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Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
Health system-evaluation-and-monitoring
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Health system-evaluation-and-monitoring

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health system assessment by using indicators

health system assessment by using indicators

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  • 1. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefatEvaluation & Monitoring of Health Systems Dr. Ahmed-Refat AG Refat 12/12/2012 1
  • 2. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Evaluation Vs MonitoringEvaluation is: “The systematic gathering, analysis and reporting of data about a system*/program** to assist in decision making.” *A “system” a set of inter-connected parts that have to function together to be effective A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health (WHO 2007) ** Program is a group of related activities intended to achieve specific outcomes. 2
  • 3. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefatWhen Is Program Evaluation Desirable? Retrospective Evaluation - is often used when programs have been functioning for some time. 3
  • 4. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Prospective Evaluation.is conducted when a new program is being introduced or when a major changes introducedA prospective evaluation identifies ways to increase the impact of a program on clients; it examines anddescribes a program’s attributes; and, it identifies howto improve delivery mechanisms to be more efficient and less costly. 4
  • 5. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Formative Vs Summative EvaluationThe broadest and most common classification ofevaluation identifies two kinds of evaluation:1. formative evaluation. =evaluation of components of a program other thantheir outcomes. 5
  • 6. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefatA formative evaluation may evaluate the degree of needfor the program, or the activities used by the program toachieve its desirable outcomes, but without evaluatingthe degree of outcome.Formative evaluation is analogous to Total Quality Management(TQM) and Continuous Quality Improvement (CQI) since all theseapproaches are a commitment to constantly improve operations,processes and activities to meet client requirements efficiently,consistently and cost-effectively.Formative evaluation then evaluates whether the program will use, ordoes use, the right mix and volumes of human resources, materials andactivities to carry out the program. 6
  • 7. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat2. summative evaluation=evaluation of the degree to which a program hasachieved its desired outcomes, and the degree to whichany other outcomes (positive or negative) have resultedfrom the program.Summative evaluations examine the changes that should or did occur as a result of the program(outcomes). 7
  • 8. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Evaluation Prospevtive – Retrospective• prospective, meaning it determines what ought tohappen (and why); or• retrospective, meaning it determines what actuallyhappened (and why). 8
  • 9. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Evaluation Internal And External1. Internal evaluation (sometimes called selfevaluation), in which people within a programsponsor, conduct and control the evaluation. Internalevaluation can more fully engage the insights ofprogram personnel but runs the risk of overlysubjective evaluation results. 9
  • 10. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Evaluation Internal And External2. External evaluation, in which someone fromOutside the program. External evaluation has theadvantage of objectivity if doneWell. 11
  • 11. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Evaluation Descriptive AnalyticalDescriptive elements of the evaluation are meant toanswer four of the questions that are the hallmark ofgood journalism, just as they are the hallmark of gooddescriptive evaluation: WHO WHAT WHEN WHEREDescription alone does not answer WHY & HOW. 11
  • 12. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefatThe why and how questions that are answered by analytical evaluation. 12
  • 13. Health System Evaluation and MonitoringDr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat 13
  • 14. Health System Evaluation and MonitoringDr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat 14
  • 15. Health System Evaluation and MonitoringDr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat 15
  • 16. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Monitoring Monitoring is the constant orrecurring collection and examinationof selected information on programactivity over the life of the program. 16
  • 17. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefatMonitoring Information can be used for two purposes:1. to alert the program to changes in program operationthat might be signals of possible program failure; and2. to provide a body of information that will be usedwhen each kind of evaluation is carried out.Monitoring can emerge from prospective evaluations,and can provide raw material for retrospectiveevaluations. 17
  • 18. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefatThe Difference between Outputs and Outcomes An output is a measurable result of activities within a program, reflecting the immediate result of the activities but not directly reflecting the effect on clients of the program. An outcome is a measurable positive or negativechange to clients of a program or to other stakeholders. 18
  • 19. Health System Evaluation and MonitoringDr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat 19
  • 20. Health System Evaluation and MonitoringDr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat 21
  • 21. Health System Evaluation and MonitoringDr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat 21
