Series

Health Statistics 4
From data to policy: good practices and cautionary tales
Carla AbouZahr, Sam Adjei, Churnrurtai Kanchanachitra

Summary
Sound statistics are a key component of evidence. However, many institutional, political, and practical barriers Lancet 2007; 369: 1039–46
impede effective use of data to inform policy. In the fourth paper in this Series on health statistics, we look at the This is the fourth in a Series of
relation between health statistics and policymaking at country and global levels. We propose a fourfold framework to four papers on health statistics
help the transition from data to policy. Good practices include: (1) reconciling statistics from different sources; Health Metrics Network, World
Health Organization,
(2) fostering communication and transparency, including reaching out to the media for dissemination; (3) promoting
27 Avenue Appia, 1211 Geneva
country ownership of data and statistical analyses; and (4) addressing conflicts of interest, including those arising 27, Switzerland
when workers responsible for attainment of health goals are also charged with measurement and monitoring of (C AbouZahr MSc);
progress. Further investments are needed not only in primary data collection across a full range of sources but also Initiative for Maternal
Mortality Programme
in building capacity in countries to analyse, interpret, and present statistics effectively in ways that are meaningful
Assessment, University of
and useful for policymaking. Aberdeen, Aberdeen, UK
(S Adjei MD); and Institute for
Statistics have been described as the eyes of policymakers,1 many forms: research, economic, and statistical Population and Social
Research, Mahidol University,
yet health policymakers too often find themselves unable modelling; cost-benefit analyses; stakeholder opinion;
Bangkok, Thailand
to see clearly through the fog of competing, confusing, and public perceptions and beliefs. The important feature (C Kanchanachitra MD)
misleading, or missing data. In this Series, researchers is use of rigorous techniques to develop and maintain a Correspondence to:
have tackled the vexed issue of why, at a time of robust evidence base from which to develop policy Carla AbouZahr
unprecedented global interest and investment in health, options. Sound statistics underpin evidence-based policy, abouzahrc@who.int
provision of clear answers to simple questions—such as although they are rarely sufficient. In addition to
who dies from what cause and whether things are getting statistical data, provision of a solid analysis that sets
better or worse—is proving so hard. First, Boerma and information in context is important, as is understanding
Stansfield2 pointed to evolving complexity in health of stakeholder perceptions that could give rise to different
challenges, inveighed against epidemics of indicators, analyses of the same dataset. Here, we will focus on the
and suggested strategies to address the supply-demand systematic and rigorous use of statistics to inform
imbalance. In the second paper, Murray3 posited advocacy, programme design, and policy choice,
standards of good practice for health statistics and forecasting, monitoring, and assessment.6
critiqued well-meaning initiatives, such as the In public health, the underlying assumption is that
Millennium Development Goals (MDGs), which end up good data will lead to better decisions, which will result
distorting statistical processes. Third, Walker and in enhanced population health. This idea is the basic
colleagues4 took the user viewpoint and issued the classic premise of the Health Metrics Network and is implicit in For the Health Metrics Network
warning—caveat emptor. efforts by other groups to augment availability and quality see http://www.healthmetrics
network.org
In this fourth and final paper in the Series, we look at of health statistics, such as the Harvard Initiative for
how these global processes are perceived, interpreted, Global Health or the Initiative for Maternal Mortality
and modified at country level. How do national Programme Assessment.7–10 However, the assumption of
decision-makers manage the health statistics maelstrom, a linear relation between evidence and policy has been
navigating the stormy waters between their country’s justifiably questioned.11 In practice, no necessary linear
needs and global demands, advocacy and objectivity, sequence exists from good data to better health.
so-called empirical and modelled estimates, and Various types of data are obtained at different levels of
disease-specific and health-system perspectives? We the health system, to be used by several actors for many
recommend a fourfold schema of good practices to reasons. Providers generate and use information in the
stimulate better use of statistics to inform national context of patients’ care; managers need data to enhance
policymaking. Our approach is directed mainly at workers efficiency and effectiveness; planners rely on statistics for
whose role is to translate data into information for policy operational decisions; and policymakers use information
action, at both country and global levels. for prioritisation and resource allocation (figure 1). At the
level of clinical practice, good quality of care is greatly
The rocky path from data to policy facilitated in the presence of well-kept records of patients’
Evidence-based policymaking has been defined as a characteristics and providers’ responses. Yet good clinical
“rigorous approach that gathers, critically appraises and record-keeping remains far from universal.12 As we move
uses high quality research evidence to inform policy up the health-system pyramid, the link between data and
making and profession practice”.5 Evidence can take decisions seems more tenuous, and many factors come

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 Series
Strategic Global Strategic decision-making
information Policies and priorities
National Resource allocation
planners
Implementation of policies
Operational
District managers Resource management
information
Facility management
Facilities Operational efficiency
Coverage
Patients’ Patients and communities Patients’ care
care Community mobilisation
Figure 1: Various data needs at different levels
into play when strategic decisions about resource
allocation are made.
