Running an international survey in a small country : challenges and opportunities

Abstract

Background: National and international authorities recognize that health surveys are major sources of information on health conditions. Smaller states may prefer using health surveys to registries because they are cheaper to maintain. Nevertheless, smaller states carry out far fewer national health surveys than larger states. One reason could be that the value of surveys depends on the number of people interviewed rather than the proportion of the population. Therefore, survey costs per capita are substantially higher in smaller states. Methods: Malta is a small state with a population of under half a million. It forms part of the European Union, which has provided financial assistance and external expertise in performing international health surveys. We present the European Health Interview Survey in Malta as a case study to review the challenges for small states and the typical adaptations necessary for implementing national health surveys and meeting international health data obligations. Results: We identified the lack of health survey infrastructure, difficulties in recruiting the large samples recommended by international organizations, survey fatigue, and a lack of resources for marketing, incentivization, analysis and dissemination. Low-cost solutions have been devised to address some issues, such as marketing and incentives, which exploit specific characteristics of small states. Conclusion: In the absence of administrative data or epidemiological registers, surveys are important tools for evidence-based policy-making in small states. The experience of Malta could help other small states to minimize the resources required to run national health surveys.