Afghan Journalists Take Temperature of the Nation with Health Data Journalism thanks to Ambassador Eva Constantaras

December 18, 2014
Journalists in Afghanistan learn how to collect and interpret data to better understand the state of healthcare in their country.

(Internews' data journalism training in Afghanistan is covered in this post from Eva Constantaras is Internews' Data Journalism Advisor.)

Journalists in Afghanistan are faced with the task of tracking the new administration's pledges to improve the health of the country's citizens. But before they can do that, they need to understand the state of healthcare in the country today.

For two weeks, two groups of journalists dedicated themselves to understanding and communicating the health of Afghans through data, through an Internews project with Nai, a local organization supporting open media in the country. The workshops were the second phase of a multi-year data journalism project.

The workshops focused on the technical skills of data journalism, as well as on finding and understanding basic information about healthcare in Afghanistan and translating that information into compelling stories.

In one exercise, participants looked at three basic fact sheets about healthcare in Afghanistan produced by the World Health Organization (WHO).

Two groups examined the Afghanistan Non-communicable Diseases (NCD) Country Profile 2014, and their different approaches underscore the challenges of effectively incorporating data into stories.

The first group listed out the percentages of causes of death from smallest to largest for both genders and then separately for males and females.

They practiced converting percentages to more understandable ratios (such as "1 in 13 children in Afghanistan die before their fifth birthday" instead of "the under-five mortality rate in Afghanistan is 7.9%"). They also explored how to find concrete story angles in overwhelming amounts of data.

The other group working on the same fact sheet honed in on the percentage of women dying of cardiovascular disease in Afghanistan. They compared the number of women dying of cardiovascular disease to men, then provided a comparison to rates of other leading diseases. Finally, they introduced risk factors such as blood pressure and obesity that may be contributing factors and mentioned the lack of an official government policy to respond to the rising health threat. Participants discussed the importance of sourcing reasons behind trends from other data or experts and not relying on personal opinions or assumptions.

The third group examined a WHO fact sheet comparing regional and national healthcare indicators and spending on healthcare. After reviewing all the data in the charts, the team decided to focus on comparing investment in per capita healthcare to demonstrate that while Afghanistan has invested more over the last 10 years, it is not keeping pace with the rate of regional per capita investment, which is mirrored by healthcare outcomes. It lags behind the regional rate of improvement on indicators such as under-five mortality and also on issues such as doctor-patient ratio and births attended by a skilled birth attendant.

The final group struggled to find a compelling narrative in the WHO maternal health profile. So that journalists could more easily identify story angles in data summaries of maternal mortality rates, live births, fertility rates and skilled birth attendance, they turned to province-level data.

After learning how to search for data online using advanced Google search techniques, they familiarized themselves with finding and downloading data from the World Bank and World Health Organization. They then evaluated the reliability of the data.

Trainees scraped data (used a computer program to extract data for human-readable output) from the Maternal Health Care Trends in Afghanistan working paper produced by the Demographic and Health Survey in 2013 and analyzed the data to identify which provinces have the best and worst access to antenatal care, skilled birth attendance and post-natal care. They calculated the national average and compared the performance in their province to the national average. They visualized their findings using bar charts created on with a focus on identifying the appropriate chart type for their data, writing compelling headlines for their charts and properly citing the source of the data. Finally, they looked at the Afghanistan Provincial Health Profiles produced by the Ministry of Health to investigate how access to healthcare facilities could be influencing those results.

During the last day of the workshop, trainees applied skills they had learned throughout the training to produce small data-driven stories and visualizations about their chosen health topic.

A group investigating child health identified the leading cause of death for children under five and compared the percentage change in mortality rates for each disease from the previous decade. To connect health outcomes to financing, they compared the percentage of healthcare costs covered by government and by private citizens and how those rates have changed over the last 10 years. They found that government spending on healthcare spiked after the 2008 invasion, which correlated with a decrease in child mortality. To put the data in context, they visualized child mortality rates of Afghanistan compared to other countries in the region and calculated the percentage decrease since 2000.


Another team scraped the national budget and investigated the largest health projects in 2014. They also calculated the percentage of USAID development funding that goes to health projects each year and found it was under 6%, while 10 times more was spend on direct support to the government for issues such as security. They struggled with the budget format from the Treasury website and found it challenging to track spending on different projects over time.

The final group tackled education and literacy rates for men and women across the country. They were interested in identifying relationships between investment in education and improved healthcare outcomes.

Journalists who completed the training are competing for small grants to follow their own data journalism story ideas with the support of the Nai and Internews data team. So far ideas include comparing election turnout by women in different provinces, exploring the spike in opium exports and predicting the public health impact of the US withdrawal from Afghanistan.