22 Jul 2015

Linking DHS Data with Health Facility Data: Opportunities and Challenges

For 30 years, The DHS Program has asked women hundreds of questions about their utilization of various health care services, including family planning, antenatal and delivery care, vaccination and treatment of sick children, malaria treatment, and HIV prevention and treatment. In 1999, The DHS Program started collecting facility-level data through the Service Provision Assessment (SPA) survey. The SPA interviews providers and clients, takes stock of facility supplies and equipment, and observes provider-client consultations.  



Many people hoped that the two datasets would be easy to link for a deeper understanding of how people access services, the quality of services, and the association between access to services and health outcomes in a given country.  And because most recent DHS and SPA surveys are geo-coded (DHS since 2000 and SPA since 2009), that is, clusters and facilities are identified with their latitude and longitude, linking the data through a geographic information system should be easy, right?

Several studies have looked at using geospatial analysis to link DHS and SPA data to answer these larger questions about access to and utilization of health care services.  There are several challenges to this type of linkage. A major concern is sampling: the DHS and SPA surveys have different sampling frames and are rarely conducted in the same year. Most SPAs are samples of the health care facilities in the country, not a census. Many individuals surveyed in a DHS likely visit some of the health facilities that were not selected for the SPA. So just because a woman’s cluster is closest to a certain facility included in the SPA does not mean that that is the facility the woman visits.

CaseSTudy_figure_CropIn addition, to protect the identity of respondents, the GPS locations of DHS cluster points are geo-masked. In densely populated areas, this means that clusters may be moved away from their closest health facilities, making linkage based on geographic location less accurate. There’s also a practical concern: the DHS does not ask where individuals receive health care but rather only the type of facility where they sought care. While some people probably use their closest health facility, this is not always the case.  People may choose health facilities based on quality, specialty, cost, or anonymity, not just proximity.

SAR10Despite the challenges there have been several successful analyses linking DHS and SPA data, and program managers and researchers continue to explore the best use cases for DHS-SPA linkage.  This will be the topic of our upcoming DHS webinar on July 28th, “Considerations when Linking DHS Household Data to Data on Health Facilities and Infrastructure.”  Clara Burgert, The DHS Program’s GIS Coordinator and author of the recently released Spatial Analysis Report “Linking DHS Household and SPA Facility Surveys: Data Considerations and Geospatial Methods”  will be making a presentation on the DHS-SPA linkage opportunities and challenges.  Interested participants can register for the webinar here, and are encouraged to read SAR10 and post discussion questions for Clara and her co-authors on The DHS Program User Forum here.

Update: This webinar event has ended. Please visit this feed on The DHS Program User Forum for the presentation, discussion, and additional resources.

08 Jul 2015

Beyond Data Analysis: Collaboration and Capacity Strengthening

Participants from Nigeria, Uganda, and Malawi collaborate on interpreting malaria data.

Participants from Nigeria, Uganda, and Malawi work together to interpret malaria data.

Have you ever been to a workshop that combined interactive PowerPoints, fun hands-on activities, malaria indicator trivia games, and lots and lots of data analysis? No? Well then, you haven’t taken part in a Regional DHS/MIS Malaria Analysis Workshop hosted by The DHS Program. The malaria analysis team recently hosted two such regional workshops, one in Tanzania and the other in Senegal, with more than 30 participants representing 13 African countries.

Participants worked in country teams of 2-3 people to answer a pre-identified malaria-related research question through analysis of DHS/MIS data in Stata. While some people might cringe at the thought of an eight day data analysis workshop, in true DHS fashion there was nothing boring about this workshop. Activities throughout the workshops were designed to encompass a range of adult learning techniques – interactive PowerPoints, guided demonstrations, hands-on exercises, and small group activities were all used. The workshops culminated with each team presenting a conceptual framework, key variables, analytic methods, and preliminary results.

Chinazo Ujuju from Society for Family Health in Abuja, Nigeria reflects, “As a researcher I have the drive to analyze available data to provide relevant information for evidence-based public health interventions in my country, Nigeria. Attending the DHS/MIS data analysis workshop has equipped me with the skills to better analyze DHS and MIS datasets using Stata software. I am now competent in multivariate analysis of these datasets. I hope to use my skills to provide information for malaria programming with the ultimate goal of ensuring that relevant information are available to inform policy decisions that would improve global health.

Participants from Senegal work on their data analysis

Participants from Senegal work on their data analysis

Fankeba Souradji of Togo comments, “Je profite pour dire merci aux facilitateurs pour la qualité de la formation. Nous vous en sommes très reconnaissants.”

Though the workshop focused on strengthening data analysis skills, participants also enjoyed the opportunity to collaborate and learn from colleagues from other countries.

Nabila Hemed from the National Malaria Control Program (NMCP) in Tanzania says, “The Regional DHS/MIS analysis workshop has been a wonderful seminar that has brought together professionals of various degrees of experience. The first time I worked with DHS was two years ago. After attending this workshop I learned different issues, limits, and challenges that should be considered during analysis of DHS data. The best part was hearing various country contexts and the effects in data analysis. This helped me understand the impact of research and program decisions during analysis of DHS data. I joined this workshop under the notion that I would simply learn how to analyze to DHS data and how to use Stata. However, I got so much more than what I expected! I received a handful of knowledge and resources that I will definitely use and share with my colleagues at work.”

Participants discuss data use for decision making in a fishbowl discussion session

Participants discuss data use for decision making in a fishbowl discussion session

Though both workshops are complete, country teams are continuing work on their research proposals and abstracts. The DHS Program looks forward to seeing the final products from the workshops in upcoming scientific journals and conferences.

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.

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Anthropometry measurement (height and weight) is a core component of DHS surveys that is used to generate indicators on nutritional status. The Biomarker Questionnaire now includes questions on clothing and hairstyle interference on measurements for both women and children for improved interpretation.