Beneath the Surface

In IHME’s Seattle offices, our cohort of young researchers, the Post-Bachelor Fellows (PBFs), spend their days – and sometimes their evenings – writing code, running numbers, and poring over the complex metrics that result. The research is all about global health, but they work locally until their turn comes for a stint of fieldwork abroad.

Read more

Deep Dive

To understand what drives health disparities in a country, you have to decide where to begin counting.

IHME researchers in countries around the world that are part of the Access, Bottlenecks, Costs, and Equity (ABCE) project are developing new tools and building new evidence for improving the equity and cost effectiveness of health systems. 

Read more

Innovations

Influenza vaccination is the most effective method for preventing flu virus infection, but many Americans do not receive the vaccine.

Read more

Connections

All summer long, IHME faculty and staff attended conferences and events, presenting and educating diverse audiences about our recent innovations and findings. 

Read more

Ripple Effect

The First Lady of Zambia, Dr. Christine Kaseba-Sata, has been working to improve the health of Zambia’s women and children for two decades. As an obstetrician and lecturer, she is a tireless advocate for programs in safe motherhood and newborn care.

Read more
THE DIRECTOR'S VIEW

When the Institute for Health Metrics and Evaluation (IHME) was created five years ago, we envisioned an independent research institute rooted in academia while operating as an independent, results-driven organization. Far from working in isolation, we also anticipated growing into collaborative partnerships with colleagues around the world who share our goals of capturing accurate health information to inform strategic decision-making and improve health worldwide.

From the start, our faculty members, researchers, and fellows have been building productive relationships with researchers, policymakers, and health experts in multiple regions. In recent issues of IHME Impact, we told you about our important work with the Salud Mesoamérica 2015 Initiative to lower maternal and neonatal mortality in southern Mexico and Central America. In the spring, we launched an innovative, multiyear collaboration with the Kingdom of Saudi Arabia to monitor the health status of Saudi citizens and to inform health policy priorities.

In this issue, you will learn how IHME faculty, fellows, and staff are bringing effective projects to fruition in Colombia, Ghana, Kenya, and Zambia, with plans to ultimately expand to 15 countries. The Access, Bottlenecks, Costs, and Equity (ABCE) project is identifying constraints to cost effective and equitable access to health systems, with a strong focus on delivering antiretroviral therapy and HIV prevention services.

In conducting this research, IHME is partnering with local teams and ministries of health, who look forward to having critical data for setting effective policies to improve their health systems’ performance. UNICEF has also been an essential collaborator in several countries, both in its contribution to collecting information and in communicating results to local policymakers. The goal of the ABCE project, as for all of IHME’s work, is to improve people’s health through better information. 

This issue of Impact outlines how IHME is carrying out our research in developing countries and communicating the results to stakeholders around the world.

  1. Beneath the Surface shares the perspectives of IHME fellows and researchers who spent months in Africa assessing the cost effectiveness of health systems and training local teams to continue the research.
  2. Deep Dive describes the central components of the equity and cost effectiveness research by focusing on the approach taken in Kenya.
  3. In Connections, we welcome our new Post-Bachelor Fellows and Post-Graduate Fellows and look at how IHME is collaborating at home and abroad with fellow global health proponents.
  4. Innovations summarizes IHME’s recently published research, including studies on GDP per capita data and influenza vaccination coverage and the perception of obesity in the US.
  5. In Ripple Effect, we visit the First Lady of Zambia, an obstetrician and advocate for maternal and newborn health, who values research IHME conducted in partnership with the University of Zambia.

Thank you for your interest in IHME’s mission and work. We look forward to another five years of advancing health measurement worldwide.

Christopher J. L. Murray
IHME Director
DEEP DIVE
IHME focuses on health disparities research through careful data analysis

To understand what drives health disparities in a country, you have to decide where to begin counting.

