25 Apr 2019

Luminare: The DHS Program Blog Series on Innovation

This blog post is part of Luminare: The DHS Program Blog Series on Innovation. You can find additional posts in the Luminare series here.


Electronic data collection is now the standard in virtually all DHS surveys.

While The DHS Program is known for comparability and standard methods, it would not be relevant today without innovation. We’ve made big leaps – like moving from paper to tablet-based interviewing and from basic print publications to web and mobile data dissemination. We’ve integrated complex biomarker testing and developed weeks-long curricula in data analysis and use. We’ve also made hundreds of smaller, less flashy improvements, such as use of WhatsApp to communicate with field teams and the use of checklists to improve biomarker collection. Innovation – large and small – is part of life at The DHS Program, as we are constantly seeking new ways to solve problems, increase efficiency, and improve data quality while meeting the needs of an increasingly diverse audience. 

Over the course of the next several years, we will be undertaking a systematic review of new ideas, from new biomarker assays to non-traditional partnerships. This new blog series is just one of the ways that we will be exploring and sharing innovations. We will also be holding topical consultations with experts, reviewing the academic literature, attending key conferences, and interviewing key informants such as external survey experts, staff, consultants, and implementing agency representatives. 

Joanna Lowell, DHS-8’s Senior Science Advisor and Innovation Champion

In DHS-8, we have an even stronger mandate to innovate, and for the first time ever, we have a formal innovation strategy which is led by our new Senior Science Advisor, Joanna Lowell. Her job, in part, is to lead the “deliberate exploration and strategic incorporation of state-of-the-art advances in survey tools methodologies, and partnerships.”   

We welcome your ideas. You can reach out to Joanna directly at Innovations@dhsprogram.com and look out for announcements regarding other ways to contribute. 

10 Apr 2019

The DHS Program at the 2019 PAA Annual Meeting

DHS Program staff at the 2018 PAA Annual Meeting in Denver, Colorado. © 2018 ICF

Today marks the first day of the 2019 Population Association of America (PAA) Annual Meeting, and we’re excited to be back! The PAA Annual Meeting attracts demographers and other public health professionals from across the world to present their research, hear of others’ findings, and network with peers.

DHS Program staff will be available at booth #1 in the exhibition hall to answer your questions about DHS data, to provide tours of our web and mobile tools, and to distribute free DHS Program publications. So don’t be shy and stop by the exhibit hall to say hello!

Download The DHS Program at PAA Flyer for more details.

DHS Program staff will also be presenting their findings using DHS data. Find the schedule below:

04 Apr 2019

Spotlight on Implementing Agencies: Democratic Republic of the Congo

In January 2019, The DHS Program welcomed visitors from the Democratic Republic of the Congo. This post is one in a series of interviews with visitors to DHS headquarters.

Don’t read French? You can use the translate feature at the top of the page!

Nom : Didine K. Kaba

Pays d’origine :  République Démocratique du Congo

Titre et organisation : Professeur (MD, PhD), Département d’Epidémiologie et Bio statistiques, Ecole de Santé Publique de l’Université de Kinshasa

Rôle dans l’EPSS RDC 2017-2018 : Co-Investigateur de l’enquête


Vous pouvez nous raconter un peu sur votre expérience avec l’EPSS RDC 2017-2018 ?

C’est une enquête intéressante qui nous a permis d’auto évaluer nos compétences dans la réalisation d’une enquête de grande envergure. Dans l’EPSS, il s’est agi d’un échantillon des formations sanitaires disséminées partout en RDC.

Le pays étant grand (26 provinces), les données ont été collectées par vague, qui a été décidée afin de diminuer les sites de formation, permettre une bonne supervision des formations, et assurer ainsi la qualité des données.

Une autre chose que nous avons expérimenté, c’est l’appropriation de l’enquête par le Ministère de la Santé Publique, présent de l’adaptation des questionnaires jusqu’à la rédaction du premier draft du rapport de l’enquête. Son implication à tous les niveaux a facilité la tâche à nos différentes équipes, plus particulièrement à celles chargées de la collecte des données.

