Ties Boerma: improving health statistics

Abstract

It was a passion for Africa that drew Ties Boerma into health statistics fresh from medical school in the Netherlands. Although determined to work in tropical medicine, he soon realised clinical practice was not for him; medical demography seemed the ideal way to combine his interest in population health with an understanding of underlying clinical issues. Boerma is now Director of WHO's Department of Measurement and Health Information Systems, but over the years he has had to adapt his expertise in medical demography to diverse settings. While studying for an MSc in medical demography at Groningen's State University in the early 1980s, Boerma spent a year as a research assistant at the Medical Research Centre in Nairobi, Kenya. Returning to the country a few years later as regional health adviser for The United Nations Children's Fund, he faced the challenge of putting theory into practice—for example, by training health workers to create immunisation data graphs. He admits his role wasn't always easy. “You always struggle with the clinician's view that what they see in the clinics is really what's happening.” But Boerma's real interest lay in how health statistics should be collected and analysed and he joined the US-based Demographic and Health Surveys (DHS) in the early 1990s. His work focused on such issues as causes of death in childhood, survey questions on diarrhoea morbidity, subjective reporting of birthweight, and the links between education, fertility, and child mortality. But most of all, he says, “The DHS years taught me the importance of aiming for the highest possible quality of data. Only if data collection has been done as well as possible can it be repeated in the same way. Only then can we start to think about monitoring trends. There are no short cuts to collecting quality information.” It was while working for TANESA (the Tanzania-Netherlands project to support HIV/AIDS control in Mwanza region) that Boerma established a project that is still one of his proudest achievements. In 1994, he set up a rural cohort study of 20 000 people, for which he had to recruit a demographer from Dar es Salaam and a statistician from Mwanza. With some external help and funding from The Global Fund, the community study developed into an evaluation centre that is still running today. Boerma emphasises that this success reflects the dedication of his colleagues in Mwanza. That he ends an anecdote about a personal achievement with praise for his colleagues is typical, says child health specialist and collaborator Jennifer Bryce: “he takes his work very seriously, and himself less so”. The health information field has changed considerably since Boerma first became involved, with the Millennium Development Goals (MDGs) inevitably being a key driver of this change. “Household health surveys were rare in the early 1980s, but now every country has at least one or two every 5 years; the widespread use of computers has enabled us to analyse data much more rapidly, and the ability to interpret health statistics has grown as well.” The MDG-led scale-up of initiatives against such diseases as HIV and malaria, and increased funding from donor organisations, has sparked greater demand for accountability and data on effectiveness of interventions. Knowing where the money should go in the first place is vital to have a big effect with limited resources, says Boerma. But matching “the demand for quick results and rapidly shifting donor interests with sustainable efforts to build systems and capacity for information” can be difficult. In collaboration with the Health Metrics Network and the INDEPTH network of surveillance sites, WHO's Department of Measurement and Health Information Systems is working to strengthen data collection. Causes of death, for example, are often reported by verbal autopsy, and his team have created a standardised autopsy instrument, “which is pretty much ready, and there is interest from donors to scale this up”. Several health experts are concerned that the MDGs narrow the focus of global attention on health, and Boerma also cautions against tunnel vision. “We are in a rapid health transition worldwide”, he says, creating shifts in demographics, epidemiology, and risk factors. With chronic diseases emerging as a growing problem in developing countries, he says, data collection must have a broader mandate. For example, “when there is a household survey on child health, interviewers could also try to take adults' blood pressure or get an idea of the prevalence of diabetes”. Any health estimate is only as good as the data it is based on, and improving data quality is essential when numbers become lobbying tools for disease advocates, says Boerma. Along with the Health Metrics Network, Boerma's team is helping 65 countries to achieve better standards in data collection. They are investigating the collection and use of health data, together with what analytical capacity exists, to create a strategy until 2015. Given the magnitude of this daunting task, it's just as well Boerma's on board. According to Tikki Pang, Director of WHO's Department of Research Policy and Cooperation, Boerma “has a sharp, analytical mind which cuts to the heart of issues and is coupled with a willingness to question established practices and supposedly ‘accepted’ facts”. Health statistics are no longer boring!Health statistics hit the headlines almost daily, but controversies about statistics are not uncommon. Some have their origins in technical complexities; in other cases, disagreements are a cover for vested interests and political manoeuvring. Big diseases mean big money, and disease programmes cleverly use data to advocate their case. But a conflict of interest can arise when these same programmes are responsible for monitoring progress. Thus the highest possible standards and transparency are required. Full-Text PDF Health statistics now: are we making the right investments?Increases in international funding for health have been accompanied by accelerating demand for more and better statistics, which are needed to track performance and ensure accountability. Worldwide interest in the monitoring of development, as exemplified in the Millennium Development Goals (MDGs), generates pressure for high-quality and timely data for reporting on country progress. This rapid escalation of demand has exposed major gaps in the supply of health statistics for developing countries but also provides major opportunities to increase the supply and use of sound health statistics. Full-Text PDF