IHME researchers working with UNICEF in countries around the world that are part of the Access, Bottlenecks, Costs, and Equity (ABCE) project are developing new tools and building new evidence for improving the equity and cost effectiveness of health systems. ABCE aims to create a framework that addresses these five questions:

  • How much does it cost to provide health services?
  • Who is receiving these health services?
  • What are the largest barriers to accessing care and which populations are most affected?
  • What progress is being made in expanding the delivery of health services?
  • What are the best tools for real-time monitoring and tracking health sector growth? 

For each country, research teams from IHME had to decide where to collect facility-level data. In Kenya, they used three main factors: population density, the level of child malnutrition, and health expenditure per capita. Each factor required data analysis with advanced statistical techniques to make sure the team was picking the right places to survey.

To represent the variation in population density across Kenya, the team picked counties with varying mixes of urban and rural areas. In Kenya, that also meant finding a way to survey the health facilities used by members of nomadic, pastoral tribes located in hard-to-reach parts of the country.

“These are people who don’t have a permanent home, so they are difficult populations to track,” said Dr. Emelda Okiro, an IHME Post-Graduate Fellow. “Our country partners were keen on making sure our study was representative of all the different facets of Kenya’s population, so we needed to think about how to include the pastoralists and everyone else in our analysis.”

In addition to population density, the team looked at rates of child malnutrition in choosing sampling sites. There are densely populated urban areas with high rates of malnutrition and others with low rates. The same is true for some rural areas and areas populated mostly by nomadic tribes. 

The last factor the team considered was health care expenditure, and this was in some ways the most difficult one to analyze. Kenya has some of the best hospitals in East Africa and also some of the most underfunded. 

“Nairobi has among the best hospitals in Kenya, where everything is at a very high level, from the quality of services, to the expertise of the specialists who see the patients, to the equipment,” Dr. Okiro said. “And in part because of that, people in Nairobi spend more per capita on health care,” she added.

Contrast that situation with facilities where a woman may have to give birth in the pitch black of night because the clinic has no power generators. Where there are no IV drips to administer medication. Where doctors and nurses don’t even have access to surgical gloves. Health care expenditure is a fraction of the figure in Nairobi.

With these three filters, the team was able to narrow their focus to counties that, taken as a whole, represented the mix of socioeconomic factors found nationwide. The next step is conducting exit interviews at nearly 300 facilities in Kenya and collecting data on the resources available and the health care these facilities provided. In some counties, the team only surveys one large hospital for the whole county. They call these “referral hospital” counties. In most counties, they sample 10 to 20 facilities.

“We want to capture how many children they vaccinated, how many surgeries they performed, how many babies were born,” said IHME Lecturer Michael Hanlon, leader of the ABCE research team. “Then for national and local governments we want to be able to recommend where they would need to invest to get the most for their limited resources.”

The team expects to finish the data collection and analysis in the next few months, and plans to publish their findings for Kenya and the other countries in the ABCE project starting in 2013.

William Heisel
IHME Communications

 

BENEATH THE SURFACE
IHME fellows travel afield to help countries improve equitable access to health systems

In IHME’s Seattle offices, our cohort of young researchers, the Post-Bachelor Fellows (PBFs), spend their days – and sometimes their evenings – writing code, running numbers, and poring over the complex metrics that result. The research is all about global health, but they work locally until their turn comes for a stint of fieldwork abroad.

Beginning in early 2011, for the Access, Bottlenecks, Costs, and Equity (ABCE) project, groups of PBFs are spending weeks in cities and rural areas of Colombia, Ghana, Kenya, Uganda, and Zambia. Partnering with local research teams and collaborators, they are helping to collect data on health facilities and patients from hospitals, clinics, health centers, and pharmacies. In one key collaboration, UNICEF provided critical assistance that ensured success in countries such as Ghana.  

The data will contribute to a fuller understanding of what it costs a country to run an effective health system. In another component of the project, these fellows are researching the cost effectiveness of facility-based HIV prevention and antiretroviral therapy (ART) programs to counteract HIV/AIDS infections in developing countries.

The deployed researchers are supported by a full team at IHME, including Project Officers Annie Haakenstad and Kelsey Moore. Both have visited many of the countries currently involved in the project. The research will ultimately be conducted in 15 countries, possibly including Argentina, Bangladesh, Benin, Botswana, Georgia, Mozambique, Peru, Philippines, and Turkey.

