Monitoring global health

Editor—In their critique of procedures of the World Health Organization for analysing and presenting health statistics, Murray et al make a series of misleading statements about monitoring and evaluation of tuberculosis.¹ Ironically, part of the reason that they can criticise WHO's tuberculosis statistics is that, by design, WHO is completely open about the process of gathering, analysing, and presenting data.

We refer to just three issues among many more.

Firstly, it is untrue that no affordable and feasible methods are currently available to assess tuberculosis in a community. China, India, and other countries have carried out a series of large scale population surveys of infection and disease that have shown, or have the potential to show, the impact of their tuberculosis control programmes.²,³

Secondly, after years of exposure to these statistics, Murray et al still do not seem to understand the meaning of basic indicators, such as case detection, and how they are used in planning and evaluation. These indicators are fully explained in our annual report.⁴

Thirdly, we reject absolutely the suggestion that WHO manipulates global tuberculosis statistics so as to advocate for the directly observed therapy, short course (DOTS) strategy, and fails to expose weaknesses in the data. With reference to Mozambique, the example chosen by Murray et al, our 2004 report clearly pointed out the strengths and weaknesses of the data.

WHO now routinely collects tuberculosis statistics from 200 countries, and the quality and diversity of the data on surveillance, planning, and financing are improving each year. We do not need another global health monitoring organisation that would dilute this effort and would do little to enable countries to use their data to correct their own problems. We need instead further international support for WHO and its established partners, which collectively have the mandate and expertise to carry out this work.