Health indicators an overview

Health Indicators

Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat

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Health Indicators

املؤشرات الصحية

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Knowing is not enough, we must

apply

Willing is not enough, we must do

!!!

Goethe

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Contents Definitions of indicator

Uses of indicators

Types of indicators Indicators as tools in health management

Categorization of indicators Core health indicators WHO classification European Community classification

Canadian classification

Features of a good indicator

Limitations of indicators

Data Sources for indicators

Anatomy/ components of indicator

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Definitions

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Indicator A key statistic that indicates or points to another

measure.

“A summary measure that aims to describe -

in a few numbers as much detail as possible-

about a system to help understand, compare,

predict, improve, and innovate.”

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Health indicator

is summary measures that are designed to describe particular aspects of health or health

system performance. is a characteristic of an individual, population, or environment which is subject to measurement

(directly or indirectly) and can be used to describe one or more aspects of the health of an

individual or population (quality, quantity and time).

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Health indicator-cont's

A quantitative or qualitative variable that

provides a valid and reliable way to measure

achievement, assess performance or reflect

changes connected to an ( intervention) activity,

project or program

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Health indicator-cont's

In the context of monitoring and evaluation,

An indicator is a quantitative metric (data) that provides

information to monitor performance, measure achievement and

determine accountability.

Quantitative metric – Data can measured on a numerical scale

Performance – The effective or efficient operation of an activity,

Achievement – The successful accomplishments of an activity,

Accountability – Responsibility for the performance and/or

achievements of an activity, project or program

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INDICATORS can be • Count (number of..)

• Proportion (percentage, number/per x)

• Rate (frequency of an event during a specified period expressed as per 1,000 or 100,000) in a defined population

• Ratio (numerator not included in the denominator)

• Average

• Index

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Uses of health indicators

1. Indicators are powerful tools for monitoring and communicating critical information about population health.

2. Indicators are used to support planning (identify

priorities, develop and target resources, identify benchmarks) and track progress toward broad community objectives.

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Uses of health indicators-cont's

3. Engagement of partners into a collaborative action (build awareness of problems and trends,

generate interventions). 4. Inform policy and policy makers, and can be used

to promote accountability among governmental and non-governmental agencies.

5. Health indicators help governments and community organizations analyze health needs in the community so they can set priorities for action

and develop appropriate services.

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Types of Indicators Some definitions

Basket (of indicators): A group of indicators that aims to cover a wide range of issues as validly as possible.

A common way of using a basket is for people to choose which indicators they need locally.

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Some definitions-cont's Balanced (set of indicators): A set of indicators which, taken together, reflect as much of a system as possible

without duplication, overlap or gaps

Composite indicator: An aggregation of numerous

indicators which aims to give a one-figure indicator in

order to summarizes measures even further.

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Qualitative vs Quantitative

• Quantitative

Directly measurable One-dimensional

Types: counts, continuous

• Qualitative

Descriptive May be statement of opinion or feeling Often multi-dimensional

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Composite Indices (Summary Indicators)

P R O S

Summarize complex issues for decision-makers.

Easier to interpret one number than to look for

trends across multiple indicators.

Highlight a health care organization or system’s

performance and progress on improvement.

Facilitate assessing a health care organization

or system performance over time.

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P R O S-cont's

Reduce the total number of indicators.

Facilitate ranking of health care organizations or

system on complex issues.

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C O N S

Could lead to wrong policy decisions if the

composite indicator is poorly constructed or

misinterpreted.

Could suggest simplistic policy solutions if the

composite indicator is viewed in isolation from

the individual indicators on which it is based.

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Indicators

as a tool in health management systems

model

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Indicators

in health management systems model

The systems model is a management framework that allows

managers to focus on the process of providing PHC

services in order to produce better results. It helps them to

identify the key elements of a program, which include

resources (the inputs) for carrying out a set of activities

(the process) in order to achieve the expected results

(the outcomes),

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According to system model, there are four types of

indicators: input, output, outcome and impact.

1- Input. A resource used in a program, including

financial and human resources from a variety of

sources, as well as curricula, materials, etc.

2- Output. The immediate results of program activities.

This term relates to the direct products or deliverables

of program activities, such as the number of

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counselling sessions completed, the number of people

reached and the number of materials distributed.

3- Outcome. The intermediate changes that a program

effects on target audiences or populations, such as

change in knowledge, attitudes, beliefs, skills,

behaviours, access to services, policies and

environmental conditions.

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4- Impact. The longer range, cumulative effect of

programs over time on what they ultimately aim to

change.

Interpretation of the impact indicators

Often, the long range effect ( impact ) will be a population-level health outcome, such as a change in HCV infection,

morbidity and mortality.

Impacts are rarely, if ever, attributable to a single program, but a program may, with other programs, contribute to

impacts on a population

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Exercise

Use the System Model to indicate which type of the

indicators can match each of the following statements:

1. indicate resources invested in the system.

