To understand the spread of COVID-19 throughout the world, policymakers rely on data gathered by national health information systems. To learn about the challenges this raises for low- and middle-income countries during the COVID-19 pandemic, Samuel Volkin, MPH/MBA candidate, turned to Jeremy Shiffman, Bloomberg Distinguished Professor of Global Health Policy at the Johns Hopkins Bloomberg School of Public Health and the School of Advanced International Studies. The conversation has been edited for length and clarity.
Why is it important to have strong national health information systems during COVID-19?
Shiffman: In this era of pandemic, data are essential to understand where the disease is occurring and to craft national policy. This information is needed to undertake appropriate responses to the pandemic, including how to allocate resources to provide medical care. Data collected by these systems is also needed to create models that can predict the future course of the pandemic. Data from health information systems are a crucial component of any country’s response.
Are national health information systems in low- and middle-income countries adequately developed to respond to COVID-19?
I have concerns about the strength of health information systems in many settings, including low-income countries. Many of these systems are not as strong as we would hope. This may make it very difficult to monitor the course of the pandemic in these places. That’s worrying. There’s going to be large variance in the capabilities of national health information systems to respond to COVID-19. Some may be strong, but some countries have very weak information systems in place, making it more difficult to contain an outbreak.
Why are health information systems weaker in some countries despite the ongoing need to address global health challenges?
There are many reasons. My recent paper in the Lancet posits that one—if not the only—reason for this may be the unintended effects of global health metrics initiatives that use imputation methods to estimate disease burden in low-income settings. Global health metrics uncover health problems and bring greater accountability to advance the well-being of populations in low-income settings. However, some health ministries and statistical agencies in low-income countries may have decided that it’s just not worth investing extensively in their own information systems if estimates are already being produced globally by organizations using massive computer power. It’s costly to develop these statistics locally, so they sometimes give up. That’s unfortunate because you really need this locally-grounded information for local-, district-, and national-level policy-makers to make effective decisions about where health resources should be allocated and what policy responses are needed.
Are there other potential consequences to these global health metrics initiatives?
The consequences actually extend beyond metrics. They raise the issue of the legitimacy of the distribution of power in global health governance. By producing and disseminating global health metrics, these global agencies acquire considerable power to shape national health priorities, potentially taking away power from the governments of low-income countries to shape their own health priorities and responses, including the response to COVID-19.