With IHME faculty members such as research leader Dr. Michael Hanlon, Kelsey helps recruit decision-makers, researchers, and other stakeholders to facilitate data collection or support the discussion of the ABCE project results within their country. “When meeting with representatives from ministries of health, donor organizations, nonprofits, and other health providers,” Kelsey said, “ABCE has received widespread support. The value of this information was immediately apparent.”

“We ask health policymakers what questions most need to be answered within their system,” Kelsey explained. “What are the biggest gaps in information that affect implementing informed policies? Based on these conversations, along with our in-country collaborators, we prepare policy reports, host policy forums, or provide analytical methods workshops. Better data will improve the equitable provision of health care and access to it. But the key to bringing about change is to present what we’ve learned in an effective way.”

PBF Samuel Masters, who carried out ABCE work in Ghana, Uganda, and Zambia, described the initial meetings with the Ghana Health Service and representatives from the Ministry of Health. Before training locally hired research assistants to conduct the ABCE health facility survey, the collaborators tailored the survey to suit Ghana’s needs.  For example, the questions about facility expenses were adjusted to correspond to the government’s standard accounting system.

According to Sam, “Training the research assistants went smoothly because everyone wanted the pilot phase to go well, and we’d established clear priorities in advance.” He also pointed out the capacity-building nature of the training. “The Ghana Health Service recruited three-person regional teams of pharmacists, accountants, and health records specialists, who will return to their home regions to collect the ABCE data.”

Sam takes away from his in-country experience the assurance that his computer time in Seattle has true value: “Working in the field, you can see the impact of the project on those being trained. You see people’s excitement about gaining new skills and knowledge about their country’s health system that they can apply to future analysis.”

PBF Emily Carnahan, working in Uganda, pointed out the contrast between her two work environments. “At IHME, I’ve handled vast amounts of data. Seeing the data collection firsthand in Uganda is a great reminder as to how much work goes into capturing and calculating each of those data points. We are in a unique position at IHME because we have access to enormous amounts of data, but here sometimes tracking down a single number can pose a huge challenge.”

Analyzing data for the ABCE project back in Seattle, IHME Post-Graduate Fellow Anne Gasasira, a doctor and epidemiologist from Uganda, noted the apt timing of the ART research.” For countries like Uganda that have been rapidly scaling up ART programs over the recent past but haven’t had a chance to evaluate their performance, the ABCE study will provide critical information on the current status of programs, including areas like staffing levels, availability of services, patient volumes, and patient outcomes. The Uganda AIDS Control Program is following the study’s progress with much interest and looking forward to our results.”

Anne also observed, “Very importantly, cross -country comparisons will potentially provide the opportunity for countries to learn from each other and form mutually beneficial collaborations.” Through their work in multiple countries, IHME’s up-and-coming researchers are laying the groundwork for those future collaborations. 

Patricia Kiyono
IHME Communications
CONNECTIONS
IHME collaborates, celebrates, and welcomes new fellows!

All summer long, IHME faculty and staff attended conferences and events, presenting and educating diverse audiences about our recent innovations and findings. We have had many instances of celebration, including the arrival of a new cohort of Post-Bachelor and Post-Graduate Fellows. Here is a collection of key events that took place in these months. 

Fellows encourage interactive learning at STEM Explosion Expo

Post-Bachelor Fellow Rebecca Engell discusses the importance of measuring health with a Washington State educator.

The STEM Explosion Expo in June was a popular component of an education leadership institute that helped Washington State educators implement science, technology, engineering, and mathematics (STEM) education in their communities. IHME’s exhibit introduced visitors to the field of global health research and demonstrated the importance of measuring health. IHME Post-Bachelor Fellows and staff Ian BolligerRebecca EngellMarissa Iannarone, and Nicole Johns explained IHME’s research on county-level life expectancies and how to make measurement methods engaging for students.

