1. Health and Nutrition Bratislava, 8-10 May 2003 Angela Me Statistical Division UNECE

2. NHDR Training Bratislava, May 2003 Nutrition 1. Supply 2. Outcome (weight and height) 3. Prevention 4. Quality

3. Statistical Division UNECE NHDR Training Bratislava, May 2003 Nutrition and relation to MDG 1 Outcome indicators 1. Prevalence of underweight children 2. Proportion of population below minimum level of dietary energy consumption

4. Statistical Division UNECE NHDR Training Bratislava, May 2003 Nutrition and relation to MDG 1: Methods Prevalence of underweight children population-based surveys (MICS, DHS) Proportion of population below minimum level of dietary energy consumption (proportion of undernourished population) estimates based on: food supply, inequality to access to food (household surveys), and country food needs

5. Statistical Division UNECE NHDR Training Bratislava, May 2003 Nutrition: two methods, two messages Source: UNICEF and FAO

6. Statistical Division UNECE NHDR Training Bratislava, May 2003 Nutrition: two methods, two messages Source: UNICEF and FAO

7. Statistical Division UNECE NHDR Training Bratislava, May 2003 Nutrition: methods and indicators The quality of the data affect the message select the indicator that use standard methodologies (underweight) But two indicators may carry two different messages, ex: inputs outcomes

8. Statistical Division UNECE NHDR Training Bratislava, May 2003 Nutrition: Per capita supply of calories per day Source: FAO

9. Statistical Division UNECE NHDR Training Bratislava, May 2003 Nutrition: Per capita supply of calories per day Source: FAO

10. Statistical Division UNECE NHDR Training Bratislava, May 2003 Nutrition: Stunting Prevalence (under height) Source: UNICEF

11. Statistical Division UNECE NHDR Training Bratislava, May 2003 Nutrition: Stunting Prevalence (under height) Source: UNICEF

12. Statistical Division UNECE NHDR Training Bratislava, May 2003 Health Input (expenditures) Prevention Status Morbidity Mortality Disability (?) Accessibility to services Potential access Realized access

13. Statistical Division UNECE NHDR Training Bratislava, May 2003 Accessibility to health services Potential access 1. Availability of services 1. MD/population 2. Bed/population 3. Dentist/population 4. Geographical distribution 2. Financing 1. Income 2. Visit costs 3. Insurance benefits

14. Statistical Division UNECE NHDR Training Bratislava, May 2003 Accessibility to health services Potential access 3. Organization 1. Travel time 2. Waiting time 3. Time with MD 4. Need 1. Perceived health 2. Illness episode

15. Statistical Division UNECE NHDR Training Bratislava, May 2003 Accessibility to health services Realized access 1. Utilization (objective) 1. MD/Dental visits 2. Hospital admission 3. Preventive examination 4. Time since examination 2. Preference (subjective) 1. MD courtesy 2. Quality 3. Overall satisfaction

16. Statistical Division UNECE NHDR Training Bratislava, May 2003 Accessibility to health services: Sources  Administrative records  Providers view  They may be biased toward the public sector  Health surveys  Customers view  Health surveys  DHS  LSMS  WHS  Geographic information system (GIS)

17. Statistical Division UNECE NHDR Training Bratislava, May 2003 Health Expenditure per capita in PPP$ Source: The WB

18. Statistical Division UNECE NHDR Training Bratislava, May 2003 Health Expenditure per capita in PPP$ Source: The WB

19. Statistical Division UNECE NHDR Training Bratislava, May 2003 Hospital beds per 1,000 people Source: The WB

20. Statistical Division UNECE NHDR Training Bratislava, May 2003 Hospital beds per 1,000 people Source: The WB

21. Statistical Division UNECE NHDR Training Bratislava, May 2003 Comparability of data  Differences in definitions  there is no universally accepted definition of hospital beds  physicians are defined differently particularly between West and East countries  Subjective perceptions are always difficult to measure and compare health status (to note the WHO work on the WHS in standardizing the reporting of health status) quality of services

22. Statistical Division UNECE NHDR Training Bratislava, May 2003 Health: WHO Health Report  Health system responsiveness and performance  Health system attainment: conceptual and measurement problems Disability-adjusted life expectancy (DALE) Disability-adjusted life years (DALY) Eurostat: Disability-free life expectancy  Main issue: lack of reliable data on disability

23. Statistical Division UNECE NHDR Training Bratislava, May 2003 Maternal mortality  obstetric risk associated with each pregnancy  difficult indicator to measure  it needs a comprehensive registration system of deaths and causes of death  UNICEF/WHO: guidelines on how to estimate it  difficult to measure trends  Is it the best indicator to measure maternal health in the region?

24. Statistical Division UNECE NHDR Training Bratislava, May 2003 1995 maternal mortality ratios Source: WHO/UNICEF

25. Statistical Division UNECE NHDR Training Bratislava, May 2003 1995 maternal mortality ratios Source: WHO/UNICEF

26. Statistical Division UNECE NHDR Training Bratislava, May 2003 Maternal health: process indicators  proportion of women who deliver with the assistance of a medically-trained health care provider (doctor, nurse, midwife) or skilled attendants in addition: consider the assistance of a doctor (it can measure the adequacy to solve complications)  proportion of all deliveries that are by caesarian section  use of antenatal and postpartum care  unsafe abortion

27. Statistical Division UNECE NHDR Training Bratislava, May 2003 % deliveries attended by skilled personnel Source: WHO/UNICEF

28. Statistical Division UNECE NHDR Training Bratislava, May 2003 % deliveries attended by skilled personnel Source: WHO/UNICEF

29. Statistical Division UNECE NHDR Training Bratislava, May 2003 Child mortality: MDG 4  Under-five mortality rate probability of children surviving to age 5  Infant mortality rate number of infants dying before reaching the age of one year per 1,000 live births in a given year  Proportion of 1 year old children immunized against measles

30. Statistical Division UNECE NHDR Training Bratislava, May 2003 Child mortality: Sources  Under-five and infant mortality rate death registration system, estimates: household surveys, census  Proportion of 1 year old children immunized against measles administrative records household surveys

31. Statistical Division UNECE NHDR Training Bratislava, May 2003 Child mortality If estimated, Under-five mortality provides better quality data then infant mortality

32. Statistical Division UNECE NHDR Training Bratislava, May 2003 Under-five mortality Source: UNICEF

33. Statistical Division UNECE NHDR Training Bratislava, May 2003 Under-five mortality Source: UNICEF