When health data go dark: A call to restore DHS Program funding

Header image: Dr Fassou Mathias Grovogui from CEA-PCMT, Guinea, discussing DHS analysis with Ms Gaëlle Tatiana Sehi, a PhD student from Cote d'Ivoire, 2023.

The suspension and threatened closure of USAID has severe short- and long-term negative impacts on the health of people worldwide. In a commentary published in BMC Medicine, we draw attention to a consequence of the new US administration's actions on our ability to understand the levels and changes in population health outcomes and behaviours. This is through co-financing and provision of technical support to the DHS Program, which includes nationally-representative surveys of households (Demographic and Health Surveys [DHS], Malaria Indicator Surveys [MIS]) and health facilities (Service Provision Assessments) in over 90 low- and middle-income countries (LMIC). These surveys capture high-quality data to track health-related Sustainable Development Goals (SDG) indicators and beyond.

For many LMICs, surveys implemented through the DHS Program represent the most comprehensive, continuous, and reliable source of health data. Since 1984, 452 surveys have been conducted, and their findings have served as a vital source for country stakeholders, enabling health system monitoring and planning. To date, over 300 reports and more than 6,000 peer-reviewed papers have been based on the nearly 2,000 datasets, which are made available at no cost to users worldwide.

The sudden disruption in USAID funding means that despite agreements in place with dozens of LMICs, DHS activities have been grounded to a halt. The website (www.dhsprogram.com) is already affected: effective late January, no new users or requests for access to data are being processed. The impact of these disruptions will reverberate across local, regional, national, and global levels. We highlight three such impacts here, starting with the most immediate.

(1) Disruptions to ongoing activities mean that data planned for collection or already collected will not be analysed or made available.

• The Uganda MIS and Ethiopia DHS were collecting data; activities will have been interrupted or significantly affected.

• In Malawi, Zimbabwe, Zambia and Nigeria, DHS data have been collected, but full reports and datasets have not yet been released. In Malawi, current DHS data guide PEPFAR-funded antiretroviral therapy programs for roughly 1 million HIV+ patients. Nigeria is the largest country in Africa and has among the highest burdens of preventable maternal and perinatal mortality in the world, making DHS data vital for tracking progress and informing programmes and policies.

• The data for the Democratic Republic of the Congo DHS survey from 2023-2024 are not yet available. As one of Africa's largest countries, with vast geographic challenges, ongoing armed conflict, and a fragile health system, the country faces significant obstacles in collecting alternative data for guiding policies.

• Significant uncertainties surround the 2025 surveys planned in multiple countries - including DHS in the Philippines and Togo, and SPA in Nepal - jeopardizing data collection and the livelihoods of field staff.

(2) Without future data collection, monitoring of population health indicators will be severely compromised.

• The suspension of new surveys deprives LMICs of vital population-level data needed for evidence-based policymaking. For example, without key indicators on HIV prevalence and testing uptake, persisting gaps and inequalities in HIV services will not be efficiently addressed. Similarly, a lack of human papillomavirus vaccine coverage data will mean countries cannot monitor the rollout of this crucial intervention, leaving them unable to assess who has been reached and adjust their programs accordingly.

• The absence of accessible, high-quality data undermines transparency, accountability, and evidence-based decision-making in healthcare. Data must be openly available for governments, researchers, and civil society organizations to work together effectively to advance health equity.

• The historical continuity of population health data is threatened. This data gap would prevent identification of critical trends in fertility, mortality, health outcomes and health behaviours - both within countries (across regions and urban/rural divides) and between countries. Without such data, we cannot effectively analyze how major forces like climate change, urbanization, and healthcare access affect health.

(3) Disruption to access to existing data and lack of support for its use will have devastating consequences on populations’ trust in research and on training of scientists.

• Survey participants - predominantly women - shared their personal information with the understanding it would inform research and policy decisions. Restricting access to these data violates the ethical principles and commitments made during data collection. DHS Program survey data represents a vital community resource and blocking access for researchers and policymakers breaches both ethical standards and moral obligations to these communities.

• While each country’s Ministry of Health and/or national statistics agency have the datasets collected in the past, storage and access to such data and related documentation is not assured or practically arranged.

• Without a centralised data portal, researchers lose the ability to conduct comparisons of vital indicators across time and countries. This includes the StatCompiler dashboard, a critical resource for non-technical users of DHS data, and access to and support of data users. It will prevent policymakers and other stakeholders from tracking progress towards international targets, such as the SDGs. Additionally, in the absence of this high-quality harmonised repository, evaluating the effectiveness of interventions and programmes involving multiple countries will be compromised.

• The suspension of funding will impact training of health professionals, researchers, and scientists in two ways: through suspension of training courses on survey methodologies; and through termination of access to survey data which are commonly used by undergraduate, MSc and PhD students for their theses, especially in LMICs. This significantly reduces the preparation of future national and global health leadership.

As a group of health workers, national policymakers, students, educators, and researchers who have extensively relied on the data, methods, and findings produced by the DHS Program, we call for restoration of universal access to existing data and continued operation of the DHS Program website. In the short term, we call for all the work which was already in progress in 25 countries to continue. Interrupting these processes is a substantial waste of resources from multiple donors and risks losing critical technical expertise. In addition, it negatively affects the social and moral contract of collecting data from individuals with the purpose of improving their families’ and communities’ health and well-being.

In the long term, while DHS Program funding should be restored, this crisis could serve as a tipping point for transforming these vital surveys. Any reductions in external financial support should occur gradually to protect data continuity, but this moment demands reimagining a system less dependent on US funding. By transferring technical expertise to LMICs and fostering greater leadership for them, we can build more resilient, self-reliant health monitoring systems. The alternative - a widespread reduction in the frequency and quality of population health surveys - would create dangerous blind spots in our understanding of demographic and health trends, particularly in countries where surveys run by the DHS Program are often the only source of population health data, and therefore crucial for effective health planning and response. The cost of these data going dark, measured in our inability to identify and effectively respond to health crises and population needs, far exceeds the investment required to maintain these surveys. We urgently call on the current US administration and global leaders to restore DHS Program funding and bring critical health data back to light.