assessing the status of the right to health and monitoring its progressive realization human rights...
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Assessing the status of the right to health and monitoring its progressive realization
Human Rights and Health Equity:Implications for Advocacy, Action, and
Governance3 November 2014
Session overview
• Rationale for developing indicators list• HIS core components • Global Indicators Frameworks • Regional core Indicators and metadata
Rationale for developing indicators list
• Monitor the health situation (mortality, morbidity and disability), trends in the population and distribution of health determinants and risks
• Monitor and evaluate (M&E) coverage of interventions
• Assessment of progress and performance of health systems: Data on health system (service delivery)
• Evidence for sound policy making at national and sub-national and other equity dimensions
Criteria for selection
• SMART ++– Specific (actually measure what they claim to
measure)– Measurable (and also reliable, comparable and
contextually appropriate) – Achievable (and also cost effective) – Relevant– Time-bound (and also sensitive).
HIS core components
1. Set of indicators2. Data sources for the indicators3. Analytical capacity, including data quality
control4. Dissemination and use for decision making
Global Indicators Frameworks
• Millennium Development Goals • Countdown 2015• Non-communicable Diseases• EMRO statistics brochure/ World Health
Statistics (WHS)• WHO Health System Strengthening (IHP+) • Commission on Accountability• Universal Health Coverage
Global Reference Core Health Indicators
• Rationalize and harmonize indicator reporting requirements of agency partners
• Improve alignment between global reporting needs and
country processes for monitoring of progress and performance
• Enhance efficiency and streamline investments in data sources and analyses for the indicators
• Improve the quality of results-based monitoring by focusing on better data for fewer indicators.
100 core indicators(about 100 additional indicators)
Overview of current global reference list
Health Systems Service Coverage Risk Factors Health Status0
20
40
60
80
100
120
140
Indicators by Domain
Additional (N= 109)Core (N=105)
• Fairly even distribution by domain, especially for core indicators
• Service coverage has the most indicators
Overview of current global reference list
Input Output Outcome Impact0
20
40
60
80
100
120
140
Indicators by Results Chain
Additional (N= 109)Core (N=105)
• Outcomes are the largest group, over 50% of indicators, including intervention coverage and risk factors
• Input and output indicators are few
Core indicators by sub domain and program
• HIV (12), TB (11) and malaria (7)
• Maternal / newborn (14)
• Chronic disease & health promotion (12)
• Nutrition (7)
Infectious Diseases RMNCAH Health Systems NCD & Nutrition Environment Injury and Violence0
5
10
15
20
25
30
35
HIV/AIDS
RH - FP Medicines
Nutrition Water Sanitation Pollution
Road Safety &Intimate Partner violence
Tuberculosis (TB)
Maternal &
Newborn
Financing
Chronic Disease
and Health
Promotion
Malaria
Child &
Adolescent
Information
NTD
Workforce
Outbreak & Epidemics
Governance
Service Delivery
Service Quality
Core Indicators by Sub-domain and Programme
Comparison with EMRO Core List
• Almost all EMRO indicators are included in the Global Reference List:– 68 EMRO indicators are in core list– 5 demographic and social indicators (pop size, pop growth,
school enrolment, literacy, poverty) are not– 5 EMRO indicators are in the additional list (physical activity,
ORS/ORT, HIV testing among key risk populations, malaria testing rate among suspected cases, density of 6 medical devices in facilities)
• About 58 indicators are in the Global Reference List but not in the EMRO core list
EMR-
Core Indicators Domains
A Total of 68 indicators divided in three domains:
1. Health determinants & risks (26)2. Health Status (morbidity and mortality) (14)3. Health System Response (28)
(I) Health determinants & risks
1. Population size
2. Population growth rate
3a. Total fertility rate3b. Adolescent fertility rate (15-19)
4. Net primary School enrolment
5. Proportion of population below the international poverty line
(I) Health determinants & risks (Cont’d)
6. Adult literacy rate (15- 24)7. Incidence of Low birth weight
8. Breastfeeding exclusively for 6 months
9a. Children under 5 who are stunted9b. Children under 5 who are wasted10a. Children under 5 who are overweight 10b. Children under 5 who are obese
(I) Health determinants & risks (Cont’d)
11a. Overweight (13-18)11b. Obesity (13-18)
12a. Overweight (18+)12b. Obesity (18+)
13a. Tobacco use (13-15)13b. Tobacco use (15+)
(I) Health determinants & risks (Cont’d)
14a. Insufficient physical activity (13-18) 14b. Insufficient physical activity (18+)
15. Raised blood glucose (18+)
16. Raised blood pressure (18+)
17. Anemia among women of reproductive age
18. Access to improved drinking water
19. Access to improved sanitation facilities
(II) Health Status
20. Life expectancy at birth
21.Neonatal mortality22.Infant mortality23.Under-5 mortality
24. Maternal mortality ratio
(II) Health Status (Cont’d)
25. Mortality rate by major cause of death
26a. Mortality between age groups 30 and 70 from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases26b. Road traffic death rate
27. Cancer incidence by type
(II) Health Status (Cont’d)
28. TB Case notification rate 29. Estimated number of new HIV infections
30. Reported number of HIV cases
31. Incidence of confirmed malaria cases
32. Incidence of measles cases
(III) Health System Response