In a large and complex society, policymaking is
fragmented and decisions are sometimes difficult to
make because of several players and interests (figure 2).
As a result, decision-making on important issues can be
delayed or compromised. High-level policy is thus likely
to indicate established power structures and to support
the core values and objectives of powerful elites.13 Even
when decisions are mainly technical in nature, many
factors constrain rational evidence-based approaches:
difficulties are rarely defined with sufficient clarity for
solutions to become evident, and workers making
decisions do not have the time, inclination, or technical
skills to analyse alternative options. The line of least
resistance is to allow previous guidelines to direct present
policy.14
There is a gulf of misunderstanding between policy-
makers and technical experts. Policymakers are regarded
as too busy, superficial, uninterested in detail, and prone
to drawing hasty conclusions and to making decisions
irrespective of evidence. Technical experts are perceived
to have little understanding of the policy implications of
their work and to have professional fads and use excessive
jargon. Both groups seek to legitimise their positions
with data—presenting information in different ways to
their audiences.4 The media are potentially the most
powerful bridge between technical experts and
policymakers but can add to misunderstandings.
Such difficulties are neither new nor confined to the
health sector. In 1991, the United States Agency for
International Development (USAID) funded the Data for
Decision-Making project15 with the aim to increase
effective use of data in setting health priorities and
policies. Strategies consisted largely of skills building in
For the Routine Health epidemiology and problem-solving. The Routine Health
Information Network see Information Network has postulated that the scarcity of
http://www.rhinonet.org
evidence-based decision-making is the result not so
much of technical issues related to data generation but of
institutional and behavioural barriers that impede effect-
ive use of information. In 2004, concerned at the weak-
ness of evidence-based decision-making in development
1040
policy, the Organisation for Economic Cooperation and
Development organised a world forum on statistics,
knowledge and policy.16 And Scott6 has argued that the
transition to evidence-based policymaking can best be
achieved by formulation of national strategies for the
development of statistics. The quest for evidence-based
policymaking has greatly stimulated production of health
statistics, usually generated by researchers and funded
by donors and agencies that want to show the effectiveness
of their development policies. But when statistical
estimation processes sideline locally available data they
can be perceived as top-down and disempowering at
country level. Language can be evocative in itself: what
one side describes as crude data the other perceives as
empirical; your corrected value is my guestimate. How
do these tensions arise in interactions between country
and global processes? To what extent is a country’s
policymaking affected by global efforts to enhance data
availability and quality? Does use of crude reported data
or corrected or predicted estimates make a difference?
We now review these issues and consider what safeguards
can be put in place to avoid the situation in which
statistics are brushed aside when policy decisions are
being taken.
Merits and shortcomings of different data
sources
Routinely reported service data
Health policymakers turn naturally to the health-care
system for information. Routine and administrative
reports are generated as a by-product of patient-provider
interactions and health-facility functioning. (Routine
administrative records also generate data for vital
statistics through the civil registration system. However,
in most low-income settings, these systems are rarely
comprehensive in coverage or of sufficient quality to be
used as a basis for generating health statistics.) Health
facilities are a primary source of data for notifiable
diseases and thus are at the heart of a country’s
surveillance and response programmes, although facility
case-reporting needs to be complemented by active
Health
Media Community workers Politicians Donors
Data Process of policymaking Policy
Peer Special Budgets Inertia Non-governmental
pressure interests organisations
Figure 2: Effect of vested interests on policymaking and statistical inputs
Adapted from ref 14 with permission of the World Health Organization.
www.thelancet.com Vol 369 March 24, 2007

case-seeking strategies to generate a complete picture of
epidemic risk. Facility-generated reports (sometimes
referred to as health management information systems)
are the unique source of data for delivery of medical
interventions such as antiretroviral treatments or
tuberculosis drugs.
