TABLE OF CONTENTS

INTRODUCTION 1

SECTION 1: HEALTH INDICATORS: DEFINITION, USES, AND ATTRIBUTES 4

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'HVLUDEOHDWWULEXWHVRIDKHDOWKLQGLFDWRU 13

SECTION 2: DEVELOPMENT AND MEASUREMENT OF HEALTH INDICATORS 17

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SECTION 3: DATA SOURCES FOR DEVELOPING HEALTH INDICATORS 46

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SECTION 4: PROCESSS TO EVALUATE THE QUALITY OF DATA AND HEALTH INDICATOR 63

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 (YDOXDWLRQRIPRUWDOLW\GDWD 69

SECTION 5: INDICATORS ESTIMATED BY INDIRECT METHODS: BASIC CONCEPTS, USES, AND LIMITATIONS 71
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ANNEX 80
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  0RGHOȓOH 81

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HEALTH INDICATORS: CONCEPTUAL AND OPERATIONAL CONSIDERATIONS

INTRODUCTION
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BACKGROUND
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REFERENCES

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3
SECTION 1

HEALTH INDICATORS: DEFINITION, USES, AND ATTRIBUTES

Contents
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Objective
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WRUV

AFTER READING THIS SECTION, THE READER WILL BE ABLE TO DEFINE:

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• :KDWDQLQGLFDWRULVDQGZKDWKHDOWKLQGLFDWRUVDUH

• :KDWOHYHORIPHDVXUHPHQWLVQRUPDOO\XVHGIRULQGLFDWRUVRIDSRSXODWLRQŬVKHDOWK

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1.1 ESSENTIAL DEFINITIONS

1.1.1 THE CONCEPT OF HEALTH

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The concept of health used in this document was developed in 1947 by the World Health
Organization (WHO)1. It states that health is “a state of complete physical, mental, and
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4
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1.1.2 DEFINING THE INDICATORS

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1. Aggregate measurements of health: 7KHVHDUHPHDVXUHPHQWVDYHUDJHVPHGLDQVSURSRUWLRQV
WKDW SURYLGH D VXPPDU\ YLHZ RI WKH REVHUYDWLRQV RI LQGLYLGXDOV LQ HDFK REVHUYHG JURXS IRU
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2. Ecological or environmental measurements:7KHVHUHIHUWRWKHSK\VLFDOFKDUDFWHULVWLFVRIWKH

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3. Global measurements:7KHVH UHIHU WR DWWULEXWHV RI WKH JURXS RU SODFH ZLWKRXW DQDORJXHV DW
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Every health indicator is an estimate (a measurement with some degree of imprecision)

of a given health dimension in a target population.

1.1.3 DATA, INDICATOR, AND HEALTH INDICATOR

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JLYHQSRSXODWLRQ

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Datum and indicator are not synonymous concepts, although in some contexts the
conceptual distinction may not be entirely clear.

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1.1.4 POSITIVE AND NEGATIVE HEALTH INDICATORS
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Indicators are considered positive when they have a direct relationship (association,
correlation) with healthiness. The higher the indicator value, the better the state of
health of the people in the population being studied.

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FRYHUDJHRURIPHWIDPLO\SODQQLQJQHHGV

Indicators are considered negative when they have an inverse relationship (association,
correlation) with healthiness. The higher the indicator value, the worse is the state of
health of the people in the population being studied.

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$,'6DQGSURSRUWLRQRIWXEHUFXORVLVSDWLHQWVDEDQGRQLQJWUHDWPHQW

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XVHVRUDSSOLFDWLRQVDUH

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DWWHQWLRQDPRQJRWKHUIXQFWLRQV

• Forecast or prognosis+HDOWKLQGLFDWRUVFDQEHXVHGWRDQWLFLSDWHUHVXOWVZLWKUHJDUGWRWKH
VWDWHRIKHDOWKIRUHFDVWRIDSRSXODWLRQRUDJURXSRISDWLHQWVSURJQRVLV7KHVHLQGLFDWRUV
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SUHYHQWHSLGHPLFVRUKDOWWKHWHUULWRULDOVSUHDGRISDUWLFXODUKHDOWKSUREOHPV

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VXSSRUWLQDGGLWLRQWRLQWHUUHODWHGQHVVRIWKHVHGHWHUPLQDQWV

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9
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1.3 DISAGGREGATION OF DATA BASED ON PERSON, PLACE, AND TIME

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LQRUGHUWRLGHQWLI\JURXSVZLWKSULRULW\KHDOWKQHHGVDQGGHWHUPLQHZKHUHLQHTXLWLHVH[LVW,QDGGLWLRQ
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GLVHDVHVXVFHSWLELOLW\LQDSRSXODWLRQDQGWKHLQWURGXFWLRQRIQHZYLUXVVHURJURXSVRUVHURW\SHVH[KLELWLQJ
QHZEHKDYLRUVHWF

An attribute of most indicators is that they can be disaggregated by geographical

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socioeconomic status, ethnic origin etc.). Its sensitivity to changes over time, as these
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or public policy changes), is also a necessary attribute (2).

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Global and Regional Sub-region, country, sex. Global and regional goals

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1.4 DESIRABLE ATTRIBUTES OF A HEALTH INDICATOR

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SRSXODWLRQV(10; 18-21).

