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March 22nd, 2016
Health

The Demographic and Health Surveys (DHS) programme

Since 1984, the DHS programme has been working with developing countries around the world to collect data about significant health issues, including fertility, the use of contraception, the incidence of malaria and HIV, and maternal mortality. It has also worked in concert with international NGOs such as USAID, UNICEF and the World Health Organisation. These surveys enable policymakers to make considered decisions in designing national health programmes.

The initiative

The Demographic and Health Surveys (DHS) programme was started in 1984 to provide a global understanding of health and population trends in developing countries. “DHS were initially designed to expand on demographic, fertility and family planning data collected in the World Fertility Surveys and Contraceptive Prevalence Surveys.” [1]

These surveys had been carried out in the 1970s and 1980s and originally collected comparable population-based data on fertility, contraception, maternal and child health and nutrition.

The DHS programme is implemented by ICF International and largely funded by the United States Agency for International Development (USAID) along with other donors such as UNICEF. It works with country-specific agencies to conduct nationally representative household sample surveys with coverage of a range of population health indicators in LMICs.

The specific objectives of the DRS programme were to:

  • “Collect high-quality data for policy formulation, programme planning, and monitoring and evaluation". [2]
  • “Foster and reinforce host-country ownership of data collection, analysis, presentation, and use".
  • “Increase the capacity of host-country partners to collect and use data for policy and programme purposes.”

The challenge

Before the 1980s, low- and middle-income countries (LMICs) around the world were often unable to find funding and suitable personnel to record and monitor population and health statistics. Without these, they were unable to create targeted health policies in areas such as contraception and nutrition.

The public impact

“Since 1984, the DHS programme has provided technical assistance to more than 300 surveys in over 90 countries.” [3]

The DHS programme has been able to offer host countries:

  • “High response rates. [4]
  • National coverage.
  • High quality interviewer training.
  • Standardised data collection procedures across countries and consistent content over time.”

As a result the data from DHS facilitates valid demographic and medical research focused on the monitoring of prevalence, trends and inequalities. The development of detailed geographic information systems has brought with it the ability to apply spatial and geographical analysis and visualisation.

Stakeholder engagement

The DHS programme has mechanisms in place to engage with stakeholders, in addition to having several partner organisations:

  • The DHS programme is implemented by the management consultancy ICF International and partners Blue Raster, The Futures Institute, The Johns Hopkins University Centre for Communication Programs (JHUCCP), PATH, Vysnova, EnCompass and Kimetrica.
  • USAID has invested approximately USD380 million in the project, and each dollar has leveraged approximately USD0.33 in donor and host-country contributions.

The DHS engages stakeholders at various levels of the survey structure according to their roles and interests to ensure their buy-in.

Political commitment

There is evidence that the DHS programme has received consistent support from US federal government agencies and institutions. It is largely funded by USAID with contributions from other donors such as UNICEF and the WHO.

Public confidence

There is no direct evidence for public confidence in the DHS programme. However, the fact that “response rates typically exceed 90%” [5] suggests that the public have reasonable confidence in the programme and the DHS that it conducts.

Clarity of objectives

The DHS programme has clearly defined goals about collecting data and working in partnership with the main stakeholders:

  • “Selecting the most appropriate data collection methods to ensure the provision of high-quality data.” [6]
  • “Fostering and reinforcing host country ownership of data collection, analysis, presentation, and use.” [7]
  • “Increasing the capacity capacity of host-country partners to collect and use data for program and policy purposes.” [8]

These objectives have been throughout the life of the programme.

Strength of evidence

The DHS programme evolved from World Fertility Surveys and Contraceptive Prevalence Surveys that were conducted by USAID in the 1970s and 1980s and originally collected comparable population-based data on fertility, contraception, maternal and child health and nutrition in developing countries. These initial surveys were used to inform and refine the surveys which were constructed under DHS.

“The same survey approach has been applied. “Survey field teams visit the selected geographical areas, where a complete listing of dwellings and households is compiled. From these listings, 20-30 households are selected by systematic sampling. Selected households are visited by a trained interviewer, who conducts a brief household interview and completes a household roster and identifies eligible women and men for an individual interview.” [9]

Feasibility

The feasibility of the DHS programme has been demonstrated in two main areas:

  • Financial - USAID is a major funder of DHS, along with NGOs such as UNICEF and the WHO along partner organisations in target countries. “Most DHS surveys are partially funded by UNICEF or aid agencies from other countries such as the UK and Norway.” [10]
  • HR feasibility: Each survey is conducted by local workers, who are able to engage with participants in their native language.

Management

The DHS programme is managed at the international level by ICF International. “Each [individual] DHS is conducted by an in-country institution, typically the national statistics office. The institution receives technical assistance from the DHS project to ensure data quality and international comparability. Technical assistance varies in accordance with the data needs and existing capacities of the national institution and is typically provided across all phases: survey planning and design, data collection, data processing, and report writing and dissemination.” [11]

Measurement

The DHS programme uses accepted measurement techniques such as regression models and household surveys to prepare each report.

Trends in data availability and in the use of DHS data for research is assessed through descriptive, graphical and bivariate linear regression analyses. “Researchers at DHS analyse survey results to provide richer understanding of the data [through]:

  • “Comparative reports: compare a large group of DHS countries across harmonised indicators.
  • “Trend Reports: assess trends in a given country.
  • “Analytical Studies: programme and policy relevant themes go deeper than final report tables.
  • “Qualitative reports: increase the validity of quantitative survey questions and explore the social contexts of specific issues.” [12]

Alignment

The various NGOs, such as the WHO, USAID and UNICEF are well aligned in their work with the DHS programme, both in funding and organising DHS.

The programme also cooperates closely with host countries, for example with their national statistics offices. The capacity strengthening programme serves to support DHS implementing partners by “equipping them with the tools, resources, skills, knowledge, and abilities necessary for conducting household or facility-based surveys”. [13] The DHS programme staff then work with local and global media to disseminate survey results as widely as possible.

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