Cautionary lessons can be learnt, however, when using
service data for policymaking—one related to overload,
the other to missing information. Over-reliance on
service data to monitor increasingly complex interventions
has led to a situation in which ever larger volumes of
statistics are needed. There is no shortage of analyses of
the reporting burden that health-care providers bear.17
Various solutions have been proposed, including
alleviation of reporting requirements of funders and
development partners18,19 and rationalisation of
health-indicator lists.20 The difficulty is not confined to
developing countries. In the UK, a health and social care
information centre has been established to streamline
collection and sharing of data.21 One of its underlying
principles is that reduction of the burden of data
collection for frontline health-care staff will free them to
concentrate on providing care to patients.
On the other hand, no matter how many data elements
are routinely reported, information is inevitably biased
by patterns of service use and non-use, and the extent or
direction of bias is impossible to ascertain without
recourse to other sources of data, such as population-based
surveys (see next section). Services delivered (number of
immunisations, antenatal visits, outpatients seen, etc) do
not necessarily equate to population need. The
USAID-funded world fertility surveys were established
because of low confidence in routinely reported data for
contraceptive use during a time of great concern about
population growth. Growing interest in child health in
the developing world during the 1980s stimulated the
evolution of these surveys into demographic and health
surveys. When UNICEF needed to monitor the goals of
the 1990 World Summit for Children it launched
multiple-indicator cluster surveys. These methods have
expanded greatly the volume and quality of
population-health data and thrown a harsh light on
discrepancies between routinely reported and
survey-generated information (figure 3).
Population-based data
Mistrust of service-based statistics has fuelled interest in
household surveys that can generate unbiased data for
populations as a whole rather than just the sections that
use available health services. Population-based household
surveys are a predominant approach for reporting
progress towards health goals and targets such as the
MDGs.22 However, from the perspective of a national
policymaker, household surveys have several
disadvantages. First, they need large investments in
human and financial resources and therefore are usually
funded externally, resulting in bias towards the interests
www.thelancet.com Vol 369 March 24, 2007
Series
120
Proportion of eligible Ghanaian children
Survey data
immunised against measles (%)
100 Routinely reported data
80
60
40
20
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Year
Figure 3: Comparison of routinely reported and survey data for immunisation coverage
Data from Ministry of Health, Ghana.
of donors or well-sponsored programmes. Second, they
are time-consuming (from planning to fieldwork, data
cleaning, tabulation, and analysis), are undertaken
occasionally (every 5 years or so), and generate results
spanning a period, rather than the immediate past.
Moreover, samples are rarely of sufficient size to deliver
subnationally valid results. As a result, policymakers
generally prefer to rely on data reported routinely through
health facilities, which are available locally and
continuously.
Ghana provides an example of this dilemma. Health
services in that country regularly report coverage rates
for indicators—such as antenatal care, derived from
routine service-delivery records—of more than 100%.
Such implausible numbers result from underestimation
of denominators calculated by extrapolation from the
census (about which there were some concerns in
relation to overall coverage) and probable overcounting
of numerators.23 Although demographic and health
surveys in Ghana have generated other credible coverage
estimates, they are a difficulty for planning because they
are deemed to be out of date. One solution would be to
increase the frequency of population surveys, from every
5 years to every 2–3 years. However, this change raises
the acute issue of costs and sustainability.
Growth in surveys to generate health-related data has
been fuelled by their ability to deliver statistics (including
disaggregations) on child mortality, population coverage,
and certain risk factors. In the past few years, scope for
measurement of health status with household surveys
has greatly expanded owing to cheap and reliable
diagnostic tests that can be used in the research setting
to generate population-based estimates of disease
prevalence, such as HIV infection, anaemia, and
hypertension. But surveys are not as effective for
measurement of adult mortality, which is a relatively rare
event compared with child mortality. For example, use of
surveys to apply indirect measurement techniques for
estimation of maternal mortality has been beset with
difficulties.24
1041
 Series
Reporting to global
agencies
(MDGs, etc)
1. Country data 2. Global synthesis
generation and estimate
production
The weak link Policy guidance
in low-income Disease management
countries Global health partnerships
4. Country resource 3. Global resource
allocation allocation
UN
technical standards
Donor
Figure 4: Effect of global processes on local decision-making
Estimates produced by global agencies
Population surveys and health services generate empirical
data that countries recognise. However, neither item
alone is sufficient for reporting health trends accurately
and in a timely way. To fill the gap, global development
partners produce estimates that can differ from
country-reported figures. Murray’s article in this Series3
differentiates crude health statistics (emanating from
primary data collection with no adjustments), corrected
health statistics (corrected for known biases), and
predicted statistics (based on statistical models relating
the quantity of interest to covariates).