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SECTION 2

DEVELOPMENT AND MEASUREMENT OF HEALTH INDICATORS

Contents
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2.1 CONCEPTUAL CONSIDERATIONS: INDICATORS CATEGORIZED ACCORDING TO THEIR

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INDICATOR NUMERATOR DENOMINATOR VALUE OF THE INDICATOR

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2.1.3 DEFINITION OF THE MULTIPLICATIVE BASE USED TO DESCRIBE A POPULATION
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7KHJHQHUDOIRUPXODZLWKDPXOWLSOLFDWLYHEDVHLV

X n
y * 10

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GHDWK5HJLRQRIWKH$PHULFDV

PROPORTIONAL
ABSOLUTE MORTALITY RATEb
CHAPTER OF ICD-10 NUMBER (n)
MORTALITYa (PER 100
(PER 10,000 INHAB.)
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&DUGLRYDVFXODUGLVHDVHV,, 1,640,172  17.37

Neoplasms (C00-D48) 1,131,635 20.2 

'LVHDVHVRIWKHUHVSLUDWRU\WUDFW-- 571,686 10.2 6.06

([WHUQDOFDXVHV9< 538,463  5.70

(QGRFULQHQXWULWLRQDODQGPHWDEROLFGLVRUGHUV(( 336,623 6.0 3.57

'LJHVWLYHV\VWHPGLVHDVHV.. 273,047  

1HUYRXVV\VWHPGLVHDVHV** 213,173 3.8 2.26

,OOGHÀQHGGHDWKV55  3.4 2.04

,QIHFWLRXVDQGSDUDVLWLFGLVHDVHV$% 188,330 3.4 2.00

0HQWDODQGEHKDYLRUDOGLVRUGHUV)) 163,266  1.73

'LVHDVHVRIWKHJHQLWRXULQDU\V\VWHP11  2.7 

'LVHDVHVRULJLQDWLQJLQWKHSHULQDWDOSHULRG33 72,358 1.3 0.77

&RQJHQLWDOPDOIRUPDWLRQV44 41,787 0.7 0.44

'LVHDVHVRIWKHPXVFXORVNHOHWDOV\VWHP00 30,623 0.5 0.32

'LVHDVHVRIWKHEORRGDQGEORRGIRUPLQJRUJDQV'' 27,451 0.5 

6NLQDQGVXEFXWDQHRXVGLVHDVHV// 13,110 0.2 0.14

3UHJQDQF\FKLOGELUWKDQGSXHUSHULXP22  0.1 0.06

'LVHDVHVRIWKHHDUDQGPDVWRLGSURFHVV++ 266 0.0 0.00

'LVHDVHVRIWKHH\HDQGDGQH[D++ 137 0.0 0.00

Total 5,589,507 100.0 59.21

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2.2 INDICATORS CATEGORIZED ACCORDING TO THEIR MATHEMATICAL AND
EPIDEMIOLOGICAL INTERPRETATION

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PRVWFRPPRQO\XVHGWRGHVFULEHGLVHDVHVLQSXEOLFKHDOWK

2.2.1 INDICATORS BASED ON INCIDENT EVENTS

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IURPELUWKWRWHQ\HDUVROGLWFDQEHVDLGWKDWWKHPHDVXUHRILQFLGHQFHSURSRUWLRQLQWHQ\HDUVLVWKH
ULVNWKDWDQHZERUQFKLOGLQWKDWSRSXODWLRQZLOOGHYHORSDQDOOHUJ\EHIRUHWXUQLQJWHQ

23
Calculation method:7KHLQFLGHQFHUDWHLVFRPSXWHGDVIROORZV

Number of new cases occurring in place X in a given period of time

n
INCIDENCE = * 10
Number of new cases occurring in place X in a given period of time

2.2.2 INDICATORS BASED ON PREVALENT EVENTS

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HYHQWVVXFKDVSHULRGSUHYDOHQFHEXWWKH\DUHXQXVXDODQGDUHQRWFRYHUHGLQWKLVGRFXPHQW

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DQGZKRGRHVQRWDWDVSHFLȓFSRLQWLQWLPH+RZHYHULWGRHVQRWLQGLFDWHWKHULVNRIJHWWLQJWKHGLVHDVH
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SHUVRQLVK\SHUWHQVLYHLV

Calculation method:7KHSUHYDOHQFHUDWHLVFDOFXODWHGDVIROORZV

Number of existing cases in place X at a given time

n
PREVALENCE COEFFICIENT =
* 10
Number of existing cases in place X at a given time

24
2.2.3 RELATIONSHIP BETWEEN INCIDENCE RATE AND PREVALENCE RATE
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Prevalence = Incidence * t (average duration of the disease)

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RUFRQGLWLRQZDVRISURORQJHGGXUDWLRQDVIRUH[DPSOHGLVHDVHVWKDWEHFRPHFKURQLFDQGDUHLQFXUDEOH
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HYHQWZLOODOVRWHQGWRZDUG]HUR([DPSOHVRIWKLVLQFOXGHKXPDQUDELHVDQGGHDWKGXHWRDOOFDXVHV

2.2.4 USES OF PREVALENCE AND INCIDENCE INDICATORS

Incidence is essential for analyzing the occurrence of new events in populations and their
related factors. Prevalence is essential for planning and organizing existing resources and
services as well as for obtaining additional support, when necessary.

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ULVNIDFWRUV(4).

25
2.3 TYPES OF HEALTH INDICATORS

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2.3.1 MORBIDITY INDICATORS

Morbidity indicators are designed to measure the occurrence of diseases, injuries, and
disabilities in populations.

