child health indicators for routine health...

TITLE from VIEW and SLIDE MASTER | September 21, 2017 1 |

CHILD HEALTH INDICATORS FOR

ROUTINE HEALTH SYSTEMS

Overview of indicator recommendations and

indicator and data work at global level

Theresa Diaz MD MPH

Coordinator

Epidemiology, Monitoring and Evaluation Team

Maternal, Newborn, Child and Adolescent Health Department


Overview of Presentation

Child Health Indicators guidelines and frameworks

Potential for collection through routine data

WHO and Health Data Collaborative tools and activities

to support routine health information systems and

indicator harmonization


Global Child Health Indicators Guidance

SDGs 100 CORE GS EWEC

About 23 Indicators child

specific total overlap with 100

and /or SDGs

About 14 indicators

child specific

About 20 indicators child

specific


Other child health indicators guidance and

recommendations

IMCI Indicators 1999 QoC 2013

Child Health

Programs 2005

These indicators include many quality of care measures


But which can and should be collected in

routine systems?

Criteria for ability to collect in routine

– Recorded as part of a health care visit and included in HMIS

– Other data available in other routine systems (CRVS, Logistics,

laboratory)

Criteria for selection of minimal set

– Needed for improving facility delivery of care

– Needed for district and national level tracking of health facilities

quality of care and progress toward coverage/mortality goals

– Global level monitoring - Transition from other sources (e.g.

population based surveys, health facility surveys) as many

global level standardized indicators as possible


Child Health Specific Indicators from the 16 GS key

Indicators & Data Sources (excludes nutrition)

GS 16 key indicators - related to the targets/ outcomes (SDG) CRVS Household

Survey Facility Survey

HMIS Possible Source

SURVIVE

Under-5 mortality rate (3.2.1) 100 X X

THRIVE

Coverage index of essential health services, including for RMNCAH: FP, ANC, SBA, breastfeeding, immunization, childhood illnesses treatment (3.8.2) 100

X X X

TRANSFORM

Proportion of children under 5 years of age whose births have been registered with a civil authority 100 X X

Proportion of children and young people in schools with proficiency in reading and mathematics (4.1.1.) 100 X


Child Health Specific Indicators from the other GS key

Indicators & Data Sources (excludes nutrition)

GS 16 key indicators - related to the targets/ outcomes CRVS Household

Survey Facility survey

HMIS possible source

SURVIVE

Percentage of children with diarrhoea receiving oral rehydration salts (ORS) 100

X X x

Proportion of children with suspected pneumonia taken to an appropriate health provider. 100 X

X

x

Full child immunization 100 x X

x

Use of insecticide-treated nets (ITNs) in children under 5 (% of children) 100

x

THRIVE

Percentage of children under 5 years of age who are developmentally on track in health, learning and psychosocial wellbeing, (4.2.1) 100 X x

Participation rate in organized learning (one year before the official primary

entry age), by sex (4.2.2) 100 x


BETTER DATA. BETTER HEALTH.

The Health Data Collaborative A joint effort by multiple global health partners to work alongside countries to improve the availability,

quality and use of data for local decision-making and tracking progress toward the health-related

Sustainable Development Goals (SDGs).

CONSISTS OF THE FOLLOWING WORKING GROUPS:

– Facility and community data:

– Routine health information systems

– Community data

– Facility surveys

– Measurement of Quality of care

– Logistics management and information systems

– Disease surveillance

– Population data sources:

– Household surveys

– CRVS

– Digital health and interoperability

– Health systems monitoring:

– Health workforce

– Health financing

– Data analytics and use


Health Data Collaborative: Technical working group

Routine Health Facility Information System (RHIS)

1. Review, harmonize & disseminate standards for improved facility and community based reporting

2. Identify ways in which investments in HMIS can be better aligned to ensure scale-able integrated,

sustainable systems

3. Catalyse joint support to countries to scale up and strengthen integrated facility systems, based on

international standards and good governance

4. Joint support for analysis and use of facility data for action

Global deliverables

Package of data standards & tools - indicators,

metadata, data quality, ICD coding, master

facility lists, analytical outputs, template forms,

open access

A standard Health App for DHIS

A joint strategy & investment plan for DHIS 2.0

development, implementation and maintenance

Country deliverables

Aligned support to scale up and strengthen

integrated facility based health information

systems, including IDSR, based on international

standards

Documented country best practices & guidance

for sound governance

Training Tool:

Curriculum for Analysis and use of facility data

Module

1

Module

2

Module

3

Module

4

GENERAL MORTALITY

& MORBIDITY HEALTH

SYSTEMS

PROGRAMME

SPECIFIC Core indicators

- Aggregate

- Case based

Data quality

Population estimates/

denominators

Analysis

Presentation and

communication

Mortality and causes

of death

Outpatient morbidity

&

routine surveillance

of priority diseases

Health infrastructure

Human

resources

Drugs and

supplies

General service

delivery

HIV/AIDS

Tuberculosis

RMNCAH

Immunization

Surveillance

STRUCTURE

- Introduction to data

- Indicators

- Data quality

- Core analysis

- Data limitations

- Practical assignments

STRUCTURE

- Introduction

- Indicators

- Data quality

- Analysis

- Data limitations


STRUCTURE

- Introduction

- Indicators

- Data quality

- Analysis

- Data limitations


STRUCTURE

- Introduction

- Indicators

- Data quality

- Analysis

- Data limitations


NA

TIO

NA

L

DIS

TR

ICT

FA

CIL

ITY

Malaria

NTDs, NCDs


Core analysis

Immunization coverage for each vaccine in

national schedule

Monitor drop outs

Monitor availability of vaccines and injection

supplies

Monitor cold chain (vaccine ial wastage, vaccine

temperature

Highlights/future priorities

GAVI, WHO supporting integration of EPI into

HMIS

Aligned with existing tools (e.g DVDMT)