Divided into Six subcategories:A. Health financing33. General government expenditure on health as % of general government expenditure
34. Per capita total expenditure on health
35. Share of-out-of pocket as % of total health expenditure
36. Population with catastrophic health expenditure
37. Population that gets impoverished due to out-of-pocket health expenditure
(III) Health System Response (Cont’d)
B. Health workforce38. Density of health workers: Physicians, nurses, midwives, pharmacists, dentists
39. Density of recent graduates of registered health profession educational institutions
C. Health information system40. Births registration coverage
41. Deaths registration coverage
(III) Health System Response (Cont’d)
D. Medicines & Medical products42. Percent availability of selected essential medicines and medical products in public and private health facilities
43. Density per million population of 6 selected medical devices in public and private health facilities
(III) Health System Response (Cont’d)
E. Service Delivery : access/availability/readiness 44. Density of primary health care facilities
45. Density of inpatient beds (hospitals)
46. Surgical wound infection rate
47. Annual number of outpatient department visits, per capita
(III) Health System Response (Cont’d)
F. Coverage of interventions48. Need for contraception satisfied
49a. Antenatal care coverage (1+)49b. Antenatal care coverage (4+)
50. Skilled birth attendance
51. DPT3/ Pentavalent vaccination coverage among children under 1 year of age group
(III) Health System Response (Cont’d)
52. Measles immunization coverage (MCV1)
53. Percentage of suspected malaria cases that have had a diagnostic test
54. Percentage of individuals who slept under an ITN the previous night
55. Percentage of key populations at higher risk (injecting drug users, sex workers, men who have sex with men) who have received an HIV test in the past 12 months and know their results
(III) Health System Response (Cont’d)
56. Percentage of eligible adults and children currently receiving ARV therapy among all adults and children living with HIV
57. Treatment success rate of new bacteriologically confirmed TB cases
58. Oral rehydration therapy
59. Service coverage for severe mental disorders
CensusesCensuses
Civil registrationCivil registration
Population surveysPopulation surveys
Service records(Facilities)
Service records(Facilities)
Individual recordsIndividual records
Resource records(Administrative)
Resource records(Administrative)
Population-based Institution-based
Data sources for the indicators
Main indicators derived from health facility reports
• Causes of death in facilities• Outpatient/inpatient diagnoses in facilities; malaria case rates
(lab confirmation); TB notification• OPD visits per person per year • Hospital admission rates (length of stay, bed occupancy)• Coverage estimates for key interventions
– Family planning use – Antenatal care, PMTCT, postnatal care – Institutional delivery, CS rate, birth weight – Immunization, vitamin A– ARV coverage, TB treatment success
Main indicators derived from household surveys
• Coverage of interventions such as immunization, antenatal care, skilled birth attendance, treatment of sick children, family planning use, chronic disease interventions etc.
• Risk factors: breastfeeding practices, water and sanitation; NCD risk factors (e.g. tobacco use, physical inactivity)
• Anthropometry: stunting, wasting, underweight, overweight; obesity
• Child, adult and maternal mortality for a specified period before the survey
• Biological and clinical markers
Equity
• Disaggregation of data is essential• Survey data– Age, sex, residence– Education, wealth quintiles– Large geographic units (e.g. provinces or regions)
• Facility data: – age (under 5, 5+, sometimes more detailed), sex for some
indicators– Subnational data
• Disaggregated data are often not disseminated
Metadata attributes 1
• Rationale• Definition• Related Terms• Main data source• Alternate data sources• Measurement method• Method of estimation
Metadata attributes 2
• Data type• Expected Frequency of data collection• Disaggregation• Limitations• Web-links
Gaps & Challenges
• Scarcity of human resources in HIS essential skills (statistics, demography, epidemiology, health informatics)
• Fragmented data collection systems and lack of linkages between different stakeholders.
• Lack of standardization of indicators and definitions across MS of the region• Lack of resources for carrying out population and / or household surveys• Potential problems with assurance of data security, confidentiality and
quality.• Problems with sharing / dissemination of generated evidence and results
and their use for policy and decision making processes
1. Indicators and targets1. Core set of indicators for regional use, adapted by countries2. M&E plan for national health strategy, with regular performance
reviews
2. Data generation:1. Facility reporting systems (HMIS): web-based systems2. Birth and death registration and use of ICD-10 in hospitals3. Regular household survey on health: the full spectrum of diseases4. Administrative data: NHA, HRH information system, facility surveys to
monitor service delivery (SARA) and quality
3. Health information system capacity1. Institutional capacity for analysis and dissemination: MoH, NBS,
academia, public and research institutions2. National observatory to share data and analyses: portal
Potential Priority areas for country and regional action
Eastern Mediterranean RegionFramework for health information systemsand core indicators for monitoring healthsituation and health system performance
201410953_-_WHO_-_GRA_-_Health_Indicators_2014_Op_1-35_-_Web[1].pdf
Thank You
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