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26
 LQFLGHQWRUSUHYDOHQWFDVHVDQGFDQKLJKOLJKWDSSDUHQWEXWQRQUHDOFKDQJHVLQWUHQGVRI
WKRVHLQGLFDWRUV

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HUMAN IMMUNODEFICIENCY VIRUS (HIV) DIAGNOSIS RATE

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27
HYPERTENSION PREVALENCE RATE
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WKHQXPEHURISHUVRQVLQWKHSRSXODWLRQLQDVSHFLȓHGWLPH7KHUDWHFDQEHGLVDJJUHJDWHGE\
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PROPORTION OF HOSPITAL ADMISSIONS FOR EXTERNAL CAUSES

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28
2.3.2 MORTALITY INDICATORS

Mortality data are a fundamental source of demographic, geographic and cause-of-

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or monitor health priorities and goals.

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deaths age group (2)/(3)
(4)*(5) (WHO) inhabitants

(Years) (1) (2) (3) (4) (5) (6) (7)

0-4 184 72,777,507 0.0000025 100,000 0.252825 0.08 0.0202260

5-9 71  0.0000010 100,000   0.0084525

10-14 134  0.0000018 100,000 0.184521 0.0860 0.0158688

15-19 385  0.0000054 100,000 0.542245 0.0847 

20-24 627   100,000  0.0822 0.0777431

25-29 1,017  0.0000164 100,000 1.640377  

30-34 1,665  0.0000280 100,000  0.0761 0.2127384

35-39 2,617  0.0000446 100,000 4.460215 0.0715 

40-44 4,620  0.0000864 100,000   

45-49 7,671  0.0001646 100,000  0.0604 

50-54 12,272  0.0003180 100,000  0.0537 1.7074442

55-59 17,121 30,064,772  100,000  0.0455 

60-64 22,402 24,383,765  100,000  0.0372 

65-69 27,554 20,457,174  100,000   

70-74 32,172  0.0018426 100,000  0.0221 4.0722481

75-79   0.0024670 100,000 246.703213 0.0152 

80+ 56,820  0.0037582 100,000  0.01545 5.8064021

Total 220,316 795,462,684 0.0002770 100,000 27.696585 100.00 27.72

42
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REFERENCES

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SECTION 3

DATA SOURCES FOR DEVELOPING HEALTH INDICATORS

Contents
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46
3.1 DATA SOURCES

3.1.1 PRIMARY DATA SOURCES

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3.1.2 SECONDARY DATA SOURCES

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3.1.3 ADVANTAGES AND DISADVANTAGES OF PRIMARY AND SECONDARY DATA SOURCES

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SOURCES AND DATA

Characteristics Primary Secondary

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3.3 MAIN DATA SOURCES

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3.3.1 DEMOGRAPHIC CENSUSES

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EDVLFGHPRJUDSKLFIDFWRUVRIIHUWLOLW\PRUWDOLW\DQGPLJUDWLRQ(1).

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3.3.2 HEALTH INFORMATION SYSTEMS

1DWLRQDOKHDOWKLQIRUPDWLRQV\VWHPVSURYLGHGDWDIRUKHDOWKUHODWHGHYHQWVWKHVHV\VWHPVDOVRSURYLGH
VRPH FHQVXVUHODWHG GDWD  1DWLRQDO KHDOWK LQIRUPDWLRQ V\VWHPV FDQ KDYH VXEV\VWHPV WKDW DGGUHVV
VSHFLȓFKHDOWKHYHQWVWRLQFOXGHPRUWDOLW\ELUWKVQRWLȓDEOHGLVHDVHVFDQFHUDQGRWKHUGLVHDVHUHJLVWULHV

• Mortality information systems: $OORIWKHFRXQWULHVLQWKH5HJLRQRIWKH$PHULFDVDUHUHTXLUHG

WRUHSRUWDOOGHDWKV,QVRPHFRXQWULHVWKLVUHTXLUHVWKHFRPSOHWLRQDIRUPNQRZQDVWKH
ŮGHFODUDWLRQRIGHDWKůIROORZHGE\UHJLVWUDWLRQRIWKHHYHQWLQWKHFLYLOUHJLVWU\V\VWHPZKHUH
DGHDWKFHUWLȓFDWHDOHJDOGRFXPHQWLVLVVXHG:+2KDVHVWDEOLVKHGDQLQWHUQDWLRQDOIRUP

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EHLQFOXGHGLQDGHDWKFHUWLȓFDWH7KHVHLQFOXGHWKHXQGHUO\LQJLQWHUPHGLDWHDQGLPPHGLDWH
FDXVHVRIGHDWK0RVWFRXQWULHVXVHWKH,QWHUQDWLRQDO&ODVVLȓFDWLRQRI'LVHDVHV,&'(2)WRFRGH
WKHFDXVHVRIGHDWK7KLVSHUPLWVFRPSDULVRQVEHWZHHQFRXQWULHVDQGDWGLƮHUHQWSRLQWVLQWLPH
,QVRPHFRXQWULHVHVSHFLDOO\LQUHPRWHDUHDVWKHUHSRUWLQJRIGHDWKVLVLQFRPSOHWHWKHUHE\
FRPSURPLVLQJWKHUHSUHVHQWDWLYHQHVVRIPRUWDOLW\VWDWLVWLFV7KHSURSRUWLRQRIXQGHUUHSRUWLQJ
RIGHDWKVDQGWKHSURSRUWLRQRIGHDWKVGXHWRLOOGHȓQHGFDXVHVDUHLQGLFDWRUVRIWKHTXDOLW\RI
PRUWDOLW\VWDWLVWLFV(3-5).

