Counting What Counts

When the U.S. government terminated the USAID-funded Demographic and Health Surveys (DHS) Program in early 2025, it sent shockwaves through the global health community.

For more than four decades, DHS had been the backbone of population and health data in low- and middle-income countries—supporting decisions about where to invest, who to prioritize, and what works. The program’s reach was immense:

• 90+ countries
• 452 surveys since 1984
• 6,000+ peer-reviewed studies

A temporary bridge grant has kept core activities and surveys in some countries going. But the long-term future of globally comparable, high-quality demographic and health data remains uncertain.

What’s clear is what’s at stake. Without reliable data, policymaking becomes less precise, less equitable, and less accountable.

Why Good Data Matter for Policy and People

From national budgets to local service delivery, decisions that shape millions of lives depend on a simple premise: You can’t fix what you can’t measure.

Health ministries allocate scarce resources. Legislators design policies. Civil society advocates for underserved communities. All rely on accurate, comparable, and timely data. When those data systems falter, the consequences are immediate: Blind spots widen, inequities deepen, and progress becomes harder to track or sustain.

DHS Success Stories, From Ethiopia to Pakistan

Decades of DHS data show how measurement translates into meaningful change in countries across the globe.

Ethiopia Expanded Community Health at Scale

Ethiopia’s Health Extension Program (HEP)—now widely regarded as one of the most successful community health worker initiatives in the world—offers one of the most instructive examples of how demographic data can shape, sustain, and expand a national health program over decades.

The HEP was formally launched in 2003–2004, just a few years after Ethiopia’s first-ever Demographic and Health Survey was conducted in 2000. The timing was not coincidental. A government review of the first five-year Health Sector Development Plan (HSDP-I), drawing on the newly available Ethiopia DHS findings, revealed a health system failing to reach most of its population:

• Only 1 in 4 pregnant women received antenatal care.
• Just 5% of births occurred in health facilities.
• Rural service coverage had stagnated.

The HEP was built on political will and regional innovation. But DHS data made gaps visible and actionable. The government deployed more than 40,000 community health workers nationwide, targeting underserved areas with precision.

Subsequent DHS surveys tracked progress and guided course corrections. Over time, antenatal care coverage, immunization rates, and child health outcomes improved dramatically, showing how sustained data systems enable sustained progress.

Kenya Reduced Child Stunting

In Kenya, more than 30 years of DHS data revealed a long-term decline in child stunting—from 40% in 1993 to 18% in 2022.

Because the data were consistent over time, policymakers could integrate nutrition into national strategies, monitor progress, and direct resources to the counties with the greatest need.

India Advanced Menstrual Health Policy

In India, national survey data provided the first comprehensive picture of menstrual hygiene access—highlighting disparities across regions and populations.

That evidence helped elevate menstrual health from fragmented programs to a coordinated national policy priority.

Pakistan Targeted Maternal Support

In Pakistan, DHS data on childhood mortality enabled the government to design targeted support programs for pregnant women in high-risk areas—ensuring resources reached the most vulnerable households.

How Civil Society Uses Data to Drive Change

Data doesn’t just inform governments—it empowers advocates.

PRB works with civil society organizations to translate complex data into actionable insights and put those insights into the hands of decisionmakers.

For example, under the Policy, Advocacy, and Communication Enhanced (PACE) Project, advocates used DHS data to achieve measurable policy wins:

• In Kenya, advocates used data to protect, and increase, county funding for family planning services.
• In the Philippines, data supported the expansion of youth centers providing reproductive health services.
• In northern Nigeria, youth advocates used data on child marriage to advance legislation raising the legal age of marriage.
• In Madagascar, data informed partnerships expanding access to family planning services in underserved communities.

These examples underscore a consistent pattern: when data are accessible and people are equipped to use them, policies change, resources shift, and outcomes improve.

What PRB Is Doing Now

The global community is actively working to define what comes next for demographic and health data collection.

Since the termination of the USAID-funded DHS Program, PRB has served as a neutral convener to help chart a path forward and mobilizing champions to advocate for sustained, country-driven systems.  In May 2025, PRB rapidly organized a global convening that brought together donors, national statistical offices, implementing partners, researchers, and advocates from more than 20 countries in order to align stakeholders, identify urgent funding gaps, and catalyze coordinated action.

That work is ongoing. PRB continues to support and catalyze long-term, collaborative solutions with the of advancing sustainable, country-led demographic and health surveys and strengthening mechanisms coordination, knowledge exchange, and shared action.

This effort recognizes that future systems must evolve, not just replicate past models. Governments, researchers, and civil society all need data that are responsive, inclusive, and actionable.

A Critical Window and a Path Forward

The bridge funding currently sustaining DHS activities provides a narrow window to act.

The question is not simply whether to restore a program. It is whether the global community will invest in the data systems needed to guide the next generation of progress.

Without that investment, the erosion of data systems will lead to less informed decisions, weaker accountability, and missed opportunities to improve lives.

With it, countries and communities can continue to make evidence-based decisions that expand access, reduce inequities, and strengthen health systems. This is why PRB is committed to defending data access and integrity, from West Pokot, Kenya, to West Virginia, USA. Because counting people—their births and deaths, their health and wellbeing, their access and exclusion—is not just about numbers. It is about visibility, power, and the fundamental right to be seen in the decisions that shape people’s lives.