Using analytical techniques is widely accepted to
generate correction factors and predicted statistics in
economics and demography25 but is less common in
health research. Conflicts might arise when a country’s
reports differ from agency estimates. As Boerma and
Stansfield note,2 UN agencies report progress towards
health MDGs with predictions rather than direct
measures. WHO’s World Health Report 200026 was
criticised because country indices of health-system
performance were largely developed at WHO
headquarters.27 When the first global burden of disease
study was published in 1996,28 critics argued that the
weakness of the underlying data resulted in an
inappropriate reliance on statistical modelling and
extrapolations. These results have nonetheless been
hugely influential in policy debates at global and country
levels, largely because of their effect on donor priorities
and funding streams.29–31 Figure 4 summarises the effect
of international agencies on generation and use of
information for global and national policymaking.
In an ideal world, a country’s decisionmaking would
result directly from analysis and use of national data. In
practice, health and development agendas are greatly
affected by statistical and analytical work of development
agencies such as WHO, UNICEF, and the World Bank,
whose statistics for child mortality or HIV prevalence are
used to prioritise external aid. Distribution of global
1042
resources exerts powerful pressure on a country’s
concerns, both directly (in the form of donor allocations)
and indirectly (through technical guidelines and
standards). The end result is that the desirable path
linking a country’s data to national resource allocation is
actually the weakest link in the chain.
This cautionary tale has important riders, however.
Despite the controversy that agency estimates sometimes
generate, they can fill an important void and help
countries set policy priorities and tackle neglected or
emerging issues. Stimulated by global results,
policymakers in developing countries are demanding
national global burden of disease exercises to help
ascertain priorities for health intervention; Tanzania and
South Africa have used the approach at subnational level
also.30,31 Similarly, the interest of policymakers in
cost-effectiveness analysis was stimulated after initial
global work by WHO.32
An additional benefit of global estimation is reduction of
discord by stakeholders of values for particular indicators.
In 2001, when the UN Secretary General gave development
agencies the task of reporting annually on progress towards
the MDGs, the extent of the disharmony was laid bare. To
highlight just one example, different values for child
mortality were reported by WHO, UNICEF, the UN
Department of Economic and Social Affairs, and the World
Bank. Today, through the efforts of groups such as the
Child Health Epidemiology Reference Group and the
UNAIDS Reference Group on Estimates, Modelling and
Projections, which bring together independent technical
experts to advise agencies, vastly better and more consistent
figures are used by all agencies.
Smoothing the pathway from information to
policy: a fourfold schema
Although important challenges need to be addressed in
terms of data availability and quality, resolution of these
technical issues alone is unlikely to be sufficient to
overcome barriers to evidence-based policymaking.
Smoothing the pathway from information to policy needs
action on the demand side, including management of
tensions arising from different values and conflicting
political, technical, and cultural perspectives. We present
a fourfold schema of good practices at country and global
levels that can help facilitate better links between data
and policy (panel).
Data reconciliation
Policymakers, whether at national or global level, are
interested in results rather than processes and appreciate
clarity above all. They have to make decisions at speed
and must be able to process information quickly. Their
range of responsibilities is such that they cannot have
in-depth knowledge about every issue.33 Nothing is worse
from a policy perspective than statistics that are complex,
difficult to interpret, and subject to disagreements.
Complaints about use of modelled or imputed data
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sometimes arise because of the potential for endless
debates about validity and appropriateness of statistical
methods used.
A report to the UN statistical commission expressed
concern at the extent of “significantly modified or
imputed data” for reporting on progress towards MDGs.34
Imputed data are perceived to be unhelpful for analysis
at country level. This issue is more than simply about
data quality but is an indication of the nature of
measurement in complex arenas such as health.
Measurement is always subject to error, and when several
techniques are used to obtain data for the same variable,
differences inevitably arise, as shown by debates on
statistics of prevalence of HIV in sub-Saharan Africa.35
Discrepancies in prevalence estimates derived from
antenatal surveillance and household surveys can result
in confusion and loss of credibility if not presented
carefully to policymakers and the public. Reconciliation
of statistical values arising from different sources and
measurement techniques should be a standard part of all
analysis, presentation, and dissemination endeavours.
Capacity for such reconciliation needs to be built at
country level rather than monopolised by development
partners.
