Evidence and Information for Policy

Christopher J.L. MurrayExecutive Director

Evidence and Information for Policy

World Health Organization

National Capacity to Monitor the Health-Related MDGs

Evidence and Information for Policy

National Information Needs• Strategic decision-making

• Informing programme managers to improve implementation

• Dynamic monitoring critical outcomes -- key to accountability

• Building the evidence base on determinants and interventions for health

Evidence and Information for Policy

Minimal National Data Systems

• Health Service Providers -- intervention delivery, case notifications, ANC surveillance

• Household Surveys

• Vital Registation

• Inputs -- National Health Accounts, human resources

Evidence and Information for Policy

Balancing Emphasis• For programme implementation, there is

a premium on information that is local and timely e.g. service delivery registries

• For monitoring and evidence building and strategic decision-making, there is a premium on validity

• Major issue for health-related information systems is balancing these needs

Evidence and Information for Policy

Health Service Providers

• Both case notifications and intervention delivery registries, in low and middle-income countries highly biased towards public providers complicated by reporting incentives.

Evidence and Information for Policy

Comparisons of Coverage Estimates from DHS Comparisons of Coverage Estimates from DHS versus Routine Sourcesversus Routine Sources

Adjusted DPT3 coverage rates by birth cohort, 45 countries, 1985-1998

0%

20%

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100%

0% 20% 40% 60% 80% 100%

Demographic and Health Surveys

Rout

ine In

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ation

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ms

Differences (in percentage points) in adjusted DPT3 coverage rate, by source of data, 45

countries

-40%

-20%

0%

20%

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0% 20% 40% 60% 80% 100%

Routine

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S)

Evidence and Information for Policy

Household Surveys

• For nutritional status, immunization coverage, child mortality, bednets use, HIV seroprevalence, ARV use, safe water, sanitation, indoor air pollution household surveys are low-cost, valid and reliable strategy.

• National capacity to field household surveys limited. Efforts by DHS, MICS, LSMS and WHS to increase capacity.

Evidence and Information for Policy

The World Health SurveyWHS 2002

73 SURVEYS in 73 countries 73 SURVEYS in 73 countries

Household - long : 56Household - long : 56

Household - short: 13Household - short: 13

CATI :CATI : 4 4

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

© WHO 2002. All rights reserved

Evidence and Information for Policy

National Capacity to Analyze Data

• In many countries that have undertaken household surveys, national capacity in the health sector to analyze the data is limited.

• WHO training workshops, national report writing projects, training materials.

Evidence and Information for Policy

Vital Registration

• For child and maternal mortality, malaria and tuberculosis death rates, and for a host of other health indicators, vital registration with cause of death reporting according to the ICD is a highly effective data collection tool.

• In low-income countries, VR coverage largely limited to selected urban areas.

Evidence and Information for Policy

AVAILABILITY OF NEW OR RECENT VITAL REGISTRATION DATA (complete or

partial)WHR2000 & WHR2001

Number of countries with recent Vital Registration data

WHR2000 WHR2001Africa 3 7The Americas 21 33Eastern Mediterranean 3 10Europe 43 51South-East Asia 4 6Western Pacific 8 21

World 82 128

Evidence and Information for Policy

Strengthening VR

• Some progress in expanding VR coverage e.g. South Africa

• Development and dissemination of tools to use incomplete VR data e.g. Zimbabwe

• Use of sample schemes or population laboratories

Evidence and Information for Policy

WHO Monitoring

• Each year in the World Health Report WHO reports on infant and child mortality, adult mortality, life expectancy, healthy life expectancy, and national health accounts

• For 2003, an expanded set of core indicators will be reported.

Evidence and Information for Policy

Reporting Criteria Agreed by Member States

• Each figure to be included must:– established validity of the measurement method– reliability quantified through an assessment of

uncertainty– established inter-individual and cross-population

comparability– period of consultation not concurrence with

Member States– data audit trail