Health indicators an overview

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An indicator is a quantitative metric (data) that provides information to monitor performance, measure achievement and determine accountability.

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Health indicators an overview

  1. 1. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat ‫املؤشرات‬ ‫الصحية‬ Health Indicators 1
  2. 2. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Knowing is not enough, we must apply Willing is not enough, we must do !!!Goethe 2
  3. 3. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 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 3
  4. 4. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Definitions 4
  5. 5. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 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.” 5
  6. 6. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 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). 6
  7. 7. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Health indicator-conts  A quantitative or qualitative variable that provides a valid and reliable way to measure achievement, assess performance or reflectchanges connected to an ( intervention) activity, project or program 7
  8. 8. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Health indicator-contsIn 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 scalePerformance – 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 8
  9. 9. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 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 9
  10. 10. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Uses of health indicators1. 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. 11
  11. 11. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Uses of health indicators-conts3. 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. 11
  12. 12. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Types of Indicators Some definitionsBasket (of indicators): A group of indicators that aimsto cover a wide range of issues as validly as possible.A common way of using a basket is for people tochoose which indicators they need locally. 12
  13. 13. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Some definitions-contsBalanced (set of indicators): A set of indicators which,taken together, reflect as much of a system as possiblewithout duplication, overlap or gapsComposite indicator: An aggregation of numerousindicators which aims to give a one-figure indicator inorder to summarizes measures even further. 13
  14. 14. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefatQualitative vs Quantitative• Quantitative  Directly measurable  One-dimensional  Types: counts, continuous• Qualitative  Descriptive  May be statement of opinion or feeling  Often multi-dimensional 14
  15. 15. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefatComposite Indices (Summary Indicators)PROS  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. 15
  16. 16. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefatComposite Indices (Summary Indicators)  P R O S-conts  Reduce the total number of indicators.  Facilitate ranking of health care organizations or system on complex issues. 16
  17. 17. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefatComposite Indices (Summary Indicators)CONS  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. 17
  18. 18. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Indicators as a tool in health management systems model 18
  19. 19. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Indicators in health management systems modelThe 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), 19
  20. 20. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 21
  21. 21. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 21
  22. 22. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 22
  23. 23. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefatAccording 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 23
  24. 24. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 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. 24
  25. 25. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat4- 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 25
  26. 26. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 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 system4. percentage of doctors trained in safe delivery skills.5. indicate achievements made in specific health strategies6. funds that are used to implement the project. 26
  27. 27. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat7. The immediate products or results of the activities implemented8. the number of personnel trained,9. number of deliveries conducted,10. number of contraceptives distributed.11. Indicator that measured at the program level is called12. The intermediate results of the activities implemented,13. contraceptive prevalence rates 14. percent of births with skilled birth attendants. Unlike outputs 27
  28. 28. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 15. outcomes are measured at the population level is …16. MMR or infant mortality rate.17. achievements of a health program or health system18. institutional delivery rate19. breastfeeding in one hour rate20. achievements in health status of particular group of people21. Maternal Mortality Ratio, Infant Mortality Rate, Total Fertility Rate etc.22. number of training sessions organized or number of educational materials developed. 28
  29. 29. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 29
  30. 30. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 31
  31. 31. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Categorization of health IndicatorsCore 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. 31
  32. 32. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat2. 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. 32
  33. 33. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 33
  34. 34. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Indicator Types :WHO Classificationhttp://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 34
  35. 35. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefathttp://www.who.int/whosis/indicatordefinitions/en/index.html 35
  36. 36. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefatIndicator Types :EC Classification 88 Indicator Demography and socio-economic situation Health status Determinants of health Health interventions: health services Health interventions: health promotion 36
  37. 37. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefathttp://ec.europa.eu/health-eu/health_in_the_eu/ec_health_indicators/index_en.htm 37
  38. 38. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefathttp://ec.europa.eu/health/indicators/echi/list/index_en.htm 38
