Category Archives: Data

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. 

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

03 Dec 2018

16 Days of Activism against Gender-based Violence

We are halfway through the 16 days of Activism against Gender-based Violence, but there is still time to get involved. The DHS Program has a variety of resources to help you learn about the prevalence of violence against women around the world.

Since 2000, The DHS Program has collected domestic violence data in more than 50 countries. Explore the domestic violence results in five recently released Demographic and Health Surveys from the Philippines, Senegal, Haiti, Timor-Leste, and Uganda in a new infographic developed for this year’s 16 Days of Activism against Gender-based Violence.

Share our infographic using the links below.  

Share the #16days infographic on Facebook

Tweet the #16days infographic

Additionally, try our easy-to-use mini tool to compare indicators of gender inequality, women’s empowerment, gender norms, and more. For even more domestic violence data, you can visualize these indicators by background characteristics, over time, and across countries using STATcompiler

Photo Credit: © 2004 Syed Ziaul Habib Roobon, Courtesy of Photoshare

 

25 Sep 2018

The New and Improved Guide to DHS Statistics

What is the Guide to DHS Statistics?

The purpose of the Guide to DHS Statistics is to provide transparent documentation to users to assist them in understanding DHS datasets and to enable them to reproduce the statistics in DHS reports. DHS surveys collect a wealth of information on a wide range of topics from a representative sample of the population in the countries that participate in The DHS Program. For each country, the information collected is processed, tabulated, and presented in a report that describes the living conditions and the demographic and health situation in the country.

Many of the procedures involved are straightforward and are familiar to demographic analysts. However, other procedures need special attention and have been developed based on experience accumulated over many years regarding the preferred way of calculating certain indicators, what to guard against, and what not to forget.

Who is the guide for?

The Guide to DHS Statistics is meant to be a tool for all data users: for those just starting out in data analysis and for those with advanced skills who need a tool for checking procedures. It is intended to serve as a reference document for those directly analyzing DHS data as well as for users who desire a deeper understanding of indicator definitions. The tool can help those who use DHS data to monitor and evaluate programs and assist in informed decision-making.

What’s new in this version of the guide?

The updated Guide to DHS Statistics serves as a replacement for the old tool, but also as an expansion. Though it provides the same basic indicator definitions and calculation information as the original tool for the indicators used in DHS-4, the new guide goes far beyond the original content by adding the many new indicators and topics that are now covered by the DHS-7 tabulation planNew features in the guide include variables, details of numerator and denominator calculations, discussions of changes over time, links to other relevant data use tools and resources, and links to API indicator data. Complex indicators include examples or figures to facilitate understanding. View an example of an indicator page here.

Where can you find the guide? What else can you expect?

The new guide was a team effort of many DHS Program staff members, and the result is a document that is available as a PDF and online as an interactive tool. In the near future, the guide will be expanded to include chapters on female genital cutting and fistula. The tool will be continuously updated as the DHS core questionnaires and tabulation plans change to ensure that data users always work with the most up-to-date reference guide to the universe of DHS data.

Online Guide to DHS Statistics

PDF Guide to DHS Statistics

21 Sep 2018

Global Goals Week 2018

This week marks the beginning of Global Goals Week, a week where the United Nations and partners come together to bring awareness to accelerate progress to the Sustainable Development Goals (SDGs), also known as the Global Goals. The DHS Program collects data to calculate approximately 30 of the indicators supporting the SDGs. You can find the full list of DHS-related SDG indicators here.

The infographic below highlights three Global Goals using recent DHS data from Haiti, India, Timor-Leste, and Uganda:

Anyone can contribute to these goals by spreading the word. Share the infographic below, and don’t forget to stay connected by using #GlobalGoals throughout the week. Explore the indicators described in the infographic and more in one easy-to-read table using STATcompiler.

 

Click to share the infographic on Facebook
Click to retweet the infographic on Twitter

 

07 Aug 2018

World Breastfeeding Week 2018

World Breastfeeding Week, held annually from August 1-7, is a week where over 180 countries come together to promote and support breastfeeding. And although World Breastfeeding Week 2018 has come to a close, you can still take part in advocating for breastfeeding and its role in achieving the Sustainable Development Goals with DHS data:

  • Use STATcompiler to discover and share the prevalence of exclusive breastfeeding for children under 6 months.
  • Use STATcompiler to discover what percent of children age 6-9 months are breastfeeding and consuming complementary foods.
  • Share and retweet the new World Breastfeeding Week 2018 infographic using DHS data from 5 recently released Demographic and Health Surveys (DHS).

The DHS Program has collected breastfeeding data for over 30 years and has more than 50 breastfeeding indicators available in 80+ countries on STATcompiler. Continue to share DHS data on breastfeeding and stay connected for updates and resources!

Photo Credit: © 2012 Javier Arcenillas, Courtesy of Photoshare

18 Jul 2018

Release of the 4th India National Family Health Survey

We are pleased to announce the release of the 2015-16 India National Family Health Survey (NFHS-4) Final Report and State Reports. This nationally-representative survey was conducted in over 600,000 households and interviewed both women and men to collect information on population, health, and nutrition indicators. NFHS-4, for the first time, also includes measurements of blood pressure and random blood glucose, and provides district-level estimates for all 640 districts, in addition to national and state-level estimates for most important indicators.

Download the 2015-16 NFHS-4 Final Report

State Reports for all 29 states have been released and are now available for download. The complete list of State Reports is shown below.

2015-16 NFHS-4 State Reports

Andhra Pradesh Jharkhand Punjab
Arunachal Pradesh Karnataka Rajasthan
Assam Kerala Sikkim
Bihar Madhya Pradesh Tamil Nadu
Chhattisgarh Maharashtra Telangana
Goa Manipur Tripura
Gujarat Meghalaya Uttar Pradesh
Haryana Mizoram Uttarakhand
Himachal Pradesh Nagaland West Bengal
Jammu & Kashmir Odisha  

Photo Credit: ⓒ 2015 Arvind Jodha, UNFPA, Courtesy of Photoshare

11 Jul 2018

World Population Day 2018

It’s that time of the year again, and we’re back with another World Population Day #PopPyramid Quiz! Population pyramids are great ways to visualize a country’s distribution of various age groups in a population by sex.

We also created an infographic with population pyramids from recent Demographic and Health Surveys (DHS). Scroll down below the quiz to use the infographic as a guide!

So if you think you’re ready to take on the 2018 #PopPyramid Quiz? Get started below!

Click here to open the quiz in a new window

Let us know how you did the comments below, and don’t forget to share the quiz to give others a chance to test their knowledge on population pyramids!

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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