Information communication
Even when data have been gathered and summarised to
high standards, further analysis—of what is both reported
and missing—is usually needed before the information
can be disseminated and communicated to non-technical
audiences and used as the basis for policymaking.36 Data
should be presented and assessed not for their empirical
worth alone but in formats that emphasise relations to
past trends, current policy, and fiscal considerations.
Much reporting falls far short of this standard. Even
when collection procedures are well-established and
annual reports available—containing many tables and
charts (as in Uganda37 and Cambodia38 for example)—there
is generally little in terms of verbal summary or
interpretation to guide attention to the essentials. Many
Panel: Good practice recommendations
• Reconcile data from different sources rather than relying
on only one source of information. Dependence on single
sources increases risk of making decisions based on
statistics that are incomplete or biased.
• Foster transparency in the way data are obtained,
analysed, and presented, and make effective use of the
media for dissemination of information.
• Promote country ownership of statistics and reduce
disputes between national authorities and global agencies.
• Explicitly recognise and address conflicts of interest of
stakeholders, especially of those responsible for advocacy
and fundraising for specific health initiatives and those in
charge of overall health policy.
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Series
country reports contain a wealth of raw data served in
formats unpalatable or incomprehensible to policy-
makers. Presentation of complex information in simple
charts and maps is a well-tested route to enhancing use
of data for decision-making. In Thailand, efforts to better
present and disseminate findings have been led by the
Health Information System Development Office, which
produces analytical summaries of important health topics
such as geographical differences in mortality.39
Information can be conveyed directly to policymakers
or indirectly through secondary audiences, such as
academics, researchers, health professionals, parliament-
arians, or advocacy groups, who are in a position to affect
policymakers. Communication channels include semi-
nars, peer-reviewed journals, special events, national and
international meetings, and policy briefs.
The media can be both friend and foe in translating
health information into formats for policymakers and for
civil society. Examples of misinterpretation of health
statistics by the media are numerous and the line between
appropriate public information and the creation of panic
and so-called trial by media can be a fine one.40 Failure to
distinguish cases of diarrhoea from cholera caused panic
in South Africa, for example.41 On the other hand, the
public can be reassured when media reporting is timely
and accurate.42 Some countries have set standards and
guidelines for information dissemination, including
relations with the media.43 Statistics Canada relies on
media coverage to inform the public of the findings of its
many surveys and related programmes and, in the case
of the census, the actual census-taking. Policies have
been elaborated to guide this ongoing relation.44
Country ownership
If a country’s policymakers are to use data for
decision-making then they need to feel that the statistics
in question are actually theirs—that they have a part to
play in changing the situation.14 Scientific criteria alone
are rarely sufficient to persuade policymakers who have
to account for overall policy context, stakeholder
perceptions, and societal values. One of the difficulties
with global estimation efforts is that they sometimes fail
to generate ownership on the part of those in a position
to effect change at a country level. Ownership means
more than passive consultation from technical experts to
national focal points. In developing estimates of HIV
prevalence, a proactive approach has been taken to
ensure country involvement. The estimation and
projection package and spectrum AIDS modules,
developed with support from WHO and UNAIDS, are
used by countries themselves to generate prevalence
estimates and mortality projections based on sentinel
surveillance data. This approach has helped greatly, not
only to ensure acceptance of the results but also to
strengthen basic data collection because all countries
receive training and capacity building on a regular basis.
However, the process is costly and time-consuming and
1043
 Series
can be perceived as diverting resources away from the
delivery of interventions.
By contrast with HIV estimates, those for maternal
mortality were developed by WHO, UNICEF, and the
United Nations Population Fund (UNFPA) with little
country involvement.45 Although the estimates had a
positive effect in terms of drawing attention to a hitherto
neglected issue, many countries objected strenuously to
the estimates, and policymakers disavowed their use.
However, these statistics did stimulate attention to
empirical data collection. For example, Thailand
undertook a systematic review of data for maternal
mortality and noted that, depending on source and
methods, estimates of maternal mortality could vary by a
factor of three.46
Good examples of enhancing ownership are emerging
from the move to decentralisation and district-level
autonomy.47 When data gathered at district level can be
analysed and managed effectively, and a direct link is
made to decision making (in particular, resource
allocation), the sense of ownership is raised and
evidence-based decisionmaking is fostered. This process
requires skills to be built at local level, not only in data
collection but also in data handling, management,
analysis, and report writing. The Tanzania Essential
Health Interventions Project31 links data producers,
district managers, and policymakers through district-level
estimates of burden of disease (based on local mortality
data) and district health expenditures.
