Data Priorities for Population and Health in Developing Countries: Summary of a Workshop (1996)

Duff Gillespie, director of the Center for Population, Health, and Nutrition (PHNC) of the U.S. Agency for International Development (USAID), described some of the new challenges facing population and health policy makers and their needs for demographic and health information. Since 1972, household surveys have been widely used and respected as reliable sources for key population and health indicators in developing countries. USAID has been a prime sponsor of these surveys for decades, beginning with the World Fertility Surveys and the Contraceptive Prevalence Surveys and continuing with three successive phases of the Demographic and Health Surveys (DHS), as well as surveys conducted with assistance from the Centers for Disease Control (CDC). For many countries, these surveys have provided reasonably accurate estimates of fertility rates and infant and child mortality rates, as well as contraceptive prevalence and method mix over time. Increasingly, the DHS surveys have also provided rich detail on maternal and child health practices, suitable for use in monitoring the outcomes of health programs. While these measures remain at the nucleus of all population and health information needs, more and different information is also needed. For example, information on subgroups and special populations has become increasingly important as greater emphasis has been placed on understanding behaviors and social networks that influence decisions and actions. Thus, survey items and qualitative techniques have been developed to meet a growing need for management information about attitudes and perceptions.

In an overview of the strategic plan for USAID's Center for Population, Health, and Nutrition, Dawn Liberi discussed the agency-wide process of "reengineering." In the future, USAID plans to be more oriented toward results and to delegate more authority to managers who will be held accountable for achieving results. The new approach is designed to entail collection of appropriate data, improved management, and improved collaboration with development partners.

The agency has four strategic objectives:

• (1)	reduce unintended pregnancies;

• (2)	reduce maternal mortality;

• (3)	reduce infant and child mortality; and,

• (4)	reduce sexually transmitted disease (STD) transmission with a focus on human immunodeficiency virus (HIV).

Related to these strategic objectives are program outcomes that emphasize improved quality and accessibility of services and the adoption of positive behaviors by households and communities. In order to assess the effective use of resources at a reasonable cost, USAID staff have identified a set of performance indicators that they consider valid, reliable, and manageable. Liberi asked workshop participants for their ideas on cost-effective approaches for performance indicators, evaluation, and research, and ways to increase sustainability and build greater data collection capacity in developing countries.

In the discussion following Liberi's presentation, several participants distinguished information needs for the design and development of programs from needs for monitoring performance. Although USAID sponsors some of the research needed for the former task—for example, through the operations research projects—some participants said that the agency lacks a systematic mechanism for considering and funding data collection and analysis that would contribute to program design; they also expressed concerns that the reengineering would focus all attention on the monitoring of routine indicators. More broadly, however, many of the workshop participants applauded the USAID strategic plan for its emphasis on greater accountability for program outcomes, though there were also concerns about the potential divergence between strategic objectives developed for USAID and the needs of host countries.