2. number of doctors per 100,000 people.

3. indicate activities of the health system

4. percentage of doctors trained in safe delivery skills.

5. indicate achievements made in specific health strategies

6. funds that are used to implement the project.

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7. The immediate products or results of the activities

implemented

8. the number of personnel trained,

9. number of deliveries conducted,

10. number of contraceptives distributed.

11. Indicator that measured at the program level is called

12. The intermediate results of the activities implemented,

13. contraceptive prevalence rates

14. percent of births with skilled birth attendants. Unlike

outputs

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15. outcomes are measured at the population level is …

16. MMR or infant mortality rate.

17. achievements of a health program or health system

18. institutional delivery rate

19. breastfeeding in one hour rate

20. achievements in health status of particular group of people

21. Maternal Mortality Ratio, Infant Mortality Rate, Total Fertility

Rate etc.

22. number of training sessions organized or number of

educational materials developed.

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Categorization of health Indicators

Core health indicators are needed to assess change in three major domains .

1. Determinants of health. These include socioeconomic, environmental, behavioural and genetic determinants or risk factors. Such indicators also characterize the contextual

environments within which the health system operates.

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2. Health system. These include: inputs to the health system and related processes such as policy, organization, human resources, financial resources, health infrastructure, equipment and

supplies; outputs (e.g. health service availability and quality, information availability and quality); and immediate health system outcomes (e.g. coverage of the population with key health services).

3. Health status. These include mortality, morbidity, disability and well-being.

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Indicator Types :WHO Classification

http://www.who.int/whosis/indicatordefinitions/en/index.html

Health Status Indicators: Mortality Health Status Statistics: Morbidity Health Services Coverage Statistics Risk Factors Statistics Health Systems Statistics


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Indicator Types :EC Classification 88 Indicator

Demography and socio-economic situation Health status Determinants of health Health interventions: health services Health interventions: health promotion

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http://ec.europa.eu/health-eu/health_in_the_eu/ec_health_indicators/index_en.htm

http://ec.europa.eu/health-eu/health_in_the_eu/ec_health_indicators/index_en.htm

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http://ec.europa.eu/health/indicators/echi/list/index_en.htm


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Canada Canada’s Health Indicator Framework:

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Good Indicator

What makes a good indicator?

Good metadata makes a good indicator !!

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Good Indicator

A poorly designed, or poorly chosen indicator with reliable data, or

a well designed indicator with unreliable and /or untimely data,

has very little value (and is sometimes positively dangerous).

Among the dozens of factors at play in data collection for

indicators, there are at least three that should always be

addressed because of their impact on the credibility of the data:

(1) validity, (2) reliability and (3) bias.

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Validity: The extent to which a measurement or test accurately

measures what is intended to be measured.

Reliability: The consistency of the data when collected repeatedly

using the same procedures and under the same conditions.

Bias: Any effect during the collection or interpretation of

information that leads to a systematic error in one directionguide

in deciding if an indicator is a good indicator:

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Characteristics of good Indicators:

The Good indicator Should be:

a. valid, i.e., they should actually measure what they are supposed to measure;

b. reliable and objective, i.e., the answers should be the same if measured by different people in similar circumstances;

c. sensitive, i.e., they should be sensitive to changes in the situation concerned,

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Characteristics of good Indicators: -cont's


d. specific, i.e., they should reflect changes only in the situation concerned,

e. feasible, i.e., they should have the ability to obtain data needed, and;

f. relevant, i.e., they should contribute to the understanding of the phenomenon of interest.

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Characteristics of good Indicators: -cont's


• Acceptable: is the indicator acceptable to both those

being assessed and those undertaking the assessment?

Action focused. Indicators should lead to action.

Measurable. Not only must the data collection methodology be

defined, it must also be feasible to collect the data.

Simple. Although he was not talking about indicators

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Five characteristics define SMART Indicators:

Specific – focused and clear

Measurable - quantifiable and reflecting change

Attainable - reasonable in scope and achievable

within set time-frame

Relevant - pertinent to the review of performance

Time-Bound/Trackable - progress can be charted

chronologically

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Facts about indicators Indicators only indicate: They do not capture or convey the

many dimensions of a given situation and/or activity.

They are directional: They provide basic information on the

past, present and possible future course of an activity, program

and/or behaviour.

They are also very context-specific: Higher values or

lower values can be either good or bad, depending on the

situation.

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Indicators are not designed to replace more detailed

investigations of specific issues, nor should they be used

to do so Indicators are an essential part of effective monitoring

and evaluation.

They can provide vital information on performance,

achievement and accountability. However, indicators are

only one part of a comprehensive M&E system.

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Some limitations of indicators:

Indicators rarely indicate specific cause of the

problem and possible comparison over time and

across facilities and Districts to show trends in

order to be useful.

