Discrepant estimates of key indicators for Millennium Development Goals 4 and 5: the public sector's experience in Rwanda

Abstract

BackgroundDebates about differing methodologies and results for estimating key global health indicators have major implications for policy makers in developing countries as the 2015 deadline for the Millennium Development Goals (MDGs) approaches. We aim to encourage discussions about accountability to countries on the part of stakeholders involved in estimation by relating Rwanda's experiences working to assess its progress towards MDGs 4 and 5. MethodsWe reviewed publicly available reports and databases maintained by multinational global health agencies to analyse discrepancies related to MDGs 4 and 5 for Rwanda. FindingsWHO's September 2012 and the United Nations Population Fund's (UNFPA's) November 2012 estimates of Rwanda's child mortality rate differed by 107% (54·1 and 112·0 deaths per 1000 livebirths, respectively), leading to very different conclusions about progress towards MDG 4. Because maternal mortality ratio estimates are based on fewer data sources, recent point estimates did not differ widely between sources; however, retrospective estimates did, making confident assessment of progress towards MDG 5 difficult. WHO, UNICEF, and the GAVI Alliance estimates falsely indicated that vaccine completion rates fell from above 95% to below 85% in just 2 years—a discrepancy with demographic and health surveys and programme data rectified through a technical workshop. Many discrepancies seem to be related to outdated projections of Rwanda's annual birth cohort that account for a 450% rise in contraception uptake and a 25% drop in total fertility rate since 2005. Failing to incorporate such key demographic changes in population estimates can yield declining coverage estimates even if the true proportion of children receiving an intervention remains constant or increases. InterpretationThe incorporation of country-derived data into international models should be accompanied by country consultations. Countries should be engaged as partners in identifying the most robust and timely primary data sources. Support for the development of vital registration systems in countries like Rwanda must be a pillar of the post-2015 development agenda. FundingNone.