Researchers participate in forum of health economists

In June, IHME Lecturer Santosh Kumar, with IHME Post-Graduate Fellow Rouselle Lavado and Research Assistant Joe Dieleman, engaged audiences with their presentations of IHME’s work on tracking health financing at the 4th Biennial Conference of the American Society of Health Economists. They spoke on quality of care as a constraint on health services in India, estimating out-of-pocket expenditure from household surveys, and how governments manage development assistance for health.

IHME plays key role in Seattle’s Next Fifty Global Health Month

From July to August, IHME cosponsored educational activities to celebrate global health month, showcasing Washington State’s efforts to improve the world’s health. The Global Health Experience Exhibit featured personal stories of prominent global health challenges – cancer, malaria, diabetes, and threats to maternal and child health. IHME provided visitors with a deeper understanding of these health conditions by exhibiting data-rich maps and offering an interactive tool in the exhibit’s activity tent. On a Sunday in July, some 3,000 people gathered at Groundswell: A Night for Global Health to hear noteworthy speakers, including IHME’s Director Christopher Murray and philanthropist Melinda Gates, emphasize the importance of maternal and child health improvements.

Research leader joins panel on maternal health

Professor Rafael Lozano, who leads IHME’s maternal mortality research, participated in the panel “The Key Challenges of Maternal Mortality in Latin America and the Caribbean” in June as part of a Latin American and Caribbean regional consultation in Mexico City. Dr. Lozano discussed what current maternal mortality numbers tell us about the state of women’s reproductive health as part of the planning for the 2013 Women Deliver global conference, dedicated to improving maternal health.

New social research shared at conference on public opinion research

In May, the American Association for Public Opinion Research held a conference focusing on challenges that public opinion and survey researchers face as a result of new technologies and communication media. IHME researchers Dr. Bernardo Hernández Prado, Visiting Fellow Ali Mokdad, Post-Graduate Fellow Gulnoza Usmanova, and former Post-Graduate Fellow Catherine Wetmore presented papers on research methods, study design, and multimode strategies in social research to a wide variety of survey experts, consumers, and funders of social opinion research.

IHME joins USAID in call to lower child deaths

IHME Director Christopher Murray presents the results of an analysis on ways to prevent child deaths at the USAID Call to Action event in Washington, DC.

In concurrence with USAID’s 5th Birthday campaign, recognizing that most child deaths occur before the age of 5, the USAID Child Survival Call to Action high-level forum, held in June in Washington, DC, explored the most effective ways to allocate resources toward ending preventable child deaths. IHME Director Christopher Murray discussed the drivers behind reducing child mortality, such as maternal education, and innovation, such as new ways of reaching disadvantaged communities. USAID has contracted with IHME to complete an econometric analysis of available health data and public health research, and make recommendations for policy action to lower child mortality rapidly by 2035.

IHME gathers over 30 organizations to discuss the Malaria Control Policy Assessment

In April, IHME held a consultative meeting on the Malaria Control Policy Assessment (MCPA) project in Uganda with the Uganda Malaria Surveillance Project. Associate Professor Stephen Lim, leader of IHME’s intervention coverage research, presented an introduction to the MCPA project to local experts in the field, who provided guidance and feedback on the direction of the research and on how to effectively distribute the results.

Global Burden of Disease 2010 Study worldwide consultations

Since September 2011, IHME in coordination with collaborators has been sharing the preliminary results of the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study (GBD 2010 Study) in a series of worldwide meetings. The study will produce new estimates measuring the impact of hundreds of diseases, injuries, and risk factors in 21 regions around the world. The following meetings are the most recent GBD-related discussions that have taken place.

