As global health faces unprecedented funding cuts and the future of major data systems hangs in the balance, one question is becoming increasingly urgent: How will countries continue to generate the evidence needed to improve health?
By Natalie Apcar and Philip Anglewicz
For more than fifty years, surveys like the Demographic and Health Surveys (DHS), World Fertility Surveys, and Multiple Indicator Cluster Surveys (MICS) have been the backbone of public health decision-making, providing governments, researchers, and development partners with the data needed to shape policies, allocate resources, and measure progress. But with uncertainty surrounding the future of data, the global health community is entering a pivotal moment.
For Philip Anglewicz, Director of the William H. Gates Institute for Population and Reproductive Health, the conversation isn't simply about preserving existing approaches—it's about reimagining how high-quality data are collected, shared, and used. Read on to hear more about what Dr. Anglewicz shared in a recent interview for Sage Publications' collection on survey research, where he focused on the survey innovations of Performance Monitoring for Action (PMA).
"Anytime you collect data in a country that's not your own, you have an obligation to that population...to serve purposes that are important to them."
That philosophy has guided the evolution of PMA, which emphasized innovations in survey data for global reproductive health. Originally launched to monitor commitments made at the 2012 London Summit on Family Planning, PMA has continually pushed the field forward—not only by producing high-quality data, but by rethinking how surveys can better serve the countries that rely on them.
PMA Surveys: Designed for better evidence, trust, and action
One of PMA's defining contributions has been its groundbreaking survey design. By embedding a longitudinal panel within repeated cross-sectional surveys, PMA enabled researchers to understand not only what is happening at a population level, but how women's experiences, behaviors, and decisions change over time. "We shifted to a really innovative and revolutionary study design," Anglewicz explains—opening the door to analyses that traditional surveys cannot provide.
Another innovation was the connection between supply and demand-side factors in family planning and reproductive health (FP/RH). In addition to surveys of women and households, PMA also interviewed entities that provide FP/RH services in each community where data are collected. This permits examining issues like the impact of service quality on contraceptive use, for example.
PMA also challenged conventional approaches to data collection by investing in local expertise. Rather than bringing interviewers into communities from outside, the project recruited and trained resident female enumerators who understood local languages, customs, and social norms. The result was greater trust, stronger participant relationships, and better science.
Importantly, these innovations were never intended only to produce better data. From the outset, PMA partnered with ministries of health and country-based Technical Advisory Groups to ensure survey questions addressed the priorities of policymakers and program leaders. In collaborations with PMA’s in-country partners, governments have used PMA findings to strengthen family planning programs, address adolescent pregnancy, understand unmet need for contraception, and improve services for underserved populations. The goal was always clear: ensure that data collected in countries are used to improve health in those same countries.
That approach proved especially valuable during the COVID-19 pandemic. While many large international surveys paused data collection, PMA adapted by conducting carefully designed phone follow-up interviews with women already enrolled in the study. Those data challenged widespread fears that contraceptive use would dramatically decline during the pandemic, demonstrating the value of flexible, longitudinal data systems that can respond quickly during times of crisis.
Today, PMA continues to evolve through partnerships that apply its innovative platform to emerging public health questions. With support from the National Institutes of Health (NIH), PMA is examining the drivers of women's sexual and reproductive empowerment—including the role of male partners—in Burkina Faso, as well as the intersections of aging, cognitive health, and reproductive health among adults ages 40 and older in Côte d'Ivoire. The platform is also supporting evaluations of Marie Stopes International programs in Nigeria and the Democratic Republic of the Congo, while generating new evidence on DMPA-SC and contraceptive self-injection across multiple countries. Together, these collaborations demonstrate how PMA continues to provide partners with timely, policy-relevant evidence to address evolving reproductive health priorities.
The Future of Survey Designs in Global Health
Yet even as PMA continues to expand into new areas of research, Anglewicz believes the greatest challenge facing global health surveys is no longer methodological. "It's not survey methods. It's not bias," he says. "It's what data are we even going to have in the future?"
As countries grapple with shrinking research budgets and uncertainty around the future of global survey programs, the need for timely, reliable, population-based data has never been greater. At the same time, new technologies offer opportunities to rethink what comes next. From smartphone-based data collection to artificial intelligence, the tools available to researchers continue to evolve.
"We're really just on the cusp. How can we use AI and other technological advancements to really improve survey data collection and bring us into the next era?"
The future of global health data will depend not only on embracing new technologies, but on preserving the principles that have made surveys like PMA successful: scientific rigor, meaningful local partnerships, transparency, and a commitment to ensuring that evidence informs action.
In a rapidly changing world, innovation in data collection is no longer just a technical challenge—it is essential to improving health and advancing equity worldwide.
To watch the full interview with Dr. Anglewicz, visit the Sage Publications website.
