The Pan American Health Organization (PAHO) wishes to express its appreciation for the joint efforts made by its technical units and Country Offices, as well as by experts at Ministries of Health, who provided technical assistance and guidance during the preparation of this document.
Production of the document was led by the Health Analysis, Metrics and Evidence Unit (HA)/ Department of Evidence and Intelligence for Action in Health (EIH), under the coordination of Vilma Gawryszewski. Preparation of the preliminary material also benefited from the collaboration of Andrea Gerger, Bremen de Mucio, Gabriela Fernandez, João Risi Jr., Oscar Mujica, Pablo Durán, Patricia Soliz, and Roberta Caixeta. The final document was revised and produced in collaboration with Elisabeth Duarte and Enrique Vázquez.
Special thanks are due to the following working group participants: Olga Araya, Laura A. Barufaldi, Gustavo Bretas, Roberta Caixeta, Elisabeth Duarte, Bremen De Mucio, Pablo Durán, Gabriela Fernández, Vilma Gawryszewski, Andrea Gerger, Carlos Guevel, Lilia Jara, José Moya, Rodolfo Peña, João Risi, Jr., Patricia L. Ruiz, Antonio Sanhueza, Patricia Soliz, Cintia H. Vasconcelos, Enrique Vázquez, and Carlos C. F. Vidotti.
This publication was financed by the Ministry of Health of Brazil and PAHO.
INTRODUCTION
The purpose of this publication is to assist Member States in the Region of the Americas to select, manage, interpret and use health indicators. Its overall aim is to facilitate progress towards the monitoring and analysis of health situations and trends. Measuring and monitoring health indicators are important to provide a foundation for measuring inequalities and guide evidence-based decision making in public health.
This document examines conceptual and practical considerations for selecting and calculating health indicators. It is intended for two main audiences: a) national level persons with responsibility for generating, analyzing, and validating timely and reliable data on health systems and services and this includes persons in vital statistics agencies and public health professionals; and b) users of health information for decision-making to strengthen health service delivery. However, the authors recognize that the Member Countries in the Region are at varying levels of progress with regard to human resources and nstitutional capacities to produce reliable, comparable, and consistent health information.
BACKGROUND
The Pan American Health Organization (PAHO) Regional Core Health Data Initiative (RCHDI) was launched in 1995 to contribute to knowledge about the state of ealth and wellbeing of populations and promote the use of reliable data for decision-making. The objective of the RCHDI is to monitor the health goals and andates of PAHO's Member States, in addition to annually compiling a minimum set of data and indicators to characterize the health situation and trends in the egion. In 1997, the 40th Directing Council of PAHO adopted resolution CD.40.R10, institutionalizing the RCHDI. One hundred and eighteen indicators were elected and grouped into subject areas. Since 1997, the majority of Member Countries and territories have implemented the RCHDI to monitor their health situation and trends at the national and subnational levels (1, 2). The PAHO Strategic Plan 2014-2019, continues to promote the use of strategic health information as a tool for decision-making in health to include policy-setting, reorganization of health services, and mobilization of resources, among other things.
In recent years, there has been marked improvement in the capacity of the Member Countries to generate and analyze health information. In many cases, this effort has been enhanced by their subscribing to the RCHDI. This improvement can be seen, for example, in the capacity of many countries to properly monitor and evaluate their achievement and/or progress towards of Millennium Development Goal (MDG) targets. Building on the MDG initiative and to complete the targets hat they did not achieve, countries are now required to monitor 17 Sustainable Development Goals (SDG) with 169 targets under the 2030 Agenda for ustainable Development that was adopted by world leaders in 2015. This universal Agenda reaffirms health as a fundamental right. The goals and targets epresent a global aspiration for the planet, for people, and for their prosperity; they articulate the desire that no one should be left behind. To this end, SDG-3 states: "To ensure healthy lives and promote well-being for all at all ages." In order to monitor these targets, accessible, high-quality, timely, eliable, and disaggregated data are needed to measure advances, ensure that no one is left behind and are essential to decision-making (3).
The document contains five sections. Section 1 discusses health indicators, definitions, uses, and attributes; Section 2, development and measurement of health indicators; Section 3, data sources for developing health indicators; Section 4, steps in evaluating the quality of data and health indicators; and Section 5, indicators estimated by indirect methods: basic concepts, uses, and limitations. Each section begins with a summary of its specific objectives, and includes a list of relevant links to websites and complementary documents. It is hoped that this publication will constitute a valuable resource to strengthen health information systems and promote the integration of data into the decision-making process.
RELATED LINKS
- Strategic Plan of the Pan American Health Organization 2014-2019
- Preparing the Region of the Americas to Achieve the Sustainable Development Goal on Health
- Sixty-ninth World Health Assembly WHA69.11. Health in the 2030 Agenda for Sustainable Development
- Inter-agency Health Information Network (RIPSA). Core indicators for health in Brazil: Concepts and applications - 2nd ed. RIPSA. Brasilia: Pan American Health Organization; 2008. (version in Spanish)
- United Nations General Assembly. Seventieth Session, October 2015. Transforming Our World: the 2030 Agenda for Sustainable Development
REFERENCES
1. Pan American Health Organization (PAHO). Collection and utilization of core health data. Washington, D.C.: PAHO; 14 July 1997 (document CD40/19). Available at: https://www.paho.org/english/gov/cd/doc165.pdf
2. Pan American Health Organization (PAHO). 10-year evaluation of the Regional Core Health Data Initiative, 2004. Available at: https://www.paho.org/english/gov/cd/CD45-14-e.pdf
3. United Nations, 2015, TO/RES/70/1. Available at: http://www.ipu.org/splz-e/unga16/2030-e.pdf