Assessing the status of the right to health and monitoring its progressive realization Human Rights and Health Equity: Implications for Advocacy, Action, and Governance 3 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 indicators 2.Data sources for the indicators 3.Analytical capacity, including data quality control 4.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 Fairly even distribution by domain, especially for core indicators Service coverage has the most indicators

Overview of current global reference list 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)

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 rate 3b. 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 stunted 9b. Children under 5 who are wasted 10a. 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 mortality 22.Infant mortality 23.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 diseases 26b. 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 financing 33. 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 workforce 38. Density of health workers: Physicians, nurses, midwives, pharmacists, dentists 39. Density of recent graduates of registered health profession educational institutions C. Health information system 40. Births registration coverage 41. Deaths registration coverage

(III) Health System Response (Cont’d) D. Medicines & Medical products 42. 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 interventions 48. 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

Censuses Civil registration Population surveys Service records (Facilities) Service records (Facilities) Individual 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 targets 1.Core set of indicators for regional use, adapted by countries 2.M&E plan for national health strategy, with regular performance reviews 2.Data generation: 1.Facility reporting systems (HMIS): web-based systems 2.Birth and death registration and use of ICD-10 in hospitals 3.Regular household survey on health: the full spectrum of diseases 4.Administrative data: NHA, HRH information system, facility surveys to monitor service delivery (SARA) and quality 3.Health information system capacity 1.Institutional capacity for analysis and dissemination: MoH, NBS, academia, public and research institutions 2.National observatory to share data and analyses: portal Potential Priority areas for country and regional action

Eastern Mediterranean Region Framework for health information systems and core indicators for monitoring health situation and health system performance _-_WHO_-_GRA_-_Health_Indicators_2014_Op_1-35_- _Web[1].pdf

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