L’EPSS RDC 2017-2018 est la première EPSS en RDC. Vous pouvez commenter sur quelques défis ou succès spécifiques à une telle enquête, surtout étant la première expérience ?

Un défi c’est l’immensité du pays, avec accès très difficile dans l’arrière-pays, sans compter le fait que des conflits armés étaient encours dans le pays pendant la collecte des données. Au sein d’une même province, le transport aérien était parfois nécessaire pour accéder à des formations sanitaires soit séparées des autres par des champs de guerre ou alors d’accès difficile par route. Nous disposions également dans l’échantillon des formations sanitaires qui ne pouvaient être atteintes que par pirogue ou hors-bord. Ainsi, nous devrions d’une part respecter l’échantillon des formations sanitaires pour assurer la représentativité et d’autre part veiller à la sécurité des agents de collecte des données. Ce défi a également été relevé. En effet, nous avons collecté les données dans 1380 formations sanitaires sur les 1412, seuls deux pourcents de formations sanitaires n’ont pas été enquêtées.

Comment espérez-vous que les données de l’EPSS RDC 2017-2018 soient utilisées ?

Ces données sont très importantes et très attendues dans le pays. Chaque programme s’intéressera aux données en lien avec son domaine d’intervention. Les données de cette évaluation serviront à l’identification des problèmes à résoudre en vue de l’amélioration de la qualité de l’offre de service des soins en RDC.

Quelles sont d’autres leçons apprises ou pensées que vous aimeriez partager ?

  • Une autre procédure de rédaction d’un rapport d’enquête : informations clés pour chaque chapitre, encadrés pour définir chaque indicateur et commentaires par caractéristique de base ;
  • Maitrise de la formation des adultes/Andragogie : utilisé dans la formation des agents de collecte des données ;
  • Analyse des éditions secondaires des données et des tableaux de qualité avec feedback vers les agents de terrain pour l’amélioration de la qualité des données collectées ;
  • La collaboration entre institutions et le fait d’avoir de la considération des uns envers les autres au sein de l’équipe de recherche ont été le gage de la réussite de l’EPSS RDC 2017-2018. Chaque membre de l’équipe de recherche (agent de collecte des données, facilitateurs/superviseurs, agent de saisie, équipe informatique, équipe de coordination, etc.) avait fait de cette enquête son affaire. Notre motivation était la satisfaction de voir l’enquête se dérouler avec succès. Oui, c’était ça la clé de notre réussite.

The 2017-18  Democratic Republic of the Congo SPA  was released on March 22, 2019.

Download the final report here.

© ICF

21 Mar 2019

DHS Data Users: Insights on Health System Quality from the Service Provision Assessments

© 2017 Magali Rochat/VectorWorks, Courtesy of Photoshare

This new blog series, DHS Data Users, captures examples of how you, the data user, have incorporated data from DHS, MIS, and/or SPA surveys into your analyses, at your institution, or to influence policies or programs. If you are interested in being featured in the ‘DHS Data Users’ blog series, let us know here by submitting your example of DHS Program data use. 


The year 2018 saw an upswell of interest in health system quality with the publication of three global reports highlighting critical deficits in quality in health systems in low- and middle-income countries [1,2,3]. Much of the empirical basis for these reports was drawn from the Service Provision Assessments (SPA), the lesser-known surveys conducted by The Demographic and Health Surveys (DHS) Program, which provide comprehensive assessments of health systems in low-resource settings from Haiti to Nepal.

