Gates Package — page 547

Stories of progress like this underscore the importance of setting goals and measuring progress toward them. A decade ago, there was no official record of a child's birth or death in rural Ethiopia. At the Germana Gale Health Post, I saw charts of immunizations, malaria cases, and other health data plastered to walls. Each indicator had an annual target and a quarterly target. All this information goes into a government information system to generate regular reports. Government officials meet every two months to go over the reports to see where things are working and to take action in places where they aren't. At health posts in Ethiopia, meticulous record-keeping, including folders tracking the health of newborns, has helped the country reduce child mortality and increase vaccination coverage (Dalocha, Ethiopia, 2012). Yet while measurement is critical to making progress in global health, its very hard to do well. You have to measure accurately, as well as create an environment where problems can be discussed openly so you can effectively evaluate what's working and what's not. Setting targets for immunization and other interventions can motivate government health workers, but it can also encourage over-reporting to avoid problems with supervisors. Ethiopia' recent effort to monitor the progress of its immunization program is a good example of learning from data and--the hardest part--using data to improve delivery of the right solutions. A recent national survey of Ethiopia's vaccination coverage reported vastly different results from the government's own estimates. Ethiopia could have ignored this conflict and reported the most favorable data. Instead, it brought in independent experts to understand why the measurements were so different. They commissioned a detailed independent survey that pinpointed geographic pockets of very high coverage--and very low coverage. The government is now working to develop better plans for the poorer performing regions. The progress Ethiopia is making on the MDGs is now capturing the attention of its neighbors. Much like Ethiopia, which learned from the Indian state of Kerala, other countries including Malawi, Rwanda, and Nigeria are now rolling out health extension programs after visiting Ethiopia to learn from its experience. 2013 Annual Letter from Bill Gates N