  • In June, IHME Director Christopher Murray and Affiliate Professor of Global Health Alan Lopez, two lead researchers behind the original Global Burden of Disease study, discussed some of the preliminary findings from the GBD 2010 Study at the University of Queensland's Global Leadership Series in Washington, DC.
  • Also in June, Dr. Murray and Dr. Lopez attended a debate and discussion focused on the preliminary findings from the GBD 2010 Study. The invitation-only event was hosted by the Pan American Health Organization (PAHO).
  • To gather feedback from high-level decision-makers, Dr. Murray and IHME Professors Dr. Rafael Lozano and Dr. Ali Mokdad gave a July presentation of the preliminary GBD results relevant to the Middle East region. Held in Amman, Jordan, the session was co-hosted by the World Health Organization’s Regional Office for the Eastern Mediterranean.
  • In a two-day conference in July, organized by PAHO and the government of the Dominican Republic, Dr. Lozano led a panel on analysis and decision-making based on the GBD 2010 Study’s preliminary results. Ministers of health from eight countries offered comments and reactions to the GBD global and country-based research.

Happy fifth anniversary, IHME!

On July 1, IHME celebrated the fifth anniversary of the Institute. Since our creation, we set out to measure the world’s greatest health challenges and evaluate the solutions being used to address them. As Julio Frenk, IHME Board Chair and Dean of the Harvard School of Public Health, noted, “So many initiatives never make it to the fifth birthday. They just disappear. They fail. Not only has IHME made it, but it has done so at this incredible level of accomplishment.”

IHME’s Abraham Flaxman wins the TR35 award for innovation

Each year 35 innovators under the age of 35 from around the globe receive the prestigious TR35 award to honor how their work is changing our world. For the first time, this highly selective award from Technology Review, published by the Massachusetts Institute of Technology, went to an expert in health measurement: IHME Assistant Professor Abraham Flaxman. Past winners include Facebook founder Mark Zuckerberg and Google co-founders Sergey Brin and Larry Page.

One of Dr. Flaxman’s innovations is exemplified in the Global Burden of Disease 2010 Study. His new disease modeling system has allowed researchers to combine all of the world’s data on the prevalence, incidence, remission, and mortality of a disease and produce consistent estimates of the way the disease progresses through the population.

Other notable innovations include Dr. Flaxman’s achievements in verbal autopsy (VA), a method to determine causes of death in settings lacking complete death certification. He spearheaded the development of the most accurate VA estimates to date. His stock-and-flow model is critical in tracking the distribution of insecticide-treated bed nets to prevent malaria. And Dr. Flaxman’s advancements in data-driven data quality audits (D3QA) are widely commended for ensuring that health data and other data gathered from household surveys are accurate. D3QA is being used to estimate mortality from war-related causes in Iraq.

Dr. Flaxman hopes this recognition for his accomplishments in the field of global health “inspires other people to look at the area,” adding, “There is so much room for innovation in global health, the challenges are huge, and the stakes couldn’t be higher.”

IHME welcomes new fellows

This month, IHME welcomes a new cohort to our Post-Bachelor Fellowship (PBF) program. The PBF program brings recent college graduates to IHME for academic research, education, and on-the-job training and mentoring from professors and researchers. We are also pleased to have several new Post-Graduate Fellows join us for self-directed research and interdisciplinary collaboration in health metrics.

Post-Bachelor Fellows

Left to right: Margaret Robinson, Andrea Stewart, Joseph Frostad, Kristen Delwiche, Austin Schumacher, Marielle Gagnier, Kyle Heuton, Chelsea Liddell, David Roberts, Anthony Bui 

Anthony Bui is from Southern California and has received his Bachelor of Arts in Economics from the University of California, Berkeley.

Kristen Delwiche is from Portland, OR, and received her Bachelor of Science in Biochemistry from the University of Puget Sound.

Joseph Frostad is from Seattle, WA, and received his Bachelor of Arts in Program on the Environment from the University of Washington.

Marielle Gagnier is from Birmingham, MI, and received her Bachelor of Science in Mathematics from Michigan State University.

Kyle Heuton is from Saint Paul, MN, and received his Bachelor of Science in Chemical Engineering and Mathematics from the University of Minnesota.

Chelsea Liddell is from Montana, and has received her Bachelor of Arts in Engineering from Dartmouth College.

David Roberts is from Vancouver, WA, and received his Bachelor of Science in Chemistry from Stanford University.

Margaret Robinson is from Sunderland, MA, and received her Bachelor of Science in Physics from Williams College.