These surveys include a detailed audit of facility resources, provider interviews, direct observations of primary care services, and exit interviews with patients or caretakers. Each assessment is a sample of the complete health system (public and private) or in some cases a complete census. The resulting wealth of data enables assessment of structural inputs to quality of care, the care process – both competent care and user experience – and some outcomes from care, primarily user confidence in the health system. A small but increasing number of researchers is delving into all the SPA data have to offer. Among the insights the SPA surveys have yielded just from my own research are:

  • Most health systems assessed are not fully prepared for basic health care.
    A comparative study of 8,443 facilities in 9 countries based on SPA surveys between 2007 and 2015 found that hospitals averaged between 69% (Senegal 2012-2014) and 82% (Tanzania 2015, Namibia 2009) on the service readiness index defined by the World Health Organization for primary health facilities. Non-hospitals achieved at best 68% readiness (Namibia 2009) and at worst only 41% (Uganda 2007, Bangladesh 2014) [4]. Within primary care services – antenatal care, family planning, and sick child care – service-specific service readiness is not highly predictive of competent care being delivered.
  • Across facilities with a similar level of readiness, provider adherence to clinical guidelines varied widely. Correlation between readiness and observed clinical quality was more consistent for observations of labor and delivery, though only two SPA surveys include these data [5].
  • In Kenya, where the 2010 SPA did include direct observation of labor and delivery, both structural quality of maternity care and observed clinical quality was higher in facilities in wealthier areas than facilities in poorer areas, with women in the poorest areas receiving care that complied with only half of recommended clinical guidelines on average [6].
  • Across 8 countries, adherence to clinical guidelines was lower in sick child care, where providers completed only 38% of the standard Integrated Management of Childhood Illness (IMCI) items, than in family planning (46%) and antenatal care (57%) [7]. The median sick child consultation lasted only 8 minutes [8]. Focusing specifically on Malawi, where the survey team conducted a limited re-examination of sick children, providers diagnosed pneumonia in only 1 in 5 children who showed symptoms of pneumonia per the IMCI guidelines [9].
  • Analysis of the 2013-2014 Malawi SPA survey with a simultaneous household survey suggested that poor quality care may contribute to avertable neonatal mortality, with a predicted prevalence of neonatal mortality of 28.3 deaths per 1,000 in lower quality facilities and 5.2 deaths per 1,000 in higher quality facilities, among women who would choose higher quality if it were more accessible to them [10].

As attention shifts from describing health system quality to improving it at scale, robust and ongoing measurement will be an essential tool for governments and researchers alike, particularly the direct observation of care delivery and perspective from patients themselves that makes the SPA such a unique and valuable resource.

References


Written by Dr. Hannah Leslie

Dr. Hannah Leslie is a Research Associate at the Harvard Chan School of Public Health; she served as the Measurement Research Lead for the Lancet Global Health Commission on High-Quality Health Systems in the SDG Era. She received her MPH and Ph.D. in Epidemiology from the University of California, Berkeley. Her research has made extensive use of the Service Provision Assessment surveys to 1) develop metrics of structure and process quality in LMICs, 2) describe current quality of care, and 3) assess predictors and effects of poor quality. Her recent work focuses on effective coverage calculations, patient experience measurement, and quality of care as a driver of HIV testing and treatment retention.

08 Mar 2019

International Women’s Day 2019

© 2016 Kato James, Courtesy of Photoshare

The DHS Program is now in its 35th year with a long history of helping to collect, analyze, and disseminate data on women’s empowerment, gender equality, men’s engagement, and gender-based violence within the context of health and development. Historically, The DHS Program has integrated attention to gender in all its activities and aspects of its operations, from the types of data collected and disaggregated and analyses conducted, and the “how” and the “who” of data collection, capacity strengthening, dissemination, and use.

Over the coming five years, The DHS Program will continue its cross-cutting approach to gender integration into its work and surveys. In particular, The Program will endeavor to help achieve the agency-wide commitments mandated by USAID’s Gender Equality and Female Empowerment Policy. The DHS Program supports USAID’s objectives and has adopted an updated Gender Integration Strategy with the following priorities:

  1. Continued collection of high-quality data for gender indicators and sex disaggregation: The project will continue to contribute to evidence-based, gender-integrated health programming by providing the data necessary for understanding gender disparities related to health, including disparities in wealth, access to resources, and decision making power. Similarly, it will continue to collect data on domestic violence; early marriage and skewed sex ratio; household headship; women’s relative earnings and control of their earnings; women’s ownership of a house, of land of a bank account, and of a mobile phone; as well as female genital cutting and fistula.