• Birth registration systems:7KHVHDUHDVRXUFHIRUFHQVXVGDWDDQGIRUWKHFROOHFWLRQRIYLWDO

VWDWLVWLFV,QDOORIWKHFRXQWULHVLQWKH5HJLRQRIWKH$PHULFDVLWLVFRPSXOVRU\IRUHYHU\OLYHELUWK
WREHUHSRUWHG,QPRVWRIWKHVHFRXQWULHVELUWKVRFFXULQKHDOWKIDFLOLWLHVZKHUHDIRUPNQRZQ
DVWKHŮGHFODUDWLRQRIOLYHELUWKůLVLVVXHG6XEVHTXHQWO\WKHELUWKPXVWEHUHFRUGHGLQWKHFLYLO
UHJLVWU\ZKHUHDELUWKFHUWLȓFDWHDOHJDOGRFXPHQWLVLVVXHG'HFODUDWLRQVRIELUWKVJHQHUDWHGDWD
IRUIRUPXODWLQJLQGLFDWRUVWKDWDUHKLJKO\XVHIXOLQPRQLWRULQJPDWHUQDODQGFKLOGKHDOWKGXULQJ
WKHSUHQDWDOGHOLYHU\DQGSHULQDWDOSHULRGVZKLOHDOVRSURYLGLQJLQIRUPDWLRQRQDSRSXODWLRQŬV
IHUWLOLW\SURȓOH6WDQGDUGL]LQJGHȓQLWLRQVIRUPVDQGYDULDEOHVRILQWHUHVWIDFLOLWDWHFRPSDULVRQV
EHWZHHQFRXQWULHVDQGRYHUWLPH7KHPDLQOLPLWDWLRQLQZRUNLQJZLWKELUWKLQGLFDWRUVLVWKHIDFW
WKDWFRYHUDJHPD\EHLQFRPSOHWHSDUWLFXODUO\LQUHPRWHDUHDVZLWKLQFHUWDLQFRXQWULHVWKHUHE\
FRPSURPLVLQJWKHUHSUHVHQWDWLYHQHVVRIWKHUHVXOWLQJVWDWLVWLFV7KHSURSRUWLRQRIXQUHJLVWHUHG
ELUWKVDQGRILQFRPSOHWHLQIRUPDWLRQRQLPSRUWDQWYDULDEOHVDUHLQGLFDWRUVRIWKHTXDOLW\RIELUWK
UHJLVWUDWLRQ(6).

These two systems are sources of data to develop indicators. Information systems
that include vital statistics, especially on mortality and births, have many strengths to
include: (1) a high level of sustainability since all countries have legislation mandating
the collection of vital statistics; (2) continuous periodicity as data are prepared
continually, as occurrences are recorded; and (3) a high level of representativeness in
QHDUO\DOORIWKH5HJLRQZLWKVSHFLȐFSUREOHPVLQVRPHDUHDVGXHWRXQGHUUHSRUWLQJ

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0RVW RI WKH 5HJLRQŬV FRXQWULHV KDYH QDWLRQDO VXUYHLOODQFH V\VWHPV HVWDEOLVKHG E\ WKHLU
PLQLVWULHVRIKHDOWK7KHVHGLƮHUKRZHYHUIURPFRXQWU\WRFRXQWU\ZLWKUHJDUGWRWKHQXPEHU
RI GLVHDVHV XQGHU VXUYHLOODQFH WKH W\SH RI LQIRUPDWLRQ FRPSLOHG WKH XVH RI HOHFWURQLF RU
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HQYLURQPHQW7KHVHUHJLVWULHVFRPSLOHLQIRUPDWLRQRQDOOFDVHVRIWKHVHGLVHDVHVWKURXJKWKH
KHDOWKFDUHQHWZRUNRUWKURXJKVHQWLQHOVXUYHLOODQFHXQLWV6XFKV\VWHPVDUHDVRXUFHRIGDWDRQ
PRUELGLW\LQGLFDWRUVWKDWDUHXVHIXOLQGLVHDVHSUHYHQWLRQDQGFRQWUROHƮRUWV(8).

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LQGLFDWRUV LQFOXGH D UHSUHVHQWDWLYHQHVV DOWKRXJK WKHUH FDQ EH YDULDWLRQV EDVHG
RQWKHFKDUDFWHULVWLFVRIWKHFRXQWU\ŬVV\VWHPEDKLJKOHYHORIVXVWDLQDELOLW\IRU
PRQLWRULQJWKHGLVHDVHVWKDWDUHVXEMHFWWRUHJXODWLRQDQGRUOHJLVODWLRQDQGFKLJK
SHULRGLFLW\DVGDWDDUHFRPSLOHGFRQWLQXRXVO\

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KHDOWK FRQGLWLRQ LV XVXDOO\ HVWLPDWHG LW LV LPSRVVLEOH WR PHDVXUH SUHFLVHO\ LWV
UHSUHVHQWDWLYHQHVV

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ZHUHHVVHQWLDOLQIRUPXODWLQJVWUDWHJLHVWRFRQWURODQGHOLPLQDWHYDFFLQHSUHYHQWDEOHGLVHDVHV
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LQWHUUXSWHGWKHHQGHPLFWUDQVPLVVLRQRIPHDVOHVDQGUXEHOOD

• Population-based cancer registries:7KHVHDUHWKHJROGVWDQGDUGIRUSURYLGLQJLQIRUPDWLRQRQ

