reason could be that somewhat wealthier households had already ensured higher levels of education for their daughters, even before school fees were abolished in Burundi. The education reform thus made less of a difference in their lives. Very poor families, on the other hand, were far more likely to be constrained by the costs of primary education. When that barrier was removed, their daughters could finally access schooling, and this had transformative effects also for sexual and reproductive health. For the most disadvantaged, education is more likely to open up new economic opportunities. We found that policy-induced education increased their likelihood of working outside their own household for a cash income, which raises the opportunity cost of early childbearing. The classic economic theory by Nobel Prize laureate Gary Becker and colleague Jacob Mincer suggests that when women have better employment prospects, they are more likely to postpone childbirth. And they invest more in their children but tend to have fewer of them. This is precisely what we observed in our data. Education also seems to empower women by increasing their knowledge and capacity to access information. We found that literacy rates among poor women rose significantly with each added year of schooling. Another prominent theory in the literature on education is that educated women are more likely to understand and use contraception, make informed reproductive decisions and challenge traditional gender norms. Rethinking one-size-fits-all policies Our study underscores an important lesson for policymakers: education policies can be highly effective, but not necessarily for everyone in the same way. When evaluating the success of reforms like free primary education, we must go beyond average effects. Aggregated data can mask substantial differences between groups. If we had only looked at average outcomes, we might have concluded that free schooling had little effect on teenage childbearing. But by disaggregating our data by household wealth, we see a different and far more hopeful picture. Free schooling has powerful effects – if we know where to look. DM First published by The Conversation. Frederik Wild is a postdoctoral researcher at the University of Heidelberg in Germany. David Stadelmann is chair of economic policy and economic development at Bayreuth University in Germany. This story first appeared in our weekly Daily Maverick 168 newspaper, which is available countrywide for R35.
The Hindu
10-06-2025
- Politics
- The Hindu
India's population reaches 146.39 crore, fertility rate drops below replacement level: UN report
India's population is estimated to have reached 146.39 crore by April, says a new UN demographic report, which adds that the country's total fertility rate (TFR) has declined to 1.9, falling below the replacement level of 2.1. The population is expected to grow to 170 crore before starting to dip in about 40 years, the report titled 'State of the World Population 2025: The Real Fertility Crisis' says. It calls India the 'world's most populous nation', while pegging former leader China's current population at 141.61 crore. The demographic indicators in the United Nations Population Fund report for 2025 are close to India's own projection of its population published in 2019 by a technical group of experts. According to these projections, India, as of 2025, is estimated to have a population of 141.10 crore. The decennial Census, due to have been conducted in 2021, has been delayed and the government has now announced that it will be completed by March 2027. The last Census was conducted in 2011. According to the latest Sample Registration System statistical report published by the Office of the Registrar General of India for 2021, the TFR in India was 2.0, the same as the year before, with the report saying that the replacement level TFR 'has been attained' nationally. The TFR measures the number of children a woman is expected to have throughout their reproductive age. Replacement level TFR is the rate needed for each generation to replace the previous generation's population. The real crisis The UN report says that millions of people are not able to realise their real fertility goals. Calling this the 'real' crisis, and not overpopulation or underpopulation, the report calls for the pursuit of reproductive agency — a person's ability to make free and informed choices about sex, contraception and starting a family — in a changing world. India's youth population remains significant, with about 24% of the population in the age bracket of 0-14, 17% in age group of 10-19, and 26% in the age group of 10-24. Further, the report estimates that 68% of the population in India is of working age (15-64 years). The elderly population (65 and older) currently stands at 7%, a figure that is expected to rise in the coming decades as life expectancy improves, it adds, confirming the projections the government in India has been working with. The UN report says that as of 2025, life expectancy at birth is projected to be 71 years for men and 74 years for women. The report says its statistical tables on demographic indicators 'draw on nationally representative household surveys' such as 'Demographic and Health Surveys (DHS) Multiple Indicator Cluster Surveys (MICS), United Nations organizations estimates, and inter-agency estimates'. 'They also include the latest population estimates and projections from World Population Prospects: The 2024 revision, and Model-based Estimates and Projections of Family Planning Indicators 2024 (United Nations Department of Economic and Social Affairs, Population Division),' it adds.