    The DHS Program will monitor and respond to emerging needs for gender data important for women’s health and demographic behavior. The DHS Program is soliciting public feedback through March 15, 2019, on potential new areas/indicators/questions, including on the measurement of gender equality, male engagement, women’s empowerment, decision making, and domestic violence. This feedback will help identify some of the current gender-related data gaps.

  2. Increased focus of dissemination efforts to highlight gender disparities in health and resource and opportunity access: Data collected on gender and women’s empowerment are widely disseminated using digital, print, and other means. Most indicators are readily available on the STATcompiler, The DHS Program’s Mobile App, and the DHS API. The DHS Program website also maintains a “Gender” topic page, which provides a one-stop shop for gender indicators from DHS surveys.
  3. Enabling gender equality in access to opportunities, capabilities, learning, and resources: The DHS Program will continue its efforts to ensure that there is no discrimination by sex, pregnancy status, sexual orientation, or gender identity in access to opportunities for training, employment, and learning all along the survey continuum.
  4. By maintaining confidentiality and gender-sensitive protections. The DHS Program has strict ethical guidelines to protect respondents and interviewers and ensure confidentiality of respondents, their families, and of the data. While these guidelines apply to all respondents, they also specifically recognize the need for special protections for women in certain circumstances.
  5. By exploring technologies to ask highly sensitive questions: Several of the questions asked in DHS surveys are highly sensitive. While some of these sensitive questions are asked of both women and men, such as number of sexual partners, some others are mainly asked of women, including questions on experience of sexual violence. Improving the validity of responses to these questions remains a challenge for any survey program, and it is important to look for ways to both improve reporting and also provide respondents with a more secure platform to disclose sensitive information, such as audio computer assisted self-interviewing (ACASI).
  6. By continuing to integrate gender into the research agenda: The DHS Program’s research agenda continues to include innovative studies that shed light on the linkages between gender and health. The DHS Program will undertake many new research projects that will contribute to a better understanding of the level and changes in women’s empowerment and the interface between gender and health outcomes as well as gender disparities in health, while also applying a gender lens to analyses that do not directly involve gender indicators. In the meantime, read the latest gender analytical publications.

For International Women’s Day 2019, The DHS Program invites you to explore the wealth of gender-related resources and publications available at dhsprogram.com. Learn more about Sustainable Development Goal #5, Gender Equality indicators available in DHS surveys in the infographic below.

28 Feb 2019

Strengthening Nutrition Data Quality at The DHS Program

A health technician tests a child for anemia during a survey training. © 2018 ICF/Sorrel Namaste

“Everything bad can go wrong at collecting the sample, and you can’t get any good results from a bad sample. ” – Informant from the Enhancing Nutrition Data Quality Report

Data for decision-making is vital as countries work to reduce the burden of malnutrition and to measure progress towards the Sustainable Development Goals and the Global Nutrition Targets 2025.

The DHS Program, a leading source of nutrition data globally, has invigorated its focus on the quality and depth of the types of nutrition data collected. To this end, a qualitative study was undertaken to identify how to enhance the quality of nutrition data. Interviews were conducted with 50 experts internal and external to The DHS Program, and DHS staff participated in focus group discussions. Informants highlighted critical challenges that exist in collecting anemia, anthropometry, and infant and young child feeding data in large surveys while also offering solutions to strengthen data quality.

The outcomes from the study are summarized in the report “Enhancing Nutrition Data Quality in The DHS Program” which calls for the implementation of 32 recommendations. The DHS Program is already addressing most of these recommendations (21 out of the 32) and plans to take up additional recommendations throughout DHS-8. These include revising hemoglobin cutoffs in STATcompiler, working with the WHO to develop a technical error of measurement value for passing an anthropometry standardization exercise, and testing new indicators for real-time monitoring of fieldwork. Future blog posts will explore the application of these recommendations across the stages of a DHS survey.