WKLVGLVHDVH&DQFHUUHJLVWULHVFRPSLOHFODVVLI\DQDO\]HDQGUHSRUWLQIRUPDWLRQRQDOOFDQFHUV
RFFXUULQJLQDJHRJUDSKLFDOO\GHȓQHGSRSXODWLRQ7KHLQIRUPDWLRQLVFROOHFWHGIURPDPXOWLSOLFLW\
RIVRXUFHVLQFOXGLQJKRVSLWDOVFOLQLFDODQDO\VLVODERUDWRULHVDQGGHSDUWPHQWVRIYLWDOVWDWLVWLFV
5RXWLQHFDOFXODWLRQRIUDWHVSHULQKDELWDQWVSURGXFHGE\SRSXODWLRQEDVHGFDQFHU
UHJLVWULHVSURYLGHVLQIRUPDWLRQWKDWFDQDVVLVWSXEOLFKHDOWKRƱFLDOVWREHWWHUXQGHUVWDQGWKH
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DVZHOODVSURYLGHLQSXWIRUUHVHDUFK

3.3.3 ROUTINE DATA FROM HEALTH FACILITIES

$VSDUWRIWKHLUQRUPDODFWLYLWLHVKHDOWKIDFLOLWLHVJHQHUDWHKLJKO\XVHIXOGDWDRQWKHGHOLYHU\RIVHUYLFHV
KRVSLWDOL]DWLRQVFRQVXOWDWLRQVVXUJHULHVLQVHUWLRQRISURVWKHVHVHWFFRYHUDJHRIKHDOWKLQWHUYHQWLRQV
UHVRXUFHVQXPEHURISK\VLFLDQVQXUVHVDQGEHGVQXPEHURIYDFFLQHVJLYHQKHDOWKVHFWRUH[SHQGLWXUHV
HWFDQGGLVHDVHSDWWHUQV)RUDQXPEHURILQGLFDWRUVŪVXFKDVDFFHVVWRKHDOWKVHUYLFHVDQGWKHFHVDUHDQ
VHFWLRQ UDWHŪGDWD IURP KHDOWK IDFLOLWLHV DUH WKH VROH VRXUFH 0RUHRYHU KHDOWK IDFLOLWLHV DUH LPSRUWDQW

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GHFLVLRQV

Unlike household surveys, data from health facilities are produced continuously, and
can generate reports annually, or more frequently, as necessary.

:LWKLQ WKH 5HJLRQ SDUWLFXODUO\ LQ WKH &DULEEHDQ WKH FRXQWULHV KDYH VKRZQ DQ LQFUHDVLQJ LQWHUHVW LQ
LPSOHPHQWLQJQDWLRQDOLQIRUPDWLRQV\VWHPVRQKRVSLWDOL]DWLRQVDPEXODWRU\DQGHPHUJHQF\VHUYLFHVDQG
LQWKHXVHRIHOHFWURQLFPHGLFDOUHFRUGV6RPHFRXQWULHVVXFKDV%HOL]HDQG'RPLQLFDKDYHPDGHPDMRU
LQYHVWPHQWVLQWKHVHDUHDV

6LQFHWKHVHGDWDVRXUFHVWHQGEHFUHDWHGIRUDGPLQLVWUDWLYHSXUSRVHVUDWKHUWKDQIRUPRQLWRULQJRIKHDOWK
HYHQWVSHUVHWKHHSLGHPLRORJLFDOGDWDWKH\JHQHUDWHPD\KDYHELDVHVWKDWDƮHFWWKHLUFRYHUDJHTXDOLW\
DQG XVHIXOQHVV ,Q VRPH RI WKH FRXQWULHV WKHVH V\VWHPV DUH IUDJPHQWHG DQG LQIRUPDWLRQ H[FKDQJH
EHWZHHQWKHSXEOLFDQGSULYDWHVHFWRUVLVGLƱFXOWOHDGLQJWRODWHLQFRPSOHWHDQGRULQFRUUHFWUHSRUWV
'HVSLWHWKHVHFKDOOHQJHVWKHUHLVUHDVRQIRURSWLPLVPJLYHQWKHJURZLQJLQWURGXFWLRQRIQHZLQIRUPDWLRQ
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XVHRIGDWDIRUGHFLVLRQPDNLQJ(9).

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FDQEHGLVWRUWHGLIWKHLQIRUPDWLRQRQGHDWKVPLJUDWLRQW\SHRIWUDLQLQJDQGFXUUHQWRFFXSDWLRQHWFDUH
QRWSHULRGLFDOO\XSGDWHG

3.3.4 POPULATION SURVEYS

A national health survey is a descriptive cross-sectional epidemiological study that is

useful for calculating the prevalence of self-reported events, or events measured in the
course of the investigation, generally employing a representative (probabilistically
chosen) sample from the population of interest.

56
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SECTION 4

PROCESS TO EVALUATE THE QUALITY OF DATA AND HEALTH INDICATORS

Contents
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Examples:
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4.3 KEY STAKEHOLDERS IN THE PROCESS OF EVALUATING HEALTH INDICATORS

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ILUVWSKDVHRIWKHHYDOXDWLRQSURFHVV'DWDSURGXFHUVPDQDJHUVDQGXVHUVVKRXOGSURPRWHDFXOWXUHWKDW
YDOXHVLQIRUPDWLRQDQGLVFRQGXFLYHWRGDWDFROOHFWLRQDQGLWVPDQDJHPHQW2QJRLQJWUDLQLQJLQLWLDWLYHVRQ
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HVSHFLDOO\DWWKHORFDOOHYHO

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DQ\OLPLWDWLRQLQKHUHQWLQWKHVHV\VWHPV

