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It is quite important to deliver effective interventions to individuals and populations. Particularly at the global level, it is necessary to follow those interventions and measure how they work and what effects they have to improve health and promote development. In this chapter, we will discuss why and how we evaluate progress in global health, focusing on the importance of using the process to build local capacity and overcome public health challenges. We will also consider some of the ways in which progress in global health and development is being monitored on the global scale, and how this interacts with metrics of progress in health and development processes at national and local levels.


Imagine you are the Minister of Health of a country. How would you improve the health of the citizens of your country? You will need to follow four steps (Fig. 19-1):

  1. Define where you are. You will need to know current levels and trends in disease burden in terms of both morbidity and mortality (e.g., the current child mortality rate and whether it is increasing, decreasing, or remaining stable) and the status of health service infrastructure and capacity to set priorities and goals.

  2. Decide where you want to go. This involves thinking about what progress in global health would look like and setting specific goals (e.g., reducing child mortality to <25 per 1000 live births).

  3. Close the gap. Decide how to close the gap between where you are and where you want to be and implement. This requires choosing the best interventions in each priority area (e.g., to reduce child mortality), keeping in mind key considerations such as effectiveness, costs, and feasibility. Implementation by itself is a key step.

  4. Measure and evaluate progress along the way to make sure you reach your goal. You will need to know how well your interventions are working so that you can refine them, as needed, to reach your goal on time.


The cycle of implementation/measurement/evaluation to improve health outcomes.

This is an iterative process. Long-term success depends on countries being empowered to lead the way in setting their own health and development priorities, implementing evidence-based interventions to achieve relevant goals, and establishing systems to assess progress toward their goals. Every step in this process is important, but in this chapter we will focus mainly on step 4: measuring and evaluating progress. However, we are first providing here a more detailed overview of these four steps.

Defining Where You Are

Since data in low- and middle-income countries (LMICs) can be scarce, measuring global health is often a fuzzy process. When data are available, it can be useful to benchmark targeted health conditions ...

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