Recommendations to enhance nutrition data quality were identified across The DHS Program survey stages. © 2018 ICF

The DHS Program is committed to continuous quality improvement and is uniquely positioned to implement new data quality measures. Yet, the report is not only intended to inform operations at The DHS Program. The lessons learned are applicable to wider audiences involved in the collection and use of nutrition data throughout the world. Strengthening the quality of nutrition data will lead to improved data-driven nutrition actions.


Written by Sorrel Namaste and Rukundo K. Benedict

Dr. Sorrel Namaste is the Senior Nutrition Technical Advisor for The DHS Program. She is an epidemiologist with expertise in nutrition assessment and implementation research. 

 

 

Dr. Rukundo K. Benedict is the Nutrition Technical Specialist for The DHS Program. She is a public health nutrition practitioner with expertise in infant and young child feeding (IYCF), water-sanitation hygiene (WASH), community health systems, and the delivery of integrated interventions in low-resource settings. 

20 Feb 2019

Inside the DHS Program Q&A: Tom Pullum

Name: Tom Pullum

Position title: Director of Research

What is your role at The DHS Program? I manage the analysis team, which prepares the majority of analysis reports that are released after the Final Reports and standard recode files have been produced. I am the lead author or co-author of at least a couple of these reports each year. The analysis team also conducts the DHS Fellows Program and Data Analysis Workshops. I also assist with data quality issues that occasionally arise during the preparation of Final Reports and frequently answer questions related to statistics, demography, or Stata that are submitted to the DHS User Forum.

When did you start at The DHS Program? I joined The DHS Program in May 2011. Previously, I had been a demographer in the academic world at the University of Texas at Austin and the University of Washington. In 2010-11, I took a non-academic break to work with USAID as part of the Global Health Fellows Program, expecting to return to the University of Texas. However, the opportunity to join The DHS Program came up and I retired from the University of Texas to join The DHS Program.

What has been the biggest change in The DHS Program during your time here? The biggest change has been in the sheer volume of work, indicated by the increased number of surveys, Final Reports, and analysis reports that are conducted annually. The analysis team has become very efficient in producing analysis reports that include a large number of surveys.

What work are you most proud of? Personally, I am most proud of the methodological reports that I have been directly involved in, but in a broader way, I’m very pleased with the growth and development of the analysis team. The capacity to conduct high-quality research and workshops has steadily increased. My colleagues work well together, take initiative, and are very productive.

Do you have any newly authored publications or articles you would like to share? I would like to point people to some methodological reports that came out late in 2017 and 2018.

         

                          

How are the topics for analysis reports selected? Every year, we work with USAID/Washington to develop a list of topics for reports that will be completed by the end of the year. Reports in the Further Analysis series originate within the USAID Missions in countries that have recently done a survey. Those reports generally examine trends across at least the two most recent surveys. The Methodological Reports are intended to lead to improvements in future data collection or to increase our ability to extract useful information from the data that have already been collected.

Who is the audience for analysis reports? In addition to meeting the programmatic needs of USAID, there is a large community of DHS data users who would benefit from these reports. It is always a pleasure to hear from that larger community and to help them get the most out of the data. We hope that as many people as possible will visit our website become familiar with the reports that are available there.

29 Jan 2019

Updated Recode Manual for DHS-VII

What is the DHS-VII Recode Manual?

The basic approach of The DHS Program is to collect data that are comparable across countries. This is achieved through the use of model questionnaires and the subsequent processing of the raw data into standardized data formats known as recode files. The DHS-VII Recode Manual is an introduction to the DHS standard recode files and serves as a reference document for those analyzing DHS data.

Who is the manual for?

Data users who are analyzing DHS datasets in statistical software receive the DHS recode data files for each survey along with the survey specific recode documentation. We strongly recommend that users download this documentation as well as the questionnaires used in the surveys they analyze. The questionnaire for a survey can be located in the appendix of the final report.

What is new in this version of the manual?