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4.4 STEPS FOR EVALUATING THE QUALITY OF HEALTH INDICATORS

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DUHVRPHIXQGDPHQWDOFRQVLGHUDWLRQVWKDWFDQEHDSSOLHGZKHQHYDOXDWLQJKHDOWKLQGLFDWRUVDQGWKHVH
DUHRXWOLQHGLQWKHIROORZLQJVWHSV

Step 1. Examine the integrity of the complete and valid data on which the indicator is based
a. Is the indicator based on data representative of the target population?([DPLQHLQGHWDLOWKHSRSXODWLRQ
WKHGDWDLVVXSSRVHGWRGHVFULEH$YRLGXQGXHJHQHUDOL]DWLRQVH[WUDSRODWLRQV%HDOHUWWRSRVVLEOH
VHOHFWLRQELDVGXHWRQRQUHVSRQVHGHPDQGDQGLQGLFDWLRQELDVHVDVFHUWDLQZKHWKHUVRPHIDFLOLWLHV
JHQHUDWHPRUHUHSRUWVWKDQRWKHUVHJSXEOLFYHUVXVSULYDWHIDFLOLWLHV

E Are the variables used to calculate the indicator complete, adequate, and sufficient? &DOFXODWH DQG
WDEXODWH WKH FKDUDFWHULVWLFV RI WKH YDULDEOHV XVHG WR GHYHORS WKH LQGLFDWRU ,QFOXGH SURSRUWLRQV RI
QRQUHVSRQVHLISRVVLEOHLQYDOLGUHVSRQVHVDQGRWKHUORVVHV,GHQWLI\SUREOHPVLQFRYHUDJHRIWKH
UHOHYDQWYDULDEOHVWDNLQJLQWRDFFRXQWORZUHSUHVHQWDWLYHQHVVSRVVLEOHVHOHFWLRQELDVLQDQLQGLFDWRU
DQGFDOFXODWLRQVEDVHGRQQRQUHSUHVHQWDWLYHGDWD

c. Is the indicator based on valid data from the target population?:HUHWKHYDULDEOHVXVHGWRFDOFXODWH

WKHLQGLFDWRUPHDVXUHGFRUUHFWO\DQGZDVDPLQLPXPVWDQGDUGDSSOLHG"$QDO\]HLQGHWDLOKRZWKH

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EDVHGRQSUREOHPDWLFFDOFXODWLRQV

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Step 2. Examine the consistency of the estimated indicator with regard to personal attributes

,V WKH LQGLFDWRU FRQVLVWHQW EDVHG RQ SHUVRQDO FKDUDFWHULVWLFV" $QDO\]H FRQVLVWHQF\ FRQVLGHULQJ WKH
SHUVRQDOYDULDEOHVVH[DJHHWFRIWKHGDWDVRXUFHFDWHJRU\E\FDWHJRU\DVUHOHYDQWWRWKHLQGLFDWRULQ
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SODXVLEOH$UHWKHUHVXOWVFRQVLVWHQWZLWKH[SHFWDWLRQVIRUWKHJLYHQSRSXODWLRQVXEJURXSV"

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LQGLFDWRUE\VH[DQGWKHDJHVKRXOGDWDPLQLPXPUHIOHFWWKHJUHDWHUULVNDVVRFLDWHGZLWKFHUWDLQJURXSV
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66
Step 3. Examine the consistency of the estimated indicator with regard to place attributes
Is the indicator spatially consistent?,ISRVVLEOHDQDO\]HLWVVSDWLDOGLVWULEXWLRQE\PXQLFLSDOLW\VWDWH
XUEDQ YHUVXV UXUDO UHVLGHQFH HWF 0RVW LQGLFDWRUV KDYH DQ H[SHFWHG VSDWLDO SDWWHUQ WKDW UHIOHFWV WKH
NQRZQGLVWULEXWLRQRILPSRUWDQWULVNIDFWRUVHJSRYHUW\\RXQJYHUVXVROGHUSRSXODWLRQVPRUHRUOHVV
XUEDQL]HGDUHDVHWF([DPLQHWKHFRQVLVWHQF\RIWKHLQGLFDWRUŬVSDWWHUQZLWKUHJDUGWRH[SHFWDWLRQVDQG
LGHQWLI\VLJQVVXJJHVWLQJWKDWWKHTXDOLW\LVXQUHOLDEOH

7DEOHSUHVHQWVDYHUDJHYDOXHVRIVHOHFWHGLQGLFDWRUVIRUVXEUHJLRQVRIWKH$PHULFDV7KHVHYDOXHVFDQ
EHXVHGDVDUHIHUHQFHWRDVVHVVWKHFRQVLVWHQF\RILQGLFDWRUVLQWKHFRXQWULHV$WWKHHQGRIWKLVVHFWLRQ
WKHUHLVDOLQNWR3$+2ŬVOLVWRIFRUHLQGLFDWRUVDQGWKHLUWUHQGV

7DEOH6HOHFWHGLQGLFDWRUVRIWKH5HJLRQRIWKH$PHULFDVDQGLWVVXEUHJLRQV

NON-LA-
CENTRAL LATIN SOU-
THE NORTH LATIN ANDEAN TIN
INDICATORS YEAR AMERICAN CARIB- THERN
AMERICAS AMERICA AMERICA AREA CARIB-
ISTHMUS BEAN CONE
BEAN

Life expectancy at birth (years) 2016 77.0  75.5 74.4 73.4 74.4 77.8 73.8

Maternal mortality rate reported/100 000 lb UAD* 46.8 12.1 60.8 80.2 104.4 77.3 35.2 88.8