Conflict of interest
Although ownership is important, it should not be
confused with protectionism. Legitimate grounds exist
for disagreement about methods for generating statistics
in circumstances when the underlying database is weak.
However, a country’s policymakers also have less
defensible reasons for objecting to particular estimates.
There are powerful disincentives to openness, especially
when economic interests are concerned, and many
debates about quality of data are, in truth, about vested
interests and integrity.
A potential conflict of interest arises when people
responsible for delivery of health services or attainment
of health goals are also charged with measurement and
monitoring of progress. Perhaps the most blatant
example was the family-planning programme during the
1980s in India, in which the desire to achieve high-level
targets for contraceptive acceptance drove programme
managers to coercion and abuse.48,49 This example is
extreme, but risk of a conflict of interest is widespread.
The UK Health and Social Information Centre has
statutory independence from the National Health Service
to ensure its separation from service provision and to
permit objective monitoring.21
Overcoming the inherent tendency for programme
managers to exaggerate success and downplay failure is a
challenge in any setting. Thailand has sought to disentangle
1044
monitoring and assessment from service provision,
creating the Health Systems Research Institute in 1992,
with the mandate to assess health system and policy and to
report on progress towards national health goals.50 The
institute is made up of widely respected senior academics
and is legally independent of government, having its own
governing board, although it receives government funding.
In Ghana in 2003, a research, statistics, and information
management division was established, designed to be
independent of other corporate interests within the
ministry of health or Ghanaian health services.23 The
intention was to ensure separation of information
collection and processing functions from management
functions, thus preserving independence and integrity of
all management functions and enhancing the credibility of
monitoring and assessment. In practice, issues related to
precise demarcation of roles and responsibilities between
the government units dealing with health information are
still to be resolved. These examples are illustrative of
continuing tensions between people who provide services
and those who monitor performance.
Such debates are by no means confined to the national
setting, but can be equally potent at regional and global
levels. For example, Murray and colleagues51 have
criticised WHO for being constitutionally incapable of
maintaining objectivity and integrity in the face of
country pressures and of being driven to manipulate data
to meet the needs of disease-focused advocacy and
programming.
Conclusions
As more and more countries embark on health reforms
and strategies to reduce poverty, the need for sound
statistics to identify difficulties with implementation and
to assess outcomes will become increasingly acute. In a
complex world, keeping track of the effects of policy
decisions requires statistical systems that permit rigorous
monitoring and assessment. Very few good examples are
available, although valuable lessons have been learnt
from experiences in Mexico, which, uniquely, invested in
strengthening the health statistics system in parallel with
health reform with the explicit objective to monitor and
assess progress.52
Although good data are not sufficient, their absence
leaves space for policymaking to be driven by prejudice,
speculation, and ideology. All too often, investments in
solid country-based health information and statistical
systems have been deferred in favour of discrete data
collection exercises designed mainly with donor interests
or disease-specific programmes in mind. This situation
can lead to tensions between the global and national
levels. Yet, the apparent divide between these levels is a
false dichotomy. Countries need unbiased information
on health outcomes, and international partners benefit
greatly from harmonisation with a country’s needs. Both
will gain from a reduction of overlap and duplication of
data collection efforts.
www.thelancet.com Vol 369 March 24, 2007

Future investments should be thought through care-
fully to avoid further fragmentation of national health
information systems along disease-focused lines.
Investments should be used to build up a country’s
capacity across a full range of data sources, not only
routine service data and population-based sample surveys
but also comprehensive civil registration systems with
accurate and timely noting of births, deaths, and causes
of death. Increased investment needs to be directed into
regular health accounts so that policymakers can track
resource allocation alongside health outcomes.
Investment in building capacity in countries is equally
important for enhanced analysis and interpretation of
existing data. Production and use of better health statistics
needs a comprehensive strategic approach, aimed at
generation of better data now and at growth of sustainable
statistical capacity for the future. The sometimes
piecemeal efforts of the past have produced statistics but
not the capacity to replicate them in the future.1 To quote
Kenya’s minister for planning and national development:
“An essential component of any development planning is
data. Without data, a country’s efforts to plan for future
growth and welfare of its people cannot be grounded in
reality and therefore may be severely flawed.”1
Conflict of interest statement
We declare that we have no conflict of interest.
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