This updated manual describes the characteristics of the recode files defined for the seventh round of the DHS surveys (DHS-VII). The manual highlights the 234 new variables added during DHS-VII. In addition to an explanation of new variables, the manual now also contains:

  1. A description of the DHS Recode Data Files distributed and file naming convention used.
  2. An explanation of the Century Day Code (CDC). Beginning with the DHS-VII questionnaire (surveys with fieldwork in about 2015 and later), the woman’s questionnaire collects the day of birth for all children listed in the birth history in addition to their month and year of birth to calculate the age of children more accurately. The use of CDC affect virtually all tables related to children, particularly to children under the age of five.
  3. A list of the locations of DHS-VII core questionnaire variables in the DHS-VII standard recode variables.

Where can you find the guide?

Download the DHS-VII DHS Recode Manual Here

© ICF

22 Jan 2019

Model Questionnaire Review Portal Now Open

© 2013 Gayduo, Liberia DHS Pretest

In collaboration with USAID, The DHS Program is in the process of reviewing the Model Questionnaires and optional modules used for The Program’s flagship Demographic and Health Surveys. The objective of this review is to revise these tools under the DHS-8 contract to better meet current and emerging data needs. We are seeking input on all of the DHS Model Questionnaires, optional special topic questionnaire modules, and biomarkers that are currently in use by The DHS Program. The last comprehensive review and revision of these tools took place in 2014.

Several changes were made to the Model Questionnaires in DHS-7 in response to comments received during the review process for that round of the project. For example, questions on vaccinations were revised in response to advances in childhood immunization programs, and questions were added on postnatal care for women and newborns, on ownership of title or deed to dwelling and land, and on smoking. 

We have developed two standard forms for requesting changes:

  • Template for Requests for Revisions to the DHS Model Questionnaires, Optional Modules, and Biomarkers for DHS-8
  • Template for Suggested Deletions to the DHS-7 Model Questionnaires and Optional Modules

These forms along with a set of instructions for requesting changes to The DHS Program core questionnaires, optional modules, and biomarkers are now available on the DHS-8 Questionnaire Review Portal section of the DHS User Forum. The portal is now open for submissions. We look forward to receiving your input.

Visit the DHS-8 Questionnaire Review Portal

The Questionnaire Review Portal will be open until March 15. 

Please contact dhsqre@dhsprogram.com if you have questions about the DHS-8 questionnaire review process.

26 Dec 2018

35 Years of DHS…and 5 More to Come

What was happening in the world in 1984?

  • The AIDS virus was identified
  • Indira Gandhi was assassinated
  • Michael Jackson moonwalked and won awards for his “Thriller” album
  • Apple released the first MacIntosh computer
  • Famine in Ethiopia sparked worldwide attention

And…

A lot has changed in 35 years in the world and at the DHS project; what has not changed is that The DHS Program at ICF remains USAID’s flagship project for collecting data on population and health around the world. In September 2018, USAID awarded ICF and partners the 8th iteration of The Demographic and Health Surveys Program, which will run from 2018-2023.  Six internationally experienced organizations are partnering with ICF to expand access to and use of the DHS data including Avenir Health, Blue Raster, EnCompass, Johns Hopkins Center for Communication Programs, PATH, and Vysnova.

DHS-8 will build on the long history of DHS surveys, focusing on the collection of quality population and health data in approximately 50 countries while helping to strengthen the capacity of local implementing agencies to conduct population-based surveys.  DHS-8 also offers several enhancements, including a new Science Advisor position, who will focus on innovations in data collection and biomarkers (stay tuned for a new blog series on innovation!), an expanded virtual learning portfolio, and additional emphasis on sub-national dissemination to support evidence-based decision making.

“We are honored and eager to continue The Demographic and Health Surveys Program,” says Project Director, Dr. Sunita Kishor.  “Our staff are incredibly proud of the work we do, and we are grateful for the opportunity to continue to evolve by pursuing even greater data quality, new innovations, and deepening relationships with our valued colleagues across the globe.”

The information provided on this Web site is not official U.S. Government information and does not represent the views or positions of the U.S. Agency for International Development or the U.S. Government.

The DHS Program, ICF
530 Gaither Road, Suite 500, Rockville, MD 20850
Tel: +1 (301) 407-6500 • Fax: +1 (301) 407-6501
dhsprogram.com