What occurs after we lose world well being information?

When President Donald Trump and Elon Musk fed the US Company for Worldwide Improvement into the wooden chipper earlier this yr, one of many lesser-known casualties was the shutdown of an obscure however essential program that tracked public well being data on about half of the world’s nations.

For almost 40 years, the Demographic and Well being Surveys (DHS) Program has served because the world’s well being report card. In that point, it has carried out over 400 nationally consultant surveys in additional than 90 nations, capturing a variety of important indicators similar to maternal and baby well being, diet, schooling ranges, entry to water and sanitation, and the prevalence of illnesses like HIV and malaria.

Taken collectively, it provided maybe the clearest image ever compiled of world well being.

And that readability got here from how rigorous these surveys had been. Each began with a globally vetted blueprint of questions, utilized by a whole lot of skilled native surveyors who went door-to-door, conducting face-to-face interviews in individuals’s properties. The ultimate, anonymized information was then processed by a single contractor ICF Worldwide, a personal consulting agency based mostly in Reston, Virginia, which made the outcomes standardized and comparable throughout nations and over time. Its information powered world estimates from establishments just like the Institute for Well being Metrics and Analysis, which in flip formed public well being coverage, analysis, and funding choices all over the world. “If DHS didn’t exist, evaluating anemia throughout nations can be a PhD thesis,” mentioned Doug Johnson, a senior statistician on the nonprofit IDinsight.

Crucially, DHS additionally tracked issues few different programs touched, like gender-based violence, girls’s autonomy, and attitudes towards home abuse. Physician’s places of work aren’t consultant and solely seize people who can entry a proper well being care system. Additionally, since DHS information is anonymized, in contrast to a police report, responders don’t need to concern intervention in the event that they don’t need it. “You possibly can’t get solutions from different sources to delicate questions like those DHS posed,” mentioned Haoyi Chen from the UN Statistics Division, pointing to at least one instance: Is a husband justified in beating his spouse if she burns the meals?

Then, earlier this yr, DHS was shut down.

The choice got here as a part of the Rescissions Act of 2025, a invoice handed in June that clawed again $9.4 billion from international help and different packages. Eliminating DHS saved the federal government some $47 million a yr — solely about 0.1 p.c of the complete US help price range, or half the price of a single F-35 fighter jet.

That tiny price range minimize has had speedy penalties. The transfer halted round 24 in-progress nation surveys – 10 of which had been simply wanting ultimate publication, and three in Ethiopia, Guinea, and Uganda that had been stopped mid-fieldwork. This system’s public-facing web site stays up, however the equipment behind it’s gone. With nobody to approve new functions, the method for researchers to entry the underlying microdata has floor to a halt.

There may also be long-term injury. When governments or help organizations can now not see precisely the place kids are malnourished, the place malaria outbreaks are quietly spreading, or the place moms are dying in childbirth, they’ll’t successfully goal life-saving interventions, leaving probably the most susceptible populations to pay the value. For twenty-four nations, together with the Democratic Republic of Congo and Mali, the DHS was the only information supply for the UN’s official maternal mortality estimates. Going ahead, “it will simply be principally estimates which are based mostly on different nations’ information,” says Saloni Dattani, a editor on science and world well being at Works in Progress journal and 2022 Future Excellent 50 honoree. “We simply wouldn’t know.”

With out the information DHS supplied, international help turns into much less efficient, and fewer accountable “We now have no manner of externally or objectively estimating the constructive influence that these [aid] packages are having, or detrimental,” mentioned Livia Montana, the previous deputy director of the DHS Program, who’s now a survey director for the Understanding America Examine on the College of Southern California.

Naturally, the worldwide well being group has been scrambling to plug the big hole. The Gates Basis lately dedicated $25 million in emergency funding to rescue some ongoing surveys, and Bloomberg Philanthropies has additionally stepped in with a separate dedication to assist the trouble.

This funding is a vital lifeline, however solely a stopgap. The seek for a long-term repair has compelled a reckoning with the outdated packages’ flaws. Everybody agrees that DHS delivered high-quality, trusted information — but it surely wasn’t good. Many specialists have criticized it as basically “donor-driven,” with priorities that didn’t at all times align with the nationwide pursuits of the nations it surveyed. As an illustration, this system’s historic deal with reproductive well being was a direct reflection of the priorities of its major funder, USAID, and a few nation officers privately felt the information served the accountability wants of worldwide organizations higher than their very own speedy planning wants.

This has created a central dilemma for the worldwide growth group: is it doable to construct a brand new system that’s each genuinely country-led and likewise globally comparable?

A lifeline and a reckoning

Confronted with this information vacuum, an apparent query arises: Why can’t different world organizations just like the World Well being Group or the United Nations merely step in and take over?

It’s not out of the query, however it will be actually, actually troublesome. Consider it this fashion: The DHS Program was like a single, highly effective structure agency that perfected a blueprint and constructed homes in 90 neighborhoods for 40 years. As a result of it was a single program managed by personal contractor, ICF Worldwide, and backed by one main funder, USAID, it might implement a standardized methodology in all places it labored. As a for-profit agency, ICF’s curiosity was additionally monetary, it managed the worldwide contract and profited from the work.

