FINALLY, after some ado, we have a document in the form of the National Health Vision (NHV), which identifies major problems in, and challenges to, our healthcare system. It also outlines our vision of how we plan to address those issues and challenges. One thing that will hamper, even damage, its execution is the unavailability of critical and reliable data. It is hard to believe that we will be able to do any serious planning or resource allocation to fix our healthcare issues without access to the correct data.
During an analysis, this author found data discrepancies in major government publications for healthcare data, namely the Pakistan Social and Living Standard Measurement (PSLM), the Pakistan Demographic and Health Survey (PDHS) and the Multiple Indicator Cluster Survey (MICS). It was found that, for certain healthcare indicators, data in one government publication differed for the same indicator in the same year from the data in another publication.
First, I found data discrepancies for an indicator named “deliveries with skilled birth attendants” between the PSLM and PDHS for the year 2012-2013. As per the PSLM, the deliveries with skilled birth attendants were 53pc in Sindh; as per the PDHS, however, they totalled 61pc in that province. In Balochistan, as per the PSLM, the proportion of births with skilled birth attendants was 35pc, but according to the PDHS it was 18pc in the same province.
According to a study by Jhpiego (an international non-profit health organisation affiliated with the Johns Hopkins University), skilled birth attendants can reduce newborn deaths by 43pc and prevent two-thirds of all maternal deaths. We can save more mothers and children if we allocate skilled birth attendants efficiently (which becomes even more important when resources are already scarce) based on correct and updated data.
Second, for the indicator “children (aged 12-23 months) fully immunised”, we again found discrepancies between the PSLM and PDHS, this time for the year 2006-2007 and for almost all provinces. For Sindh, the PSLM states that 65pc children were fully immunised, whereas the PDHS reports only 37pc children were fully immunised there. For Balochistan, as per the PSLM, the same indicator was 54pc, while the PDHS records it as being 35pc. According to the PSLM, 76pc of children in Khyber Pakhtunkhwa were fully immunised, while in the PDHS the figure was 47pc.
These differences are huge and baffling. It is inevitably low-income groups that suffer most when policymakers have inaccurate data for such important performance indicators. How can we ensure that our child immunisation rate is high in all provinces, in both rural and urban areas, when the data in major surveys does not match?
Third, for the indicator named “postnatal consultation”, for KP we found a discrepancy between the PSLM and MICS for 2008-2009. In MICS, the percentage of births followed by postnatal consultation was reported as 13, whereas in the PSLM survey, the figure was given as 23pc. Again, the difference is not small.
In our society, postnatal care is usually provided at home, and the idea of postnatal consultation is to ensure that new parents are given guidance according to evidence-based healthcare practices. The lack of good postnatal consultation can result in a higher mortality rate for both mother and child. The risk decreases as time passes, but it is imperative to receive timely consultation. Ineffective postnatal consultation may not promote, or may even discourage, breastfeeding, the absence of which can contribute to infections and malnutrition. It is unclear how any meaningful planning can be done to improve this indicator without access to the correct data.
These discrepancies are alarming. First, inconsistent data perpetuates confusion — which figure do we believe? This confusion can result in a misplanned policy, and even that one misplanned policy may have an undesired effect. The collectively dismal result of several such policies can take us many steps backward.
Second, these inconsistencies reflect a lack of rigour on the part of our government. If it is not careful about data acquisition, one is forced to infer that it is not serious about data-driven and evidence-based decision-making.
Third, incorrect data in government publications shows we still have a long way to go when it comes to competent data acquisition, so, sadly, we cannot yet turn our focus to the ‘analysis’ part and proceed to policy.
Fourth, most of the tall performance claims by the government are rendered insignificant when the underlying data is unreliable.
Such important healthcare indicators should not vary so much. Any researcher or policymaker who intends to carry out research or planning will use these government publications. Even the NHV cites the PSLM. Our expenditure on healthcare is already depressingly small, and it is going to hurt us if that small expenditure is used to plan and allocate resources using unreliable data.
This opinion was published in The Dawn on 29th September, 2016.