The Data Imperative in Guatemala's COVID-19 Recovery
By Robin Brazier and Jay Gribble
On June 11, the School of Medicine of the Universidad San Carlos de Guatemala launched a new course titled "Public Health and Demography, Reproductive Health and Nutrition” for which Jay Gribble, deputy director of Health Policy Plus and family planning expert, had the opportunity to give the keynote speech. During the presentation, he stressed the importance of focusing on the need for multisectoral approaches, systems interventions, and integrated methodologies to promote local development. Building on the speech, Gribble and Robin Brazier, assistant country activity manager for Health and Education Policy Plus (HEP+) in Guatemala dive into the critical role data can play in improving public health and local development, particularly in the context of a global pandemic.
Many years ago, Jay had the opportunity to arrive in Chichicastenango the day before its famous weekly market. He remembers seeing a girl about 13 or 14 years old, who stood out from the crowd because she was the only person he saw wearing glasses. As he looked at the bespectacled girl, he wondered how her life was different from that of her mother and grandmother. Since she was wearing glasses, a rarity in her community, he wondered about her level of education, her access to health services, and what her future would look like, as she seemed not to have started having children.
Robin, having lived in Guatemala and worked directly with community leaders on expanding access to education and improving family planning services for indigenous youth, saw firsthand how data-informed health planning helps individuals fulfill their full potential. The indigenous young people with whom she worked in Guatemala are healthy and have waited to start making a family. She has followed their journeys excitedly as they have continued to advance their individual goals, lead healthy lives, and make a difference in their communities.
These experiences illuminate the intimate relationship between health—specifically, access to quality healthcare products, information, and services—and development at the individual, community, and national levels. Now, as colleagues on the Health Policy Plus project, Jay and Robin support public health programming in emerging markets with an explicit focus on monitoring and evaluation that is enabled through data collection and analysis. Health and development are inherently linked, and as the COVID-19 pandemic continues in Guatemala, a focus on improved data collection and systems, data use, and data triangulation across sectors will help decisionmakers understand and best address the pandemic’s impact across other health areas.
Data: a critical public health tool. While different types of professionals focus their attention on health and development separately, as public health professionals we must also look at these fields in an integrated way. One of the most important ways to do this is through the use of data. When applying a public health perspective, HEP+ starts by using data to understand the existing situation. What do we know about the situation? Why do some segments of the population underperform while others overperform? Guatemala’s Great National Crusade for Nutrition (GCNN)—a campaign supported by HEP+ that is seeking to improve nutrition, with an emphasis on Guatemala’s poorest and most marginalized areas—highlights the role of data in decision making. When baseline data surveys are finished in November of this year, decisionmakers can begin to assess the impact of COVID-19 on the nutritional status of women and children by comparing GCNN baseline data against data from previous surveys, such the 2018 national census. Understanding possible changes over time will inform GCNN stakeholders, including HEP+, on where to focus their attention and which types of interventions to prioritize to improve nutrition. In the future, this data can be used to measure the impact of those interventions on nutritional status.
Strengthening capacity to use data. The COVID-19 pandemic has demonstrated the urgency of having accurate public health data. Local-level data on hospital equipment, capacity, and distribution of resources to respond to the increasing and decreasing number of cases in a particular area has been critical. Accurate and available data also make it possible to examine the effect the pandemic has had on other critical health services and to make adjustments to reach communities in need. For example, OSAR Youth—the sexual and reproductive health watchdog organization’s youth-led chapter—uses a database developed by HEP+ to monitor contraception indicators in Guatemala. An analysis of data collected before and during the pandemic revealed alarming results: demand for and use of family planning and reproductive health services had declined, and indicators on maternal deaths, unplanned pregnancies, and infant deaths increased due to pandemic shutdown measures. Based on these findings, OSAR Youth initiated a social media campaign advocating for the continued offering and use of family planning and reproductive health services during the pandemic.
Triangulating data sources. Health information systems are an important data source, but their outputs often only reveal part of the big picture. After analyzing available data, we need to ask what these data are not telling us. Our work in Guatemala provides an example.
As a part of implementation of Guatemala’s COVID-19 Vaccination Plan, HEP+ is collecting and publishing data on vaccination centers. This data helps the public find their closest vaccination center and register. Registration numbers are then logged on a dashboard, which informs the Ministry of Health about vaccination rates in all departments of Guatemala and helps to prioritize vaccination resources. Presumably, health facilities have data on the size of the population in their catchment area and are able to estimate coverage rates. However, additional information is needed. To better understand vaccine hesitancy and how to increase coverage rates, HEP+ is launching a survey of healthcare workers in Guatemala to collect insights about public perceptions of COVID-19 vaccines. The results will be used to refine educational material and encourage vaccination uptake. Triangulating coverage data with qualitative data from other sources - even from other sectors outside of public health, like education - can shed light on community members’ motivations and concerns. This bigger picture helps public health decisionmakers determine next steps.
Solving health and development challenges with data. The collaborative effort of public health means that we recognize the importance of a systematic approach. Clinical services, water and sanitation, and good nutrition are monitored by separate programs and data systems, but the success of public health programs relies on understanding the complexity and interrelatedness of these area and addressing them in an integrated way. As we work to address health and development issues, we need to work to use data to help address underlying issues that impede progress; decisionmakers also need data to understand the social determinants of health, sources of gender and social equity, and social norms that undermine development efforts. The inherent link between health and development—validated by our experiences in Guatemala—requires that professionals who work in these sectors understand the contextual issues in which these challenges exist and use all available data, tools, and resources to collaborate to improve them.
Robin Brazier is a senior associate at Palladium and an assistant country activity manager for Health and Education Policy Plus activities in Guatemala. Jay Gribble is a senior director in Palladium’s health practice leadership team and deputy director for family planning and reproductive health for Health Policy Plus.