1

2

Example of training tool module

Immunization


Training Tool

RMNCAH Module Under Development

Indicator 2015 2016

Total child (< 5 years old) deaths reported in HMIS

1200 1150

% of facilities conducting child death reviews

65 70

Median and range of number child deaths among facilities conducting child death reviews

0 5

Table of child death reviews among deaths reported in HMIS

0

20

40

60

80

100

breastfeedinginitiated within1 hour of birth

Children (0.11month) given

DPT3

Under-5s withpneumonia who

receivedantibiotics

Under-5s withdiarrhea who

received ORS &Zinc2015 2016

Pneumonia, 29%

Non communicable diseases, 16% Diarrheal

diseases, 15%

Other conditions, 15%

Injuries, 14%

Measles, 5%

Meningitis/ encephalitis, 4%

Pertussis, 1% Malaria, 1%

Bar chart showing annual coverage of key interventions for child under-5

health

Distribution of under-5 children

hospitalised by Cause (out Patient Care)


Development of WHO Guidelines for home-based records for

maternal, newborn, and child health

At least 163 countries or territories are known to use some form of home-based record

Despite their wide spread use, a global synthesis on the effectiveness of home-based records for maternal, newborn, and child

health does not currently exist, nor does a comparison of the relative merits of using different types of home-based records to

provide guidance to countries based on the most up-to-date scientific evidence and through a rigorous process of evidence review

and quality appraisal to incorporate women’s, communities and health providers’ values and preferences, acceptability and

resource implications into the development of recommendations. WHO published guidance on home-based maternal records in

1994. and while useful guidance to countries for hand held records to promote effective maternal care, it was developed prior to

WHO’s renewed guidance development guidelines. While updated evidence on benefits of maternal health cards is reflected in the

2015 publication WHO recommendations on antenatal care for a positive pregnancy experience, the outcomes assessed are limited

nor does the guideline consider the comparison with an integrated card [5]. Recent WHO guidance on the use and design of home-

based records for immunization was released in 2015 [6]. This guidance targets immunization programme managers and other

national health programmes to facilitate greater standardization in the immunization content of home-based records. This guidance

did not undergo the WHO Guideline Review Commitee procedures. A guideline that synthesizes and appraises evidence on the

benefits of home-based records across maternal and child health outcomes would enable country-level decision makers to better

understand the value of home-based records, their role in a broader set of outcomes, their contribution to strengthening health

systems functioning and whether they should figure more prominently in their maternal and child health programmes.

• Despite their wide spread use, a global synthesis on the effectiveness of home-based records for maternal, newborn, and child health

does not currently exist,

• WHO published guidance on home-based maternal records in 1994 and for immunization in 2015 but neither went through rigorous new

WHO standards for guidelines

• The objective of these new guidelines is to provide evidence-informed recommendations for ministries of health in low and middle

income countries on the benefits of home-based records on maternal, newborn and child health outcomes.

• To be released in 2018


Mother and Newborn

Information for Tracking

Outcomes and Results

(MONITOR)


MONITOR Vision

There is clear, independent, harmonized,

and strategic advice for global and country

teams engaged in maternal and newborn

measurement and accountability


MONITOR

Priorities for measurement and monitoring First year

(2017)

Mapping existing indicators

Framework for collection and measurement of these

indicators

Identify the gaps in measurement and make

recommendations on harmonized measures


One suggestion moving forward

Create MONITOR type group for child to

– Advise WHO and HDC on set of indicators for global reporting

– Develop and set of standardized indicators at different levels of

the health system

– Determine best data sources for each indicator

– Advise on visualization and analysis of child health indicators

– Prioritize research for data collection and indicator validation

– Provide tools and training to build capacity to analyse data

Thank You


Upcoming HDC Tools

Extra slides


Core analysis

Completeness and timeliness Internal

consistency of data (outliers)

External consistency of data

Consistency of population estimates

Includes metrics for HTM, immunization, MCH

Highlights/future priorities

Standardize methods for data quality

Scale up of implementation and use with support

by GF, GAVI, USAID/Measure

Tool: Data quality review


Core Content

Recommended core list of facility indicators

derived from the 2017 reference list of core

health indicators

guide country selection of indicators and

definitions

reflects evolving public health

priorities/strategies

promotes better alignment, reduction in

reporting burden

Indicator metadata registry of core indicators

integrated into DHIS2 as reference

Future priorities

Training of DHIS administrators

Addressing implementation and governance

issues

2

2

Tool: Metadata repository

Indicators


WHO Health App

HIV

TB

MALARIA

IMMUNIZATION

EARLY WARNING

RMNCH

METADATA REPOSITORY

DATA QUALITY REVIEW (DQR)

MORTALITY MORBIDITY HEALTH SYSTEMS AND DISEASE-SPECIFIC MODULES

Programme specific indicators and data elements

Best practice dashboards, analyses

Aggregate and case-based

STANDARDS FOR MEASUREMENT

Core indicators and metadata

Data quality metrics

23

The WHO Health App provides reference

data standards for routine facility

reporting systems.

child health indicators for routine health...

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