{

The great void: where big data meets no data

Belinda Thompson PhD Scholar Crawford School of Public Policy Australian National University

Why does it matter?

“Ensuring that health authorities take responsibility for steering the entire health sector (not merely public sector service delivery)” as a key component of a well-functioning health system. (World Health Organization 2010)

“Problems of coordination, duplication, and lack of integration between state and non-state services underline the need for an effective working arrangement as a basis for a more comprehensive and integrated system of health provisioning at the national and district levels.”(Robinson & White 1997)

Informal interviews, emails.

Utilise networks

Conferences, conferences, conferences

Use social media to propel a survey

Strategies for finding the void

This is what I feared

Then World Bank President James Wolfensohn was forced to rely on anecdotal evidence, using the common wisdom that the church does half the work in healthcare and education in Africa in the absence of substantiated research data. (Olivier and Wodon 2012)

No data?

Survey results

{

http://adage.com/article/special-report-2013-opinion-issue/calvin-hobbes-teach-big-data/245848/

The WHO urges Member States:

(1) to gather, by means that include improved information systems and stronger policy dialogue processes, the strategic intelligence required for: objectively assessing the positive and negative aspects of health-care delivery by private not-for-profit and private for-profit providers; identifying appropriate strategies for productive engagement; and developing regulatory frameworks that ensure universal access with social protection and the reorientation of service delivery towards people-centred primary care;(World Health Organization 2010)

On the radar

“Although the potential benefits of MHFLs (master health facility list) are numerous and may seem obvious, there are few documented cases of MHFL construction and use.”

- From “Development and use of a master health facility list: Haiti’s experience during the 2010 earthquake response.” - Alyson Rose-Wood et al, 2014

- NB – WHO guidelines still in draft as at Nov 2014. Initially made available in Jan 2013.

Gems in the literature

“The space left by compromised or absent state-provided services is filled by multiple diverse actors, ranging from untrained drug sellers and folk healers to both for-profit and not-for-profit health care providers”… “healthcare provision is becoming increasingly pluralistic, unplanned, privatised, unregulated and globalised all over the world”.

– Taken from “The “empty void” is a crowded space: health service provision at the margins of fragile and conflict affected states” – Peter S Hill et al, 2014

Narrowed study area to fragile states in Asia – focus on Burma, Timor-Leste and Cambodia.

Adopted a health systems framework

Fieldwork to take place – qualitative data collection, featuring semi-structured interviews

What is next?

The OECD DAC lists Myanmar and Timor-Leste as fragile states. (Letouze, Profos & Cramer 2014) (p17)

Similarly the World Bank’s Harmonized List of Fragile State Situations FY15 (World Bank 2014) includes both countries.

The Fund for Peace’s Fragile States Index 2014 lists countries in order of risk of failure, using 12 key indicators. Myanmar and Timor-Leste are the most fragile in the region, at 24th and 31st in the world respectively.

Four other countries in the region are listed in the category “Very High Warning”: Cambodia (40), the Philippines (52), Laos (56) and Papua New Guinea (57). (The Fund for Peace 2014)

Why Fragile Countries?

Key References • Hill, PS, Pavignani, E, Michael, M, Murru, M & Beesley, ME 2014, ‘The “empty void” is a crowded

space: health service provision at the margins of fragile and conflict affected states’, Conflict and health, vol. 8, no. 1, pp. 1-10.

• Letouze, E, Profos, J & Cramer, SL 2014, Fragile States 2014: Domestic revenue mobilisation in fragile states, Organisation for Economic Co-operation and Development, France.

• Palmer, N 2006, ‘An awkward threesome—donors, governments and non‐state providers of health in low income countries’, Public Administration and Development, vol. 26, no. 3, pp. 231-40.

• Robinson, M & White, G 1997, ‘The role of civic organizations in the provision of social services’, Research for action, vol. 37.

• Rose-Wood, A, Heard, N, Thermidor, R, Chan, J, Joseph, F, Lerebours, G, Zugaldia, A, Konkel, K, Edwards, M, Lang, B & Torres, C-R 2014, ‘Development and use of a master health facility list: Haiti's experience during the 2010 earthquake response’, Global Health: Science and Practice, vol. 2, no. 3, pp. 357-65.

• The Fund for Peace 2014, Fragile States Index 2014, The Fund for Peace,, viewed 8 October 2014, <http://ffp.statesindex.org/rankings-2014>.

• World Bank 2014, Harmonized List of Fragile Situations FY15, <http://www.worldbank.org/content/dam/Worldbank/document/FY15%20Fragile%20states%20list.pdf>.

• World Health Organization 2010a, Key components of a well functioning health system, viewed 2014 12.

• ---- 2010b, Strengthening the capacity of governments to constructively engage the private sector in providing essential health-care services World Health Organization,.

• World Newsmedia Network 2013, Big Data: The four Vs, 18 November, World Newsmedia Network,, <http://www.newsbizblog.org/2013/11/big-data-four-vs.html>.