In Sweden, the Central Statistical Office (Statistiska Centralbyrån) collects statistics about the Swedish population’s health. Our partner countries though often lack national registration systems, which means that very little information is available regarding the population’s health, cause of death, life expectancy, infant mortality, maternal mortality and the incidence of HIV / AIDS. As A consequence of this it is very difficult to target the strategic health actions to specific areas where greatest effects would be achieved.
INDEPTH is an international network consisting of 43 health demographic surveillance sites for population studies in 20 low-and middle-income countries in Asia, Africa and Oceania. Through these surveillance sites a total of 3, 2 million people have been tracked over a long period of time, providing unique information about population trends in these countries. INDEPTH gets core support from Sida to develop population statistics and thus health systems in these countries can function more efficiently and strategic actions can be better targeted. INDEPTH also supports governments by planning national health care programs based on current research data. INDEPTH works to strengthen the local research capacity and influences both national and global policy making.
Data translates into healthcare systems
In many places around the world people are born and die without ever being recorded by any systems or databases. But it is essential for authorities to know "What are people dying from?"
- How can the authorities plan any form of health care if they do not know how many people are being born or dying? Says Osman Sankoh, head of the INDEPTH Network.
Statistics and information gathered about people’s lives and demographic mobility from INDEPTHs Health demographic surveillance sites forms the basis from which healthcare systems can be planned.
- Our research has been used to substantiate decisions regarding health care priorities at both a national and a regional level.
Data from the health demographic surveillance sites is used for instance in the analysis of how to prevent infant mortality, how to engage communities and get them to participate actively in strategic actions and also as background information in the development of healthcare programs.
An example of this was when at the end of the 90's testing began on the effects of people sleeping under mosquito nets treated with insecticide at research stations in Ghana, Tanzania and The Gambia. The results showed that it made a great difference to the incidence of malaria. The findings were then published in a number of scientific journals and thanks to this the use of mosquito nets is now a WHO globally recommendation.
Another example is establishment of a system of bicycle-based nurses in Ghana. This came about after one of INDEPTHs health demographic surveillance sites demonstrated scientifically how nurses on bicycles and mopeds could reach far more people in rural areas and could alleviate many common health problems. Using this method far more people could get help for minor ailments and many sicknesses can be cured at an early stage and if someone was seriously ill they could be referred to a doctor. The Ministry of Health took note of the study results and introduced the system in the whole of Ghana.
INDEPTH began with the vision of linking the already existing chain of small health demographic surveillance sites gathering population data around Africa. In 2001 INDEPTH visited Stockholm and presented their new network and their founding idea to Sida.
– Sida took a chance, says Osman Sankoh, choosing to give us money to develop a strategy. They saw that the idea was sustainable and that there was a great need for information.
And it really paid off. Today, ten years later, there are 43 active health demographic surveillance sites in the network and there are many examples of how their research results have influenced national strategic health actions. Today the health demographic surveillance sites have a broader function; they collect more social and economic data, not just data regarding the population’s health as was done before. They also have partnerships with several pharmaceutical companies investigating the efficiency and accessibility of different anti-malarials.
The method which became the standard
INDEPTH is also famous for their method of a "verbal autopsy". This is a system that was developed in collaboration with the World Health Organization (WHO) to register deaths. Death registration is standard in high-income countries, but not in low-income countries where many people are born and die without ever recorded in a database.
- The system exists, but information never reaches it. If a family loses a child and they have travel to the nearest town to register the death themselves, it easily never gets done, says Osman Sankoh.
Therefore INDEPTH developed a questionnaire which is used by health demographic surveillance sites staff to identify cause of death. 1-4 times a year they go out and record all deaths in the villages. They attempt to investigate the cause of death by posing a number of questions to the deceased’s relatives. The questionnaire is today a standardized and invaluable tool.
- Besides the feeling that every human being counts, the questionnaire is also part of passing on information to the authorities. If they know why people die, they will also know what solutions to focus on. In this way effective healthcare systems can build up and people’s lives made better!
The Millennium Development Goals 4 and 5 focus on reducing mortality of mothers and children. Specifically targeted strategic actions are needed to achieve these results. Reliable figures and accurate cause of death surveys are therefore essential in order to create effective solutions. The aim is therefore, reliable health databases to form the basis for the formulation of national policies.
INDEPTH was founded in 1998 and has received 435 million sek in support from Sida since 2001. The network has grown from 17 health demographic surveillance sites to the current 43, spread across 22 countries and three continents. The network has contributed to improving the health care in many countries. The method of 'verbal autopsy' is now a standard and is available on the WHO’s website for the many countries that do not have any other opportunity to gather cause of death statistics.