The UN and WHO, in contrast, act as the worldwide metropolis planners: Their mandate isn’t to design and construct the homes themselves, however to set the constructing codes and security requirements for everybody. In line with WHO, its position is to not “instantly fund population-based surveys,” however to supply management and convey the appropriate stakeholders collectively.

Whereas that mandate might stop the UN from merely inheriting the outdated program’s work, it makes it a perfect coordinator for the trail ahead, says Caren Grown, a senior fellow on the Brookings Establishment’s Middle for Sustainable Improvement. Grown argues that the UN is the one physique that may deal with the “heavy raise” of coordinating all of the totally different nations, donors, and organizations.

And now that the DHS has been dissolved, each Grown and Chen at the moment are a part of a UN job pressure trying to determine new internationally agreed-upon requirements for the way well being information needs to be collected and ruled.

On the identical time, different efforts are extra targeted on the sensible work of implementation relatively than on world governance. Montana is main a coalition to “rebuild components of DHS” by creating a worldwide consortium of analysis establishments that may present technical assist to nations. These efforts had been catalyzed by preliminary conversations hosted by organizations just like the Inhabitants Reference Bureau, which introduced collectively donors, authorities businesses, and world information customers to grapple with the shutdown’s speedy aftermath.

Between this mishmash, probably the most sensible growth has been a lifeline from the Gates Basis, which introduced a $25 million funding in “bridge funding.” Individually, in an announcement to Vox, Bloomberg Philanthropies confirmed its dedication to fund the completion of a further 12-country surveys over the subsequent eight months. A supply from the Gates Basis clarified that Bloomberg’s dedication is on prime of theirs, confirming the 2 are distinct however coordinated rescue efforts.

The Gates Basis framed its effort as a short lived, stabilizing measure designed to provide the worldwide well being group a much-needed respite. “We consider information is — and should stay — a worldwide public good,” mentioned Janet Zhou, a director targeted on information and gender equality on the Gates Basis. “Our interim assist helps to stabilize 14 ongoing nation surveys. … This funding is designed to provide world companions and nationwide governments the time and house wanted to construct a extra sustainable, country-led mannequin for well being information.”

That assist is aimed on the most pressing work: ending surveys that had been almost full, like in Ethiopia, and reopening the four-decade-old information archive. However relatively than giving every respective nation the cash to finish their ongoing surveys, the Gates funding can be administered by ICF Worldwide, the identical for-profit agency that ran the unique DHS.

The choice to work with the prevailing contractor, ICF Worldwide, was a practical one. Persevering with with the identical implementer was the “quickest, most inexpensive manner” to forestall waste, and “a number of host nations have shared a choice” to finish their work with the agency, mentioned a supply on the Gates Basis.

It’s a strong argument for triage in an emergency, but it surely additionally papers over deeper flaws. Check out Nigeria, for instance: Fieldwork for its 2023–’24 DHS completed in Might 2024, and the questionnaires gathered new estimates of maternal and baby deaths. Nigeria additionally ran a separate examine to probe precisely why moms and youngsters are dying. In precept, the 2 datasets ought to dovetail however past a headline-numbers report, the total DHS micro-dataset continues to be in ICF’s processing queue — seemingly frozen after DHS’s shuttering.

That bottleneck illustrates what critics imply by “donor-driven.” With barely 3 p.c of family surveys in low-income nations fully-financed by the native authorities, the WHO notes, most nations should depend on “externally led surveys…limiting continuity and nationwide possession.” When the donor funding stops, so does the information pipeline.

An ICF spokesperson pushed again saying survey priorities had been “primarily formed by the collaborating nations.” But, of the $25 million that arrived from Gates, a big portion of it’s going to go towards finishing large-scale surveys in Nigeria and Kenya, two nations that additionally occur to be key “geographies of curiosity” for the Gates Basis’s personal strategic priorities, underscoring how funders nonetheless steer the highlight.

Insiders I spoke with described ICF’s system as a “black field,” with key components of its methodology managed by the contractor, leaving nations with out the capability to face on their very own. That issues as a result of with out home-grown statisticians and know-how, ministries can’t rerun surveys or replace indicators with out exterior assist. In response, ICF acknowledged that this system has a “confirmed observe report of constructing a long-term capability,” noting that nations like India now not require its help.

However critics argue that for each India, there are a dozen different nations the place this system’s sudden collapse is proof {that a} deep, sustainable capability was by no means constructed. This dependency creates a fragile system that may, as simply occurred, collapse in a single day, leaving nations unable to proceed that work on their very own.

This unresolved pressure brings the controversy again to a central query from the UN’s Chen. “DHS has been there for 4 many years,” she asks, “and why are we nonetheless having this program doing the survey for nations?”

Chen’s query will get to the guts of the controversy. However grappling with the failings of the previous can’t get in the best way of surviving the current. Present world well being information is already a number of years outdated because of the pandemic, whereas crises in maternal mortality and baby diet proceed to unfold. The necessity is for dependable information now, as a result of the elemental actuality stays: You possibly can’t assist individuals you possibly can’t see.