  • 22. Health System Evaluation and MonitoringDr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat 22
  • 23. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Performance Indicators inEvaluation and Monitoring of Health System 23
  • 24. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Indicators of accessDefinition of Access“access” refers to the presence or absence of physicalor economic barriers that people might face in usinghealth services.Physical barriers are usually interpreted to mean 24
  • 25. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefatthose related to the general supply and availability ofhealth services and distance from health facilities.Economic barriers are usually interpreted to meanthose related to the cost of seeking and obtaininghealth care, in relation to a patient’s or household’sincome. Many of the features of “access” are alsoincluded in definitions of the structural aspects of qualityof care assessments. 25
  • 26. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefatPhysical Access  ! Percent of (rural, poor) population residing within X kilometers of a health facility  ! Percent of (rural, poor) population residing within X kilometers of a health facility  providing a package of basic health services  ! Percent of (rural, poor) population residing within X kilometers of a health facility staffed by a doctor  ! Percent of (rural, poor) population residing within X kilometers of a pharmacy  Percent of the population residing within X kilometers of a hospital 26
  • 27. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat ! Percent of population residing within X kilometers of a hospital providing 24-hour emergency (obstetric) care ! Percent of population served by 24-hour ambulance services ! Percent of health facilities equipped with telephones or radios ! Population per doctor ! Population per nurse ! Population per hospital bed 27
  • 28. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Economic Access ! Average total private cost of professionally treated outpatient illness episode as a percent of monthly per capita household income for consumers in the lowest per capita income quintile ! Average total private cost of medicines for a typical outpatient illness episode as a percent of monthly per capita household income for consumers in the lowest per capita quintile ! Average total private cost of an average hospital stay as a percent of annual per capita household income for consumers in the lowest per capita income quintile 28
  • 29. Health System Evaluation and MonitoringDr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat 29
  • 30. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Indicators of equity “The concept of equity as it relates to health systems may refer variously todifferences in health status, utilisation, or access among different income,socio-economic, demographic, ethnic, and/or gender groups” 31
  • 31. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefatEquity can be 1. horizontal and 2. vertical equity.Horizontal equity refers to the equal treatment ofequals regardless of gender, marital status and so on.Vertical equity is based on the principle that individualswho are unequal in society should be treated differently 31
  • 32. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Definition of Equity The concept of equity as it relates to health systems mayrefer variously to differences in health status, utilization, or access among different income, socio-economic, demographic, ethnic, and/or gender groups. Most health sector reform efforts directed toward system performance in low- and middle-income countries concentrate on definitions of equity related to access and utilization. 32
  • 33. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat If equity is defined mainly in terms of ensuring access ingeneral—or universal access to a package of basic or cost- effective health services in particular— Access can be modified and calculated across thepopulation, or, using coverage rates that compare access for different income, to socio-economic, demographic, ethnic, gender, geographic, or other groups considered especially undeserved. 33
  • 34. Health System Evaluation and MonitoringDr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat 34
  • 35. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefatIndicators of QualityDefinition of Quality“Quality of care” is clearly a multi-dimensional conceptand one on which there is as yet no consensusdefinition (even in the United States). 35
  • 36. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Quality of care“that kind of care which is expected to maximizean inclusive measure of patient welfare, after one has taken account of the balance of expectedgains and losses that attend the process of care in all its parts. 36
  • 37. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Quality of care is a multi-dimensional concept on which there is little current consensus. Three aspects of quality of care are commonly distinguished inthe literature, between ‘structural’, ‘process’ and ‘outcome’ dimensions . ‘Structural’ quality refers to whether appropriate resources are in place to provide health care of a minimum standard(personnel trained for their tasks, well maintained equipment and buildings, a regular drug supply). 37
  • 38. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat ‘Process’ quality generally refers to activities occurring during the interaction between the health system and the client (i.e. whether good quality care is actually delivered). Also, both the presence of accreditation and the quality of professional training and continuing education may affect quality. ‘Outcome’ quality, in addition to health status, can include patient satisfaction and perceived quality.Outcome flows from process and refers to “changes in a patient’s current and future health status that can be attributed to the antecedent health care.” 38