Maternal mortality rate estimated/100 000 lb 2015 51 13 66 87 188 87 54 105

Infant mortality rate reported/100 000 lb LAY* 13.0   17.5 32.8 18.7 10.3 17.2

Neonatal mortality rate reported/100 000 lb LAY* 8.2 4.0 10.0   12.0 7.1 15.8

Under-five mortality rate reported/100 000 lb LAY*    22.2    

General mortality rate/1 000 pop 2014 5.6 4.8 6.0 6.7 5.8 6.3 5.5 7.2

Mortality rate due to external causes/100 000 pop 2014 63.5 53.3 68.8 81.1 61.4 87.7 46.6 70.3

HIV incidence rate/100 000 pop 2015  13.1 12.3 12.4 18.0 18.2 15.3 56.8

Tuberculosis incidencie rate/100 000 pop 2014 22.1 3.0 33.2 28.4 58.8 45.3 20.8 

Stunting in children aged < 5 years (%) 2012 10.1 2.1 13.2 30.2 13.1 16.5 7.1 

Overweight in children aged < 5 years (%) 2012 7.2 6.0 7.7 5.4 7.7 6.6 10.0 6.6
Overweight in adults 2014 61.0 67.0 57.6 54.0 51.2 57.6 60.8 

/$< /DWHVWDYDLODEOH\HDU
Source: 3$+2&RUHLQGLFDWRUV+HDOWK6LWXDWLRQLQWKH$PHULFDV

67
Step 4. Examine the consistency of the estimated indicator with regard to temporal attributes

Is the indicator consistent over time?,ISRVVLEOHDQDO\]HLWVWUHQGVRYHUWLPH\HDUVPRQWKVZHHNVHWF

6RPHLQGLFDWRUVKDYHDNQRZQVHDVRQDOF\FOLFSDWWHUQRIYDULDWLRQRUWKH\LQGLFDWHKLVWRULFDOWUHQGVWKDW
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WUHQGVVXFKDVVOLJKWO\LQFUHDVLQJRUGHFUHDVLQJEXWQRODUJHLQFUHDVHVH[FHSWLQVSHFLDOVLWXDWLRQV0DMRU
WHPSRUDOIOXFWXDWLRQVFDQLQGLFDWH

, 7UXHIOXFWXDWLRQVGXHWRHSLGHPLFVGUDPDWLFHYHQWVWKDWDOWHUDQLQGLFDWRUŬVFRXUVH$QH[DPSOH

ZRXOGEHWKHXQXVXDOLQFUHDVHRIPLFURFHSKDO\FDVHVDVVRFLDWHGZLWKWKH=LNDYLUXVHSLGHPLFLQ
FLWLHVRIQRUWKHDVWHUQ%UD]LO
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HDFKRWKHUFDQDOVREHFRPELQHG7KHVHDGMXVWPHQWVPDNHWKHLQGLFDWRUVWDEOHHQRXJKWREH
PHDQLQJIXO
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H[DPSOHVRIWKLVSKHQRPHQRQDUHFKDQJHVLQWKHGHILQLWLRQRIFDVHVZLWKWKHLQWURGXFWLRQRIQHZ
GLDJQRVWLFWHFKQLTXHVLQVXUYHLOODQFHV\VWHPVXQGHURURYHUFRXQWLQJRIFDVHVEHJLQQLQJDWD
SDUWLFXODUSRLQWLQWLPHDQGSUREOHPVZLWKWKHPHWKRGVXVHGWRHVWLPDWHWKHSRSXODWLRQVL]H
EHWZHHQFHQVXVHVGHQRPLQDWRUV$VLQGLFDWHGDERYHFRPPXQLFDWLRQDQGSDUWQHUVKLSZLWKWKH
SURGXFHUVRIWKHGDWDRQZKLFKWKHLQGLFDWRUZDVEDVHGFDQEHKHOSIXOWRSURYLGHFODULILFDWLRQ
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Step 5. Examine the plausibility of the magnitude of the indicator in relation to other data sources

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WKHUHVXOWRIWKHPHDVXUHPHQWRIWKHLQGLFDWRUSODXVLEOHFRQVLGHULQJZKDWLVDOUHDG\NQRZQDERXWWKH
VXEMHFW" ,V LW SODXVLEOH FRQVLGHULQJ HVWLPDWHV PDGH E\ RWKHU PHWKRGV LQGLUHFW PHWKRGV UHVHDUFK RU

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KDYHEHWWHUKHDOWKFDUHFDQKHOSFODULI\WKHSHUFHLYHGGLVSDULW\

4.5 EVALUATION OF MORTALITY DATA

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 3UHSDUHEDVLFWDEXODWLRQVRIGHDWKVE\DJHVH[HWKQLFRULJLQDQGFDXVHRIGHDWK
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diseases
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REFERENCES
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70
SECTION 5

INDICATORS ESTIMATED BY INDIRECT METHODS: BASIC CONCEPTS, USES,

AND LIMITATIONS

Contents
(VWLPDWLRQRIWKHLQGLFDWRUVPRVWFRPPRQO\XVHGLQSXEOLFKHDOWK

Objective
7RJDLQIDPLOLDULW\ZLWKHVWLPDWHVRIWKHPRVWFRPPRQKHDOWKLQGLFDWRUVWKHLUXVHVDQGOLPLWDWLRQV

$ȒHUUHDGLQJWKLVVHFWLRQWKHUHDGHUZLOOEHDEOHWRGHȓQH
• :KDWLWPHDQVWRHVWLPDWHDQLQGLFDWRU
• 0DLQUHDVRQVIRUXVLQJHVWLPDWHV

5.1 METHODS FOR INDICATOR ESTIMATION

$QHVWLPDWHLVDQDSSUR[LPDWHYDOXHFDOFXODWHGRQWKHEDVLVRIWKHLQFRPSOHWHHYLGHQFHRUDYDLODEOHGDWD

In statistics and demography, estimating means determining or calculating the value

of something, with a certain margin of imprecision, when the thing being examined is
not known in its entirety.