Austin Schumacher is from Grass Valley, CA, and received his Bachelor of Science in Statistics from the University of California, San Diego.

Andrea Stewart is from Ipswich, MA, and received her Bachelor of Arts in Mathematics from Tufts University.

Post-Graduate Fellows

Left to right: Caterina Guinovart, Antony Stevens, Thomas Odeny

Antony Stevens is originally from London, UK, but currently resides in Brazil where he earned his PhD in Epidemiology at Universidade Federal do Rio Grande do Sul. He also brings a wealth of experience with an MSc in Computer Science and an MPhil in Anthropology from the University of London. He is on the Burden of Disease research team.

Thomas Odeny is from Kenya and earned his MPH in Epidemiology and Global Health from the University of Washington. He was a Fogarty International Clinical Research Fellow in Kisumu, Kenya. Thomas received his Bachelor of Medicine and Surgery from the University of Nairobi. He is on the Health Service Delivery Constraints research team.

Caterina Guinovart is from Barcelona, Spain, where she earned a PhD and MD at the Universitat de Barcelona. She received her MSc in Epidemology at the University of London. She is working with our Impact Evaluations research team.

Rachel Fortunati
IHME Communications 
INNOVATIONS
IHME’s recently published work

Rates of flu vaccination a success in some populations, but many Americans remain unvaccinated

Influenza vaccination is the most effective method for preventing flu virus infection, but many Americans do not receive the vaccine. Researchers used results from the 2009 Behavioral Risk Factor Surveillance System, a large ongoing nationally representative cross-sectional telephone survey designed to monitor the leading risk factors for morbidity and mortality, to estimate the prevalence of Americans receiving the influenza vaccine in the past 12 months. IHME researchers found that the flu vaccination coverage level in 2009 in the United States was 69% in adults 65 years and older but only 32% in adults between the ages of 18 and 64. These results indicate that vaccine rates among US adults fall far short of the Healthy People 2020 targets set by the US government.

Innovation: This study was designed to determine the characteristics most likely to influence Americans’ vaccination status, indicating the populations that are most in need of renewed attention to vaccination strategies. Results show that vaccine coverage in the US is related to social position and other health behaviors, with health insurance being the strongest predictor of vaccination in both age groups studied. People reporting older age, white race, higher education, nonsmoking status, being physically active, having poor physical health, or having a personal history of various chronic conditions were also more likely to have received the influenza vaccine. 

Takayama M, Wetmore CM, Mokdad AH. Characteristics associated with the uptake of influenza vaccination among adults in the United States. Preventive Medicine, March 2012

New estimates of income per capita overcome gaps in time and other data limitations

Income has been extensively studied as a determinant of health, but while several datasets are commonly used as a source for gross domestic product (GDP) per capita, no time series are complete for the years between 1950 and 2015 for the 210 countries for which data exist. IHME researchers set out to complete these existing datasets across six and a half decades for all countries and to create two new time series (one for US dollars and one for international dollars, adjusted for purchasing power parity) based on the completed source series.

Innovation: Researchers applied several stages of models, including ordinary least-squares regressions and mixed-effects models, to complete each of the seven source series from 1950 to 2015. The three US dollar and four international dollar series were each averaged to produce two new GDP per capita series for all countries from 1950 to 2015. These series are the most comprehensive time series of GDP per capita currently available and offer researchers diverse options to serve different analytical purposes. Extending the existing data to missing countries and years should facilitate population health analyses and reduce biases that arise from using series with missing information.

James SL, Gubbins P, Murrary CJL, Gakidou E. Developing a comprehensive time series of GDP per capita for 210 countries from 1950 to 2015. Population Health Metrics, July 2012

Novel analysis shows that while many Americans report losing weight over time, they are actually gaining weight

Research by IHME shows that while many Americans reported losing weight between 2008 and 2009, the actual prevalence of obesity in the United States increased over this time period. These results indicate that public health and medical professionals should interpret self-reported weight changes with caution when developing, implementing, and evaluating programs designed to prevent and control weight gain.  