  • 39. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefatStructural Indicators! Existence of national standards for professional qualifications ofhealth manpower, includingenforcement mechanisms! Proportion of health workers possessing basic professionalqualifications, including skills forspecific primary health care services! Existence of national facility standards, including enforcementmechanisms! Proportion of health facilities meeting basic structural standards,based on the services to beprovided! Presence of clear national standards for high priority healthservices 39
  • 40. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat! Proportion of facilities in which current diagnostic and treatmentguidelines are available inwriting! Presence of a national quality assurance program, includingtrained staff and establishedprocedures for quality design, monitoring and improvement. Sub-indicators of the presence ofeffective quality assurance include:> Routine review and updating of technical standards> Effective methods for communicating standards to the field level> Routine application of methods for comparing performance withstandards> Routine application of data-based problem-solvingmethodologies 41
  • 41. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat> Routine application of methods for incorporating communityinput into system design andmanagement! Proportion of health facilities that did not experience drugstockouts during the preceding threemonths! Proportion of cases in which all recommended drugs areavailable 41
  • 42. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefatProcess Indicators! Proportion of clinics in which services are fully integrated,per national standards! Proportion of health workers receiving appropriately timedand effectively conducted supervision,per national policy! Proportion of patient contacts in which treatment receivedis consistent with national diagnosticand treatment protocols, including guidelines for client-provider interaction! Proportion of referrals made and consummated inaccordance with national guidelines andstandards 42
  • 43. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat! Proportion of clients who know and understand essentialactions needed to complete treatmentsand avoid future preventable conditions! Proportion of clients who follow through to completion ofrecommended treatments (drop outrate)! Client satisfactionIndicators for Health System Performance 23 43
  • 44. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Indicators of efficiencyThe important distinction between effectiveness and efficiency isthat the latter takes into account costs.Efficiency is defined by health economists in several differentways, and can be applied to health services as well as healthoutcomes. Efficiency essentially concerns how and whichhealth services are produced, and has three dimensions:technical, economic8 and allocative . 44
  • 45. Health System Evaluation and MonitoringDr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat 45
  • 46. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefatIndicators of Efficiency! Outpatient visits per hour of physician labor (or perphysician)! Outpatient visits per hour of nurse labor (or per nurse)! Ratio of outpatient visits to personnel costs (i.e., unitpersonnel costs)! Cost per outpatient visit (or Operating cost per outpatientvisit)! Cost per hospital bed-day (or per hospital admission or perhospital discharge)! Percent of outpatient visits obtained from the private sector! Private hospital beds as percent of total 46
  • 47. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat! Personnel expenditure as a percent of total recurrent healthexpenditure! Expenditure on drugs and supplies as a percent of totalrecurrent health expenditure! Number of nurses per doctor! Number of nurses per hospital bed! Number of doctors per hospital bed! Ratio of average salary of government health worker (e.g.,doctor, nurse, technician) with a givenlevel of experience to the income of a comparable privatesector health worker! Salaries of government health workers are paid on time(yes/no) 47
  • 48. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat! Adequate performance incentives exist for governmenthealth personnel (yes/no)! Generic drug expenditure as a percent of total drugexpenditure! Government health system uses basic drug list forprocurement (yes/no)! Percent of government recurrent health budget spent onpublic health services! Primary health care expenditure as a percent of recurrentcosts! Percent of total government drug expenditures allocated toprimary care facilities! Fees are charged in all facilities (yes/no) 48
  • 49. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat! Fee levels promote efficiency (yes/no)! Referral system functions effectively (yes/no)! Average length of hospital inpatient stay! Hospital bed occupancy rate! Percent of insured enrolled in plans which use copaymentsand deductibles, managed care plans,or plans subject to global budgeting 49
  • 50. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Sustainability the capacity of the system to continueits normal activities successfully in the future Most definitions of sustainability also include the additional requirement that the system be able to expand its activities as needed to keep up with increases in demand due to economic and population growth. 51
  • 51. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Sustainability includes both financial and institutional dimensions.Financial sustainability refers to the capacity of thehealth system to replace withdrawn donor funds withfunds from other, usually domestic, sources.Institutional sustainability refers to the capacity of thesystem, if suitably financed, to assemble and managethe necessary non-financial resources to successfullycarry on its normal activities. 51
  • 52. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefatIndicators of Sustainability 52
