When President Donald Trump and Elon Musk fed the US Company for Worldwide Growth into the wooden chipper earlier this 12 months, one of many lesser-known casualties was the shutdown of an obscure however essential program that tracked public well being info 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 international locations, capturing a variety of important indicators similar to maternal and youngster well being, vitamin, schooling ranges, entry to water and sanitation, and the prevalence of illnesses like HIV and malaria.
Taken collectively, it supplied maybe the clearest image ever compiled of worldwide 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 bunch of skilled native surveyors who went door-to-door, conducting face-to-face interviews in folks’s properties. The ultimate, anonymized knowledge was then processed by a single contractor ICF Worldwide, a personal consulting agency primarily based in Reston, Virginia, which made the outcomes standardized and comparable throughout international locations and over time. Its knowledge 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 selections around the globe. “If DHS didn’t exist, evaluating anemia throughout international locations can be a PhD thesis,” mentioned Doug Johnson, a senior statistician on the nonprofit IDinsight.
Crucially, DHS additionally tracked issues few different techniques touched, like gender-based violence, ladies’s autonomy, and attitudes towards home abuse. Physician’s workplaces aren’t consultant and solely seize of us who can entry a proper well being care system. Additionally, since DHS knowledge is anonymized, not like a police report, responders don’t should worry intervention in the event that they don’t need it. “You’ll be able to’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 12 months, 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 overseas support and different packages. Eliminating DHS saved the federal government some $47 million a 12 months — solely about 0.1 % of the complete US support funds, or half the price of a single F-35 fighter jet.
That tiny funds reduce has had fast penalties. The transfer halted round 24 in-progress nation surveys – 10 of which had been simply in need of closing 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 purposes, the method for researchers to entry the underlying microdata has floor to a halt.
How the DHS has saved lives
The shutdown isn’t nearly numbers on a spreadsheet. Right here’s how DHS knowledge has formed coverage and saved lives throughout the globe.
Guinea: DHS knowledge was used to assist tailor the rollout of the brand new malaria vaccine.India: The 2019–2021 nationwide survey (India’s model of the DHS) confirmed a stark hole in menstrual hygiene between city and rural areas, which prompted a brand new nationwide coverage to handle the disparity.Nepal: A 2016 DHS survey revealed stagnating maternal mortality charges. This spurred the federal government to boost its Protected Motherhood Program, leading to extra ladies delivering infants in well being amenities somewhat than properties — and fewer ladies dying in childbirth.Nigeria: DHS surveys confirmed youngster marriage charges as excessive as 76 % in some states. Advocates used that as proof to efficiently push native governments to strengthen their legal guidelines towards the apply.
There may also be long-term injury. When governments or support 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 essentially the most weak populations to pay the worth. For twenty-four international locations, together with the Democratic Republic of Congo and Mali, the DHS was the only knowledge supply for the UN’s official maternal mortality estimates. Going ahead, “it will simply be principally estimates which can be primarily based on different international locations’ knowledge,” says Saloni Dattani, a editor on science and world well being at Works in Progress journal and 2022 Future Good 50 honoree. “We simply wouldn’t know.”
With out the info DHS offered, overseas support turns into much less efficient, and fewer accountable “We now have no means of externally or objectively estimating the optimistic influence that these (support) 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 neighborhood has been scrambling to plug the big hole. The Gates Basis just lately dedicated $25 million in emergency funding to rescue some ongoing surveys, and Bloomberg Philanthropies has additionally stepped in with a separate dedication to help the trouble.
This funding is an important 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 knowledge — however it wasn’t good. Many consultants have criticized it as basically “donor-driven,” with priorities that didn’t at all times align with the nationwide pursuits of the international locations it surveyed. As an illustration, this system’s historic concentrate on reproductive well being was a direct reflection of the priorities of its main funder, USAID, and a few nation officers privately felt the info served the accountability wants of worldwide organizations higher than their very own fast planning wants.
This has created a central dilemma for the worldwide improvement neighborhood: is it potential to construct a brand new system that’s each genuinely country-led and likewise globally comparable?
A lifeline and a reckoning
Confronted with this knowledge 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 tough. Consider it this manner: 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 non-public 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 function is to not “straight fund population-based surveys,” however to supply management and convey the proper stakeholders collectively.
Whereas that mandate could forestall 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 Growth. Grown argues that the UN is the one physique that may deal with the “heavy raise” of coordinating all of the totally different international locations, 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 drive making an attempt to ascertain new internationally agreed-upon requirements for the way well being knowledge needs to be collected and ruled.
On the similar time, different efforts are extra centered on the sensible work of implementation somewhat than on world governance. Montana is main a coalition to “rebuild components of DHS” by creating a world consortium of analysis establishments that may present technical help to international locations. 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 knowledge customers to grapple with the shutdown’s fast aftermath.
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.
Between this mishmash, essentially the most sensible improvement 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 following 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 brief, stabilizing measure designed to offer the worldwide well being neighborhood a much-needed respite. “We consider knowledge is — and should stay — a world public good,” mentioned Janet Zhou, a director centered on knowledge and gender equality on the Gates Basis. “Our interim help helps to stabilize 14 ongoing nation surveys. … This funding is designed to offer world companions and nationwide governments the time and area wanted to construct a extra sustainable, country-led mannequin for well being knowledge.”
That help is aimed on the most pressing work: ending surveys that had been almost full, like in Ethiopia, and reopening the four-decade-old knowledge archive. However somewhat 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 reasonably priced means” to stop waste, and “a number of host international locations have shared a choice” to finish their work with the agency, mentioned a supply on the Gates Basis.
A Sudanese mom sits along with her kids at a shelter within the al-Qanaa village in Sudan’s southern White Nile state on September 14, 2021. Ashraf Shazly/AFP by way of Getty Photos
It’s a robust argument for triage in an emergency, however it additionally papers over deeper flaws. Check out Nigeria, for instance: Fieldwork for its 2023–’24 DHS completed in Could 2024, and the questionnaires gathered new estimates of maternal and youngster 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 — doubtless frozen after DHS’s shuttering.
That bottleneck illustrates what critics imply by “donor-driven.” With barely 3 % of family surveys in low-income international locations 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 info pipeline.
An ICF spokesperson pushed again saying survey priorities had been “primarily formed by the collaborating international locations.” But, of the $25 million that arrived from Gates, a big portion of it is going to go towards finishing large-scale surveys in Nigeria and Kenya, two international locations 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 international locations 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 said that this system has a “confirmed observe file of constructing a long-term capability,” noting that international locations 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 international locations unable to proceed that work on their very own.
This unresolved pressure brings the talk 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 international locations?”
Chen’s query will get to the center of the talk. However grappling with the failings of the previous can’t get in the best way of surviving the current. Present world well being knowledge is already a number of years old-fashioned as a result of pandemic, whereas crises in maternal mortality and youngster vitamin proceed to unfold. The necessity is for dependable knowledge now, as a result of the basic actuality stays: You’ll be able to’t assist folks you may’t see.
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