Monitoring global healthBMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7484.195 (Published 20 January 2005) Cite this as: BMJ 2005;330:195
Problems are primarily national
- Osman David Mansoor, public health physician (, )
- Nick Wilson, senior lecturer
- Public Health Consulting, 4/14 College Street, Wellington, New Zealand
- Department of Public Health, Wellington School of Medicine and Health Sciences, POBox 7343, Wellington South 6005, New Zealand
EDITOR—Murray et al urge for improved global reporting of health data.1 They also highlight the difficulty of showing national decision makers that good health data can strongly support decision making. Why is this?
A reason may be that data are always subject to interpretation. The article by Murray et al is a case in point. They want to establish “an independent monitoring organisation,” arguing that the World Health Organization is not fit to undertake the job because of tension between advocacy, monitoring, and evaluation. But evidence that it is this tension that leads to poor monitoring by WHO is weak, at best.
In reality, the problems of global health reporting are primarily national (and sub-national). The fact that the sum of deaths claimed by different programmes is greater than the actual number of deaths reflects epidemiological methods and the current limitations in global health reporting, more than any WHO failure. The global burden of disease project was limited by these issues, but it was undertaken as effectively in WHO as in any other organisation.
Not only are there problems in capacity, understanding the value of surveillance, and coverage of health services. The reporting of health events can be politically sensitive or even economically damaging. It is therefore likely that political interference will continue (whoever collects the data) until governments can be shown that honesty pays. It is perhaps this failure that needs to be dealt with rather than setting up yet another organisation without a proper analysis of the reasons (and locus) for failures in global health reporting.
Competing interests Both authors have worked for WHO