  • 53. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefatFinancial Sustainability! Percent of total health system financed by tax revenue! Percent of government health system financed by taxrevenue! Government health expenditure as percent of totalgovernment budget! Government health expenditure as percent of GDP! Percent of total health spending financed by donors! Percent of government health spending financed by donors 53
  • 54. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat! Percent of government recurrent health spending financedby donors! Percent of government health expenditure directed toprimary care! Percent of government health expenditure directed topreventive care! Percent of government health expenditure directed to MCHservices 54
  • 55. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefatInstitutional Sustainability! Foreign doctors as a percent of all doctors! Number of months of foreign technical assistance fundedby donors! Donor expenditures on technical assistance as a percent ofall donor health expenditures 55
  • 56. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Key characteristics ofgood service delivery 56
  • 57. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Key characteristics of good service delivery .Comprehensiveness: A comprehensive range of health services is provided, appropriate to the needs of the targetpopulation, including preventative, curative, palliative and rehabilitative services and health promotion activities. 57
  • 58. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Key characteristics of good service delivery.Accessibility: Services are directly andpermanently accessible with no undue barriers of cost,language, culture, or geography. Health services areclose to the people, with a routine point of entry to theservice network at primary care level (not at thespecialist or hospital level). Services may be provided inthe home, the community, the workplace, or healthfacilities as appropriate . 58
  • 59. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Key characteristics of good service delivery .Coverage:Service delivery is designed so that allpeople in a defined target population arecovered, i.e. the sick and the healthy, allincome groups and all social groups . 59
  • 60. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Key characteristics of good service delivery .Continuity Service delivery is organized to provide anindividual with continuity of care across thenetwork of services, health conditions,levels of care, and over the life-cycle. 61
  • 61. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Key characteristics of good service delivery .Quality:Health services are of high quality, i.e. they are effective, safe, centered on the patient’s needs and given in a timely fashion. 61
  • 62. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Key characteristics of good service delivery .Person-centredness: Services are organized around the person, not thedisease or the financing. Users perceive health services to be responsive and acceptable to them. There is participation from the target population in servicedelivery design and assessment. People are partners in their own health care. 62
  • 63. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Key characteristics of good service delivery Coordination: Local area health service networks are actively coordinated, across types of provider, types of care, levels of service delivery, and for both routine andemergency preparedness. The patient’s primary care provider facilitates the route through the neededservices, and works in collaboration with other levelsand types of provider. Coordination also takes placewith other sectors (e.g. social services) and partners (e.g. community organizations). 63
  • 64. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Criteria forEvaluating Individual Indicators 64
  • 65. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefatThe indicators should be selected according to the following criteria:  ! Validity. Does it measure what it is supposed to measure  Precision. Is the indicator clearly and unambiguously defined?  ! Reliability. Will two measurements of the indicator for the same health system produce  the same result?  ! Timeliness. Is the indicator available on an annual basis and without undue delay?  ! Comparability. Can the indicator be used to compare health systems meaningfully across countries? 65
  • 66. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat  ! Additivity. Can the indicator be readily and meaningfully applied to sub-regions and to population sub-groups (e.g., gender, income)? ! Interpretability. Does a higher (or lower) value of theindicator consistently imply that a health system performs better?  ! Cost. Is the cost manageable? There is often anunavoidable tradeoff between cost, on the one hand, and validity, reliability, and timeliness, on the other hand. 66
  • 67. Health System Evaluation and Monitoring Dr.Ahmed-Refat AG Refat WWW.SlideShare.net/AhmedRefat Cited ReferencesKnowles, James C.,Charlotte Leighton, and Wayne Stinson, 1997. Measuring Results of HealthSector Reform for System Performance: A Handbook of Indicators. Special Initiatives ReportNo. 1. Bethesda, MD: Partnerships for Health Reform, Abt Associates IncMonitoring and evaluation of health systems strengthening An operational framework WHO, Geneva. October2010Margaret El. Kruk and Lynn P. Freedman.Assessing health system performance in developing countries: Areview of the literature. Health Policy 85 (2008) 263–276http://www.ppmrn.net/storage/ppmrn/Margaret%20Elizabeth%20Kruk%20Lynn%20P.%20Freedman.pdf/http://ocw.jhsph .edu/index.cfm/go/viewCourse/course/HSRE/coursePage/lectureNotes/http://www.healthsystems2020.org/content/resource/detail/528http://www.euro.who.int/en/who -we-are/partners/observatory/studies/performance -measurement-for -health-system-improvement-experiences,-challenges-and-prospectshttp://www.euro.who.int/en/who -we-are/partners/observatory/studies 67

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