Innovation: This study was the first to compare calculated and reported changes in body weight in a large state-based surveillance system. The authors used data from the 2008 and 2009 Behavioral Risk Factor Surveillance System, which asks participants to report their weight and height at the time of the interview, as well as their weight one year prior to the interview.

Wetmore CM, Mokdad AH. In denial: misperceptions of weight change among adults in the United States. Preventive Medicine, August 2012

RIPPLE EFFECT
Zambia moves to improve access to maternal and child health interventions after IHME/University of Zambia study shows disparities in country

The First Lady of Zambia, Dr. Christine Kaseba-Sata, has been working to improve the health of Zambia’s women and children for two decades. As an obstetrician and lecturer, she is a tireless advocate for programs in safe motherhood and newborn care. But recently, Dr. Kaseba-Sata became concerned that Zambia’s increased investment in improved care wasn’t adequately tracked, and as a result, there was no way to gauge if recent efforts had made any impact.

First Lady of Zambia, Dr. Christine Kaseba-Sata

“Our main worry was that we are not monitoring the interventions that are being put in and when I came across this document Maternal and Child Health Intervention Coverage in Zambia, I was really taken aback, because this is exactly what policymakers need.”

The report Dr. Kaseba-Sata stumbled upon was a collaborative effort between IHME and the University of Zambia, highlighting the preliminary results from a project to track coverage of maternal and child interventions by district as part of IHME’s Malaria Control Policy Assessment (MCPA) project.

“The objective of the MCPA study is to look at how malaria interventions helped to reduce child mortality over the last 10 to 20 years,” explained Dr. Felix Masiye, co-investigator on the MCPA project and Head of the Department of Economics at the University of Zambia. “To achieve that objective, we compiled all available data to analyze trends in coverage of maternal and child health interventions, such as malaria control, skilled birth attendance, antenatal care, and even child immunizations.”

The study showed that for the most part, malaria control interventions, such as household ownership of an insecticide-treated bed net, increased across the country. However, coverage of other interventions, such as antenatal care and some childhood vaccinations, was declining – and depending on the district, the patterns of coverage were often dramatically different.

“One of the most shocking findings was that antenatal care coverage of the recommended four visits by a pregnant mother dropped from 80% in 1990 to 40% in 2010,” Dr. Masiye said. “That finding has sparked a lot of debate here in Zambia.”

According to Zambia’s Ministry of Health, this information has already resulted in a reallocation of resources.“Your study has in a way influenced resource allocation as far as this comparison of districts is concerned,” said Dr. Peter Mwaba, Permanent Secretary for the Ministry of Health. “Now we know which are the worst performing districts and we have put in extra manpower and extra resources in those troubled districts.”

Another project that the Zambian government is paying close attention to is the Access, Bottlenecks, Costs, and Equity (ABCE) project. The ABCE project, another collaboration between IHME and the University of Zambia, aims to identify constraints to cost effective, equitable access to health systems and provide policy and strategy options to countries for improving equity in health. In Zambia, the work has concentrated on the costs and constraints to health service delivery, with a major component looking at the delivery of antiretroviral therapy and HIV prevention services.

The study covered more than 200 hospitals, clinics, and rural health outposts across the country, including private, public, and church mission-run facilities. The objective is to provide policymakers with reliable cost data when planning, prioritizing, and evaluating access to health systems.

“Really looking into the cost constraints, the actual costs, and challenges to accessing services is going to help governments rethink their social safety net policy and be able to improve services,” Dr. Kaseba-Sata said.

Zambian mothers wait outside the Nangoma health facility for their turn to visit the doctor.

While the country’s statistics office and health facilities collect an enormous amount of data, the Ministry of Health says they simply don’t have the expertise or the capacity to do the kind of analysis the IHME and University of Zambia studies have carried out.

“If you can’t measure, you can’t quantify. If you can’t quantify, you cannot control. It’s as simple as that,” Dr. Mwaba said. “Yours is one such institution that has helped us a lot.”

IHME hopes to mirror the success in Zambia by rolling out similar studies in new collaborations around the world.

Jill Oviatt
IHME Communications