  39. 39. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Canada Canada’s Health Indicator Framework: 39
  40. 40. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 41
  41. 41. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Good Indicator What makes a good indicator? Good metadata makes a good indicator !! 41
  42. 42. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Good IndicatorA 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. 42
  43. 43. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefatValidity: The extent to which a measurement or test accuratelymeasures what is intended to be measured.Reliability: The consistency of the data when collected repeatedlyusing 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: 43
  44. 44. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 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, 44
  45. 45. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefatCharacteristics of good Indicators: -conts The Good indicator Should be: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. 45
  46. 46. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Characteristics of good Indicators: -conts The Good indicator Should be:• Acceptable: is the indicator acceptable to both thosebeing assessed and those undertaking the assessment?Action focused. Indicators should lead to action.Measurable. Not only must the data collection methodology bedefined, it must also be feasible to collect the data.Simple. Although he was not talking about indicators 46
  47. 47. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 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 47
  48. 48. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 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. 48
  49. 49. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 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. 49
  50. 50. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Some limitations of indicators:Indicators rarely indicate specific cause of theproblem and possible comparison over time andacross facilities and Districts to show trends inorder to be useful.INDICATORS NEED TO CHANGE WITH TIMEAny set of health indicators should evolvein response to the changing needs of the people 51
  51. 51. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefatWHAT HEALTH INDICATORS CANNOT DOAs useful as health indicators are, it’s also importantto 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 51
  52. 52. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Data sourcesGiven the broad range of data requirements, nosingle method of data collection can meet all needs. The most appropriate data source depends on theinformation required, cost-effectiveness andfeasibility of the method, human and technicalcapacity to collect, manage and disseminate thedata, and financial and time constraints. 52
  53. 53. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 53
  54. 54. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Linking indicators and data sources Each essential indicator should be linked withone or more suitable data sources. Differentsources can be used to generate similar indicators,and decisions should be made about the mostsuitable data source given the circumstances . 54
  55. 55. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 55
  56. 56. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 56
  57. 57. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefatData Knowledge Information wisdom 57
  58. 58. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefatBetter Information Better DecisionBetter Decision Better HealthAn indicator can be defined as a data elementplaced in a given context so that it becomesinformation that can be acted upon and can be usedfor program monitoring and management 58
  59. 59. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 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. 59
  60. 60. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 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. 61
  61. 61. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 61
  62. 62. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 62
  63. 63. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 63
  64. 64. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Anatomy of an Indicator 64
  65. 65. Health IndicatorsDr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 65
  66. 66. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 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. 66
  67. 67. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Indicator components-contsRationale. The underlying principle(s) that justify the developmentand deployment of the indicator; i.e. why the indicator is neededand useful.Method of measurement. The logical and specific sequence ofoperations used to measure the indicator; e.g. data collection tools,sampling frame and quality assurance.Numerator. The top number of a common fraction, which indicatesthe number of parts from the whole that are included in thecalculation. 67
  68. 68. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Indicator components-contsDenominator. The bottom number of a common fraction, whichindicates the number of parts in the wholeCalculation. 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. 68
  69. 69. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Indicator components-contsData collection frequency. The intervals at which data are collected;e.g. quarterly, annually, bi-annually.Guidelines to interpret and use data. Recommendations on howbest to evaluate and apply the findings; e.g. outlining what it means ifthe indicator shows an increase or a decrease in a particular measure.Strengths and weaknesses. A brief summary of what the indicatordoes well and not so well.Challenges. Potential obstacles or problems that may have an impacton the use of an indicator or on the accuracy/validity of its findings 69
  70. 70. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat Exercise MDGGOAL 5: IMPROVE MATERNAL HEALTHTARGET 6 :Reduce by three quarters, between 1990 and 2015,the maternal mortality ratioIndicators: 16. Maternal mortality ratioIndicators 17. Proportion of births attended by skilled healthpersonnel 71
  71. 71. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat 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://www.who.int/whosis/indicatordefinitions/en/index.html http://gis.emro.who.int/HealthSystemObservatory/DataBase/Fo rms/IndicatorsIndex.aspx http://ec.europa.eu/health/indicators/echi/index_en.htm 71
  72. 72. Health Indicators Dr. Ahmed-Refat AG Refat (01/12/2012) www.SlideShare.net/AhmedRefat  http://ec.europa.eu/health/indicators/echi/list/index_en.htm  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/ 72

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