This is an abbreviated version of the article by our partner, DHIS2. Read the full, original version.
The past two months have been a period of great upheaval in global health, following the sudden decrease in health funding from the United States and the abrupt end of programs previously funded by USAID and other U.S. government agencies. These cuts have had profound impacts worldwide, and the ensuing gaps in treatment, services, and disease surveillance activities—to name just a few affected areas—put local and global health at risk. According to Dr. John Kaseya, Director General of Africa Centres for Disease Control and Prevention (CDC), individual countries depend on international aid for up to 80 percent of the costs of critical health programs, including those focused on malaria and HIV treatment and prevention. Africa CDC estimates that these cuts will result in four million extra deaths in Africa per year and put the world at risk of a new pandemic.
Health data systems have also been affected by these cuts. Platforms like PEPFAR’s (the United States President’s Emergency Plan for AIDS Relief's) global HIV database, DATIM (Data for Accountability, Transparency and Impact Monitoring), have effectively been turned off overnight, and local staff who supported data collection and analysis for USAID-funded programs have been furloughed or fired, creating immediate gaps in digital records that are used to coordinate life-saving treatment. However, there is a bright spot in this dark time: an informal survey carried out through the HISP network, which provides localized DHIS2 technical assistance in 90+ low- and middle-income countries (LMICs), suggests that locally owned national health information systems remain online, and ministries of health continue to use these systems to monitor public health and plan interventions. This is thanks to long-term investments in these systems.
The situation is fragile, however. Most low-income countries are still heavily dependent on external funding for their public health systems. Digital public goods (DPGs) like DHIS2, which are the foundation for the large majority of these routine health data systems, are also primarily supported by global health funders. At a time when budgets for global health are tight, it is important to invest in effective and sustainable solutions. When it comes to health data, that means investing in routine data, open-source tools, and local system ownership.
Funding disruptions and impact on health information systems
Data systems are a small but integral part of national health systems, enabling countries to monitor population health, assess health risks, prioritize interventions, make budget decisions, and evaluate programs.
While disruptions to these systems pose a less immediate threat than shutting down HIV treatment centers or stopping food distribution, without access to data, governments struggle to manage health programs effectively.
At the HISP Centre at the University of Oslo (HISP UiO), our team develops and maintains the open-source DHIS2 software platform, which is used by ministries of health in more than 90 countries in the global south as an integrated health information system (HIS), with 75 of these countries using DHIS2 at national scale. DHIS2 thus serves as the backbone for routine data collection on public health programs that touch more than 40 percent of the world’s population—roughly 3.2 billion people. HISP UiO also coordinates the HISP network, which is made up of 23 local HISP groups based in countries in Africa, Asia, the Middle East, and Latin America. For more than a decade, these groups have worked with national, regional, and international partners to support the set up and operation of national DHIS2 systems in most of the 90+ countries where DHIS2 is used, as well as helping to strengthen the local teams within ministries of health to take direct ownership of these systems.
When the news of the U.S. funding cuts broke, it was imperative for HISP UiO to get a rapid overview of the impacts on national DHIS2 systems, so that we could identify any critical gaps and work with local and global partners to keep these essential systems online. What we found was that while many project-funded or program-focused systems have been shut down, and there are some disruptions in individual DHIS2 systems due to partial reliance on U.S. funding or seconded personnel, the trend is that national HIS systems remain online, supported by local staff, and that routine data collection and analysis continue.
Routine data systems are more resilient than parallel systems
DHIS2 plays a fundamental role in most LMICs as an integrated national HIS—the system of record that is used to collect data from health facilities on service delivery and health outcomes for all fundamental health programs, such as maternal and child health, immunization, HIV, malaria, tuberculosis, and more. Such aggregated reporting systems are the cornerstone of public health monitoring and programming, and have decades of demonstrated sustainability. They require smaller investments to scale and maintain than patient-facing systems, making them practical, reliable solutions for ensuring that crucial health data are captured and reported in low-resource settings.
Invest in what works and what lasts
Long-term investments in strengthening routine health information systems, and the open-source technologies that support them, have resulted in positive impacts on health programs in LMICs, by providing timely data to inform better decisions. In addition, by supporting local ownership and capacity, these investments have enabled systems to continue operating through the current global health funding crisis.
Of course, funding for national health systems is complex, and the specifics of how systems and staffing are funded varies by country. Ultimately, the sustainable solution is greater institutionalization, through a continued emphasis on—and investment in—health system strengthening, including data and digital infrastructure.
We have only seen the immediate effects of the sudden cuts to U.S. health funding so far. The larger, long-term effects, such as the impact on the budgets of global health funding institutions like Gavi and the Global Fund, and thus on the programs they support, remain to be seen. As far as health data is concerned, our message, in a time when budgets are tight and there is a need to focus on essentials, is to invest in what works and what lasts: locally owned routine information systems, the digital public goods they are built on, and the local capacity to keep them running. This will ensure that these systems remain resilient and adaptable, helping low- and middle-income countries meet health needs and respond to challenges in the years to come.
Initiatives like the Capacity Accelerator Network are already demonstrating how locally led capacity building efforts can strengthen routine data systems and foster sustainable, country-owned data ecosystems. Read more.