WJG declares that she is the principal scientist for a research group (Immpact) that undertakes the measurement of population health, including maternal mortality. WJG was one of the peer reviewers for the Lancet article by Hogan et al. that reported the IHME maternal mortality estimates, and was a member of the external Technical Advisory Group for the Inter-agency Group for maternal mortality. SA is a former Board member of the Health Metrics Network, former Deputy Director-General of the Ghana Health Service, former chairman of the country coordinating group of Immpact in Ghana, and former visiting Professor at the University of Aberdeen. He has provided consultancy services to the African Program of Onchocerciasis Control.
There is new urgency and potential to deliver leadership on the process of global estimation of women's and children's health.
Recent controversies over global estimates highlight fundamental questions about the performance of the “suppliers” of the figures and the needs of the “clients”.
Stakeholders in the process are now even more diverse, and include country governments, bilateral and multi-lateral agencies, academics, professional associations, and non-governmental organisations, and newer members from global philanthropic organisations and the business community.
We propose responsible estimation of global health, which is stakeholder-centric, accountable, and transparent, and which has a clear leader.
On September 22, 2010, a new Global Strategy for Women's and Children's Health was launched by the United Nations Secretary-General and over US$40 billion in resources pledged
At the heart of recent debates and controversies over global estimates—be these on immunisation
Why does this matter? Reactions from the “clients” for the estimates are as diverse as the group itself. These stakeholders include long-standing users of this information—country governments, bilateral and multi-lateral agencies, academics, professional associations, and non-governmental organisations—as well as newer users from global philanthropic organisations and the business community. However, for all of them, it is not hard to imagine the potential for confusion from there being two sets of estimates for such a key MDG target. This is perhaps felt most acutely at the country level, where earlier remarks and requests for clarity about the IHME estimates from individuals and groups based in low- and middle-income countries
Estimates are from the UN inter-agency group (UN)
So what's to be done? The need to reduce the reliance on modelled estimates is well accepted—a reliance that largely reflects the poor state of investment in health information systems in low-income countries. However, this will not remove the requirement for global comparative processes, and so efforts to improve current practice are still warranted. This brings us back to the potential of the Global Strategy, with its promising narrative around accountability: national ownership of results, strengthening countries' capacity, and harmonising mechanisms for tracking progress. Encouraging signs also lie in the frequent mention of leadership in the main document and in the press release: “Today we are witnessing the kind of leadership we have long needed”
But perhaps the most reassuring words are found in the simple phrase “we all have a role to play”
Respecting the audience whilst also maintaining balance in the orchestra is indeed the role of the conductor. The best estimates will ultimately come from the creative power of many players, and not by allowing only one approach or group to dominate at the expense of others. What must happen eventually, however, is that the players harmonise for the sake of the audience. This is what we refer to as responsible estimation (
A co-ordinated estimation process that is stakeholder-centric and has the requisite leadership to harness and harmonise inputs from all relevant technical players. The process must engage with stakeholders from the outset, continue to work transparently and consultatively with them during the creation of new figures, and support and build capacity in country to use, own, and improve the estimates.
The authors would like to thank colleagues who commented upon on an earlier version of this viewpoint: Bilal Avan, Peter Byass, Alec Cumming, Anthony Seddoh, and Sophie Witter. Acknowledgment is also given to Ann Fitzmaurice for
Institute for Health Metrics and Evaluation
Millennium Development Goal