Thursday, February 18, 2010

CA and accountability in the global health sector

Dear Colleagues

After reading the paper on Meeting the Demand for Results and Accountability: A Call for Action on Health Data from Eight Global Health Agencies I felt that I should reach out to the people who had written the paper. If they are committed to serious progress, then the CA initiative should be under consideration. This is the message:

Date: Sat, Jan 30, 2010 at 1:42 AM
To:, "Ruggiero, Mrs. Ana Lucia (WDC)"
Meeting the Demand for Results and Accountability: A Call for Action on Health Data from Eight Global Health Agencies
Dear Colleagues

I was interested in the recently published essay "Meeting the Demand for Results and Accountability: A Call for Action on Health Data from Eight Global Health Agencies".

I agree with much of what this essay describes ... but there are some areas where my recommendations would be different.

I would have liked to see in Table 1 some reference to community analysis. There is a recognition that the focus on single disease dataflows should be enhanced by broadening into an all-health focus. I argue for data that addresses all the factors that impact a person's well being in a community and especially the person's health. Money spent on water and sanitation might be more impactful than money spent on curative medicines, for example. Perhaps, money spent on a village health worker may be more useful than money spent in an urban hospital.

The goal of dataflows should be to get better results ... better health outcomes ... and this is partly done by getting better data to the international oversight and research organizations, but it is also done by getting more meaningful data into the hands of people making local decisions. This argues for more data that are useful about the health issues in a community and the resources associated with health
in that community. The key to better health is not more money spent on data, but more valuable data. Way better design of the data systems is possible and this is about using brain not just about more money.

The whole area of performance monitoring and evaluation needs a rethink. Some M&E is very good ... most is too little and too late ... and not done with an adequate level of independence and objectivity. I have experienced not being paid when my report did not satisfy the project that was being evaluated! Is this common ... no ... because
most report writers are unable or unwilling to take a stand ... and I do not blame them!

The approach to data needs to be reviewed in order to get more valuable data at much less cost. The attempts to improve the data flows do not appear to reflect optimized cost effectiveness. The technology to handle data has been cost reduced by several orders of magnitude over the past two decades ... but data still has a very high
cost. This needs to be addressed.

The approach to analysis needs to be improved. Approaches that are needed to support medical science are not needed in order to get data that deals with socio-economic matters. The cost of medical interventions is best done with an accounting approach ... and the profile of disease in a community best done using simple data recording associated with good diagnostic methods. Lots of statistics are not the best way to go for this sort of information.

It is unacceptable that most health program managers do not understand the behavior of cost in their programs, nor the impact of their programs. The difference between the concept of cost efficiency and cost effectiveness is rarely understood ... yet it is vital to good performance and progress with limited resources.

I like the fact that this essay has been written ... but it does stop short of where I believe we should be going. It is, nevertheless a useful start. If I can be helpful in clarifying these brief notes, I would be pleased to respond to any questions.

Peter Burgess
Peter Burgess
Community Analytics (CA)
And then I waited ... with not very much expectation of response.

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