WHO and Global Health Monitoring: The Way Forward

Ties Boerma and colleagues from WHO describe the agency's work and future in health indicator monitoring, as part of a cluster of PLoS Medicine articles on global health estimates

The price of promiscuity: why urban males in Tanzania are changing their sexual behaviour

This article presents evidence of a substantial change in sexual behaviour among urban factory workers during the last four years; it discusses the nature of this change and the reasons for it. Fear of AIDS was the main motivating factor, followed by economic hardship: because AIDS is incurable and because sexual relationships have a substantial transactional component, workers see themselves as paying the price of promiscuity with their lives as well as their dwindling financial resources. Respondents preferred partner reduction, and in particular sticking to one partner, to condom use. Condoms were not popular, mainly because of fears that they were impregnated with HIV and because of their association with promiscuous behaviour

Monitoring Service Delivery for Universal Health Coverage:\ud the Service Availability and Readiness Assessment

To describe the Service Availability and Readiness Assessment (SARA) and the results of its implementation in six countries across three continents. The SARA is a comprehensive approach for assessing and monitoring health service availability and the readiness of facilities to deliver healthcare interventions, with a standardized set of indicators that cover all main programmes. Standardized data-collection instruments are used to gather information on a defined set of selected tracer items from public and private health facilities through a facility sample survey or census. Results from assessments in six countries are shown. The results highlight important gaps in service delivery that are obstacles to universal access to health services. Considerable variation was found within and across countries in the distribution of health facility infrastructure and workforce and in the types of services offered. Weaknesses in laboratory diagnostic capacities and gaps in essential medicines and commodities were common across all countries.The SARA fills an important information gap in monitoring health system performance and universal health coverage by providing objective and regular information on all major health programmes that feeds into country planning cycles\u

Examining the recent trends in adolescent sexual and reproductive health in five countries of sub-Saharan Africa based on PMA and DHS household surveys

BACKGROUND: The annual collection of fertility, marriage, sexual behaviour, and contraceptive use data in the nationally representative rounds of Performance Monitoring and Accountability (PMA) surveys in sub-Saharan Africa may contribute to the periodic monitoring of adolescent sexual and reproductive health (ASRH). However, we need to understand the reliability of these data in monitoring the ASRH indicators. We assessed the internal and external consistencies in ASRH indicators in five countries. METHODS: We included countries with at least three nationally representative rounds of PMA surveys and two recent DHS: Ethiopia, Ghana, Kenya, Nigeria, and Uganda. Our analysis focused on four current status indicators of ASRH among girls 15-19 years: ever had sex, currently married, has given birth or currently pregnant, and currently using modern contraceptives among sexually active unmarried girls. We compared the PMA survey and DHS data and tested for statistical significance and assessed trends over time using Jonckheere-Terpstra test statistic. RESULTS: PMA and DHS survey methodologies were similar and, where there were differences, these were shown to have minimal impact on the indicator values. The comparison of the data points from PMA and DHS for the same years showed statistically significant differences in 12 of the 20 comparisons, which was most common for sexual behaviour (4/5) and least for contraceptive use (2/5). This is partly due to larger confidence intervals in both surveys. The time trends were consistent between the annual PMA surveys in most instances in Ethiopia, Kenya, and Nigeria but less so for Ghana and Uganda. However, both surveys highlight slow progress in adolescent and reproductive health indicators with major disparities between the countries. CONCLUSIONS: Despite the differences between PMA 2020 surveys and DHS surveys conducted in the same year, and inconsistencies of the PMA survey time series for several indicators in some countries, we found no systematic issues with PMA surveys and consider PMA surveys a valuable data source for the assessment of levels and trends of ASRH beyond contraceptive use and family planning for indicators of fertility, marriage, and sex among adolescent girls in sub-Saharan Africa

New strategies for HIV surveillance in resource-constrained settings: an overview.

Additional funding recently became available to help resource-constrained countries scale up their HIV treatment and prevention activities. This increased funding is accompanied by an increased demand for accountability from stakeholders. Many countries will need to make substantial improvements in their current HIV surveillance methods to monitor the collective national impact of these treatment and prevention initiatives. However, whereas most resource-constrained countries have monitored the prevalence of HIV, they have collected little information on other events in the HIV disease process, such as HIV incidence, rate of HIV drug resistance, number of deaths due to AIDS and only modest emphasis has been placed on AIDS reporting in generalized epidemics, resulting in severe underreporting. In addition, data on mortality trends are often not gathered. Furthermore, less than half of the countries with low-level/concentrated epidemics have tailored their surveillance systems to the local epidemic, behavioral surveillance is often not present, an integrated analysis of data is not widespread, and data are rarely used to inform policy. In January 2004, a conference was convened in Addis Ababa, Ethiopia, to examine new strategies for surveillance in resource-constrained countries, and their use in monitoring and evaluating HIV activities. This supplement summarizes the newest approaches and lessons learned for HIV/AIDS surveillance, based on presentations and discussions from that conference. This article provides an overview of HIV/AIDS surveillance in resource-constrained settings and discusses the history, current approaches, and future directions for HIV/AIDS surveillance in generalized and low-level/concentrated epidemics

Can routine health facility data be used to monitor subnational coverage of maternal, newborn and child health services in Uganda?

Background: Routine health facility data are a critical source of local monitoring of progress and performance at the subnational level. Uganda has been using district health statistics from facility data for many years. We aimed to systematically assess data quality and examine different methods to obtain plausible subnational estimates of coverage for maternal, newborn and child health interventions. Methods: Annual data from the Uganda routine health facility information system 2015–2019 for all 135 districts were used, as well as national surveys for external comparison and the identification of near-universal coverage interventions. The quality of reported data on antenatal and delivery care and child immunization was assessed through completeness of facility reporting, presence of extreme outliers and internal data consistencies. Adjustments were made when necessary. The denominators for the coverage indicators were derived from population projections and health facility data on near-universal coverage interventions. The coverage results with different denominators were compared with the results from household surveys. Results: Uganda’s completeness of reporting by facilities was near 100% and extreme outliers were rare. Inconsistencies in reported events, measured by annual fluctuations and between intervention consistency, were common and more among the 135 districts than the 15 subregions. The reported numbers of vaccinations were improbably high compared to the projected population of births or first antenatal visits – and especially so in 2015–2016. There were also inconsistencies between the population projections and the expected target population based on reported numbers of antenatal visits or immunizations. An alternative approach with denominators derived from facility data gave results that were more plausible and more consistent with survey results than based on population projections, although inconsistent results remained for substantive number of subregions and districts. Conclusion: Our systematic assessment of the quality of routine reports of key events and denominators shows that computation of district health statistics is possible with transparent adjustments and methods, providing a general idea of levels and trends for most districts and subregions, but that improvements in data quality are essential to obtain more accurate monitoring

The case for verbal autopsy in health systems strengthening

This Comment is based on a round-table discussion held at University College London on Oct 17, 2016, funded by a Health Systems Research Initiative grant from the UK Department for International Development (DFID)/Medical Research Council (MRC)/Wellcome Trust/Economic and Social Research Council (ESRC) (MR/N005597/1). We declare no competing interests.Peer reviewedPublisher PD