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71
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ANNEX
File for describing indicatorsʈ
Name of indicator Include the name of the indicator.

Definition of indicator 'HVFULEHKRZWKHLQGLFDWRULVIRUPXODWHGLQFOXGLQJNH\SDUDPHWHUV

Purpose of indicator ,QGLFDWHZK\LWLVLPSRUWDQWWRXVHWKHSURSRVHGLQGLFDWRUDQGRULWVSDUDPHWHUV

Interpretation 'HVFULEHWKHFRQWH[WZKHQQHFHVVDU\WKHLQGLFDWRU·VVLJQLILFDQFHDQGZKDWLWPHDVXUHV

Uses 'HVFULEHWKHLQGLFDWRU·VPDLQXVHVIRUSXEOLFKHDOWKSXUSRVHV

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Calculation method
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Type of indicator ,QGLFDWHZKHWKHUWKHPHDVXUHPHQWRIWKHLQGLFDWRULVDQDEVROXWHQXPEHUDSURSRUWLRQDUDWHHWF

Unit of measurement Specify the units of measurement used for the indicator.

Frequency of measure-
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ment
Area of reference ,QGLFDWHWKHFRXQWU\RUJHRJUDSKLFDUHDWRZKLFKWKHLQGLFDWRUUHIHUV

Reference period 6SHFLI\WKHWLPHSHULRGRUSRLQWLQWLPHWRZKLFKWKHLQGLFDWRUUHIHUV

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Disaggregation to the interpretation of the data. Analytical categories: sex, age group, ethnic origin, and geographic area
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Data source ,GHQWLI\WKHVRXUFHRIWKHLQGLFDWRU·VGDWD6SHFLI\PDLQGDWDVRXUFHZKHUHDSSOLFDEOH

Limitations 6SHFLI\WKHFKDOOHQJHVRUFRQVWUDLQWVLQWKHLQGLFDWRU·VPHDVXUHPHQWXVHDQGLQWHUSUHWDWLRQ

Institution responsible Include the name of the entity or unit responsible for generating, reporting, and monitoring the indicator.

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Technical notes
interpretation.

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Code and name of 5,7´$17,5(7529,5$/7+(5$3<&29(5$*($57µ
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eligible populations.

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indicator DPRQJSHRSOHZKRPHHWFULWHULDIRUWUHDWPHQWLVGHILQHGLQWHUQDWLRQDOO\DVXQLYHUVDODFFHVV

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Baseline 2013: 6 countries

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Purpose of the 7KH SURSRVHG LQGLFDWRU LV GHVLJQHG WR PRQLWRU DFFHVV WR DQWLUHWURYLUDO WKHUDS\ D NH\ HOHPHQW
indicator LQ RQJRLQJ SUHYHQWLRQ WUHDWPHQW DQG FDUH WKDW KDV D VWURQJ LPSDFW RQ SXEOLF KHDOWK RXWFRPHV
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Unit of Calculation at the national level:

measurement )RUFDOFXODWLRQDWWKHFRXQWU\OHYHOWKHQXPHUDWRULVWKHQXPEHURISHRSOHZKRUHFHLYHDQWLUHWURYLUDO
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WKHQXPEHURISHRSOHZKRQHHGDQWLUHWURYLUDOWKHUDS\7KHFRXQWU\GHQRPLQDWRUVDUHJHQHUDWHGXVLQJ
PHWKRGRORJLHVDQGVWDQGDUGL]HGVWDWLVWLFDOPRGHOLQJLQVWUXPHQWVDQGDUHSURYLGHGE\81$,'6

Calculation at the regional level:

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E\FRXQWLQJWKHQXPEHURIFRXQWULHVDQGWHUULWRULHVZLWKFRYHUDJHRIRUPRUH

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QDWLRQDOOHYHOGDWDFROOHFWLRQLVFRQWLQXRXVZLWKFDOFXODWLRQRIFRXQWU\FRYHUDJHVFRQGXFWHGDW\HDU
end.
Type of indicator Absolute

Unit of Number of countries and territories.

measurement
Frequency of Annual, at year end.
measurement
Unit of the PASB +,9KHSDWLWLVWXEHUFXORVLVDQGVH[XDOO\WUDQVPLWWHGLQIHFWLRQV&+$+7
responsible for
monitoring the
indicator
Data source 81$,'6:+2FRXQWU\UHSRUWVRQXQLYHUVDODFFHVVDQGUHSRUWVRQSURJUHVVLQWKHJOREDOUHVSRQVH
to AIDS.

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some countries, including the small island states, UNAIDS does not generate denominators.

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account.

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References +,9&RQWLQXXPRI&DUH0RQLWRULQJ)UDPHZRUN$GGHQGXPWRPHHWLQJUHSRUW5HJLRQDOFRQVXOWDWLRQ
on HIV epedimiologic information in Latin America and the Caribbean. Pan American Health
Organization, 2014.

82