INDICATORS NEED TO CHANGE WITH TIME

Any set of health indicators should evolve in response to the changing needs of the people

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WHAT HEALTH INDICATORS CANNOT DO As useful as health indicators are, it’s also important

to know what they cannot do:

They raise questions, but do not usually provide

direct answers

They should not be used in isolation to interpret a

complex health issue

They should not be used for unintended purposes

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Data sources Given the broad range of data requirements, no

single method of data collection can meet all needs.

The most appropriate data source depends on the

information required, cost-effectiveness and

feasibility of the method, human and technical

capacity to collect, manage and disseminate the

data, and financial and time constraints.

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Linking indicators and data sources

Each essential indicator should be linked with

one or more suitable data sources. Different

sources can be used to generate similar indicators,

and decisions should be made about the most

suitable data source given the circumstances .

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Data

Knowledge

Information

wisdom

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Better Information Better Decision

Better Decision Better Health

An indicator can be defined as a data element

placed in a given context so that it becomes information that can be acted upon and can be used for program monitoring and management

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Data: is a fact that alone is not significant, as is

doesn’t relate to other data.

Data—specific quantitative and qualitative

information or facts that are collected and

analyzed.

Data: Information that is fed into indicators.

Without context and comparators, data rarely

have significant meaning.

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Information: data that are processed to be useful; provides answers to "who", "what", "where", and "when" questions.

Knowledge: application of data and information; answers "how" questions.

Understanding: appreciation of "why"

Wisdom: evaluated understanding. -Wisdom is complete understanding of the effects and outcomes of Knowledge.

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Anatomy

of an Indicator

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Indicator components

When new indicators are being developed, they must be fully defined.

No indicator should be deployed without a full definition. So it is critical to

understand the terms used to define the components of an indicator.

Title. A brief heading that captures the focus of the indicator.

Definition. A clear and concise description of the indicator.

Purpose. The reason that the indicator exists; i.e. what it is for.

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Indicator components-cont's Rationale. The underlying principle(s) that justify the development

and deployment of the indicator; i.e. why the indicator is needed

and useful.

Method of measurement. The logical and specific sequence of

operations used to measure the indicator; e.g. data collection tools,

sampling frame and quality assurance.

Numerator. The top number of a common fraction, which indicates

the number of parts from the whole that are included in the

calculation.

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Indicator components-cont's Denominator. The bottom number of a common fraction, which

indicates the number of parts in the whole

Calculation. The specific steps in the process to determine the indicator value.

Data collection method. The general approaches (e.g. surveys,

records, models, estimates) used to collect data.

Data collection tools. The specific tools, patient registers, antenatal clinic surveillance) used to collect data.

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Indicator components-cont's Data collection frequency. The intervals at which data are collected;

e.g. quarterly, annually, bi-annually.

Guidelines to interpret and use data. Recommendations on how

best to evaluate and apply the findings; e.g. outlining what it means if

the indicator shows an increase or a decrease in a particular measure.

Strengths and weaknesses. A brief summary of what the indicator

does well and not so well.

Challenges. Potential obstacles or problems that may have an impact

on the use of an indicator or on the accuracy/validity of its findings

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Exercise MDG

GOAL 5: IMPROVE MATERNAL HEALTH

TARGET 6 :Reduce by three quarters, between 1990 and 2015,

the maternal mortality ratio

Indicators: 16. Maternal mortality ratio

Indicators 17. Proportion of births attended by skilled health

personnel

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Cited References http://ec.europa.eu/health/indicators/echi/index_en.htm

A guide on indicators for monitoring and reporting on the health

sector response to HIV/AIDS-WHO 2009

http://www.who.int/hiv/data/ua10_indicator_guide_en.pdf


http://gis.emro.who.int/HealthSystemObservatory/DataBase/Fo

rms/IndicatorsIndex.aspx

http://ec.europa.eu/health/indicators/echi/index_en.htm


http://www.who.int/hiv/data/ua10_indicator_guide_en.pdf



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http://nrhm-

mis.nic.in/UI/FormatsFolder/HMIS%20Manual/Health%20Progra

mme%20Manager%27s%20Manual.pdf

http://www.who.int/gho/publications/world_health_statistics/W

HS2012_IndicatorCompendium.pdf

http://toolkits.urbanreproductivehealth.org/toolkits/measuring-

success/indicators

http://data.worldbank.org/topic/health

http://datatopics.worldbank.org/hnp/


http://nrhm-mis.nic.in/UI/FormatsFolder/HMIS%20Manual/Health%20Programme%20Manager%27s%20Manual.pdf



http://www.who.int/gho/publications/world_health_statistics/WHS2012_IndicatorCompendium.pdf

http://www.who.int/gho/publications/world_health_statistics/WHS2012_IndicatorCompendium.pdf

http://toolkits.urbanreproductivehealth.org/toolkits/measuring-success/indicators

http://toolkits.urbanreproductivehealth.org/toolkits/measuring-success/indicators

http://data.worldbank.org/topic/health

http://datatopics.worldbank.org/hnp/

Health & Medicine

Health indicators an overview