Beyond the Demographic and Health Survey: on the past and future of population health surveillance

Summary box
At the start of 2025, the Demographic and Health Survey (DHS) programme was paused due to the defunding of USAID, illustrating the fragility of the international data infrastructures on which many national health systems rely.

Detailing the history of the DHS and its role in Malawi’s health system, this commentary outlines what the DHS programme provides national health systems, what it may have cost them and how these shortcomings might be addressed going forward.

Our four discrete suggestions for the future of health surveillance are national ownership and oversight; community involvement; the streamlining of surveys; and the continuation of international collaboration around accessibility and standardisation.

We conclude by arguing that greater consideration of the history of the DHS, and a more critical analysis of donor-driven cross-sectional surveillance, is essential for the future reorientation of population health.