Questions to ask about indicators in global health meetings

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Photo by Lukas on

I just turned in my book manuscript, The Uncounted: Politics of Data in Global Health to the publisher this week. It will come out in mid-2020, if all goes well.

Meanwhile, here’s something I’ve been playing with: questions to ask if you’re in a global health meeting and confronting a slide presentation with indicators, targets and models.

Indicators and targets

  • Were these indicators selected through a process that was democratic, transparent, and that included elected representatives of my government/my community?
  • Is this an indicator that was put in place because it’s a priority for someone outside of my country or community?
  • Does the indicator measure something that seems important to me? If not, who is it important to?
  • Are these indicators signs mostly used to communicate to a public audience?
  • Are these indicators trying to focus attention on something that needs to be changed, such as a policy or a priority? If so, is the work to meaningfully create that change being adequately supported and funded?
  • Is the indicator going to produce the kind of data I need to make informed decisions?
  • Does the indicator require data that is disaggregated by gender? If not, why not?
  • Do the indicators relate to an index which rank-orders things as better or worse that cannot reasonably be rank-ordered, because they are different from one another?
  • If the indicator is a coverage (or percentage) indicator, does the baseline estimate of the population exist, and is that baseline plausible?
  • What do these indicators leave out, and why?
  • Does the data to report against this indicator exist? If not, where will it come from?
  • What are the consequences if the targets are not met?
  • Are the targets realistic for our context? Are they too ambitious, the right level of ambition, or not ambitious enough?
  • Do the targets require laws or practices to change in order to be achievable? If so, is this work being funded and supported?

Infectious disease models

  • Do I actually understand how this model was constructed?
  • If not, why is it being shown to me? Am I being asked to sign off on or legitimize something that I don’t fully understand in order to legitimize a plan of action that someone else wants to see happen?
  • What are the unstated assumptions behind this model? Does the model assume that there will be funding in place, for example? Does it assume a supportive legal environment? Does it assume gender equality is not a problem?
  • Are the models being used to predict a future scenario?
  • Is the model telling me a story about the future? Is it a story that serves some specific political or economic interest? Whose interest is that? Is it an interest shared by my community?
  • Check for an ‘elephant in the room’: Is the story the model tells a realistic and plausible one? Are there difficult realities that the model is failing to address or consider?
  • If so, why aren’t those difficult realities factored into the model?
  • How could those difficult realities be factored in?
  • Is anyone excluded from the model who should be factored into it?

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