Global Indicators: Metadata Indicator name 1. Proportion of countries aligned with WHO global strategy on Proportion of countries whose national health policies strategies and plans are aligned with the WHO global strategy on with evidence documenting (b) implementation plan; (c) accountability mechanism (mode of documentation to be decided by individual Member States) All strategies Number of countries whose national health policies strategies and plans are aligned with the WHO global strategy on with evidence documenting (b) implementation plan; (c) accountability mechanism Denominator All member states Monitoring and assessment of global progress towards integrated, peoplecentred care. Does not take into account how income-setting or development of health system may affect implementation of framework. No countries currently reporting Reporting through WHO mechanisms, survey Novel, aligned with WHO EURO regional indicator for Health 2020 strategy
2. Community linkages Percentages of facilities with formal systems for linking services with community health workers (CHWs), for any services Empowering and engaging people and communities/ Empowering and engaging communities : Number of facilities with formal systems for linking services with community health workers, for any services Denominator: Total number of health facilities Formal linkages between facilities and community teams enables continuity and people-centred care. Indicator could be subject to reporting bias, i.e. formal system is not defined. Also, indicator does not evaluate the quality or effectiveness of the systems identified. SDI, PEPFAR-SIMS, MDGI (MNCH), UNICEF (MNCH) Facility assessment Health Facility Assessments indicators and methods (Aug 2016)
3. Equity mainstreamed in health policy Number of countries integrating inequality monitoring in health information systems to inform policies and plans, and monitor SDGs progress Empowering and engaging people and communities/reaching underserved and marginalized populations : Number of countries responding affirmatively to survey question on inequality monitoring Denominator: Total number of countries responding Equality monitoring a necessary step to formulating policies and plans to address inequities. Does not evaluate impact of policies and plans Mid 2017- WHO Survey WHO Survey WHO Survey, data collection starting Mid- 2017
4. Composite coverage index (Equity) The composite coverage index is a weighted score reflecting coverage of eight RMNCH interventions along the continuum of care: demand for family planning satisfied; antenatal care coverage (at least one visit); births attended by skilled health personnel; BCG immunization coverage among one-year-olds; measles immunization coverage among one-year-olds; DTP3 immunization coverage among one-year-olds; children aged less than five years with diarrhoea receiving oral rehydration therapy and continued feeding; and children aged less than five years with pneumonia symptoms taken to a health facility. This indicator is based on aggregate estimates. Empowering and engaging people and communities/ Reaching the underserved and marginalized % Coverage disaggregated by Data are derived from re-analysis of Demographic and Health Surveys (DHS) micro-data which are publicly available using the standard indicator definitions as published in DHS documentation. The analysis was done by the International Center for Analysis and Monitoring of Equity in Health and Nutrition based in the Federal University of Pelotas, Brazil. Disaggregation Education level Wealth: Wealth quintile Location (urban/rural) Geographic Location Composite measure of equity Limited to RMNCH spectrum of health needs. Approx. 50 countries Population Survey, DHS/MICS Health Equity Assessment Toolkit (HEAT) https://whoequity.shinyapps.io/heat/
5. Service-specific availability and readiness Percentage of facilities that offer and meet tracer criteria for specific services Reorienting the model of care/ Defining service priorities based on life course needs : Number of facilities that offer and meet tracer criteria for specific services Denominator: Total number of health facilities and total number of facilities offering specific services Readiness is an essential component of an effective health system. Indicator allows comparison of facility level service-specific readiness. Does not identify reasons for differences in service specific availability and readiness (i.e. disease burden, population characteristics) 19 current countries, anticipate addition of 17 additional countries 2017-2018 Facility assessment Global 100 Core Indicators, SARA, SPA
6. Access to palliative care Consumption of morphine-equivalent strong opioid analgesics (excluding methadone) per death from cancer in a given time period Reorienting the model of care/ Defining service priorities based on life course needs : Consumption of morphine equivalent strong opioid analgesics per death from cancer in a given time period Denominator: All cancer deaths in a given time period Access to palliative care is an essential component of an effective health system. Consumption of opioids is a proxy indicator for pain control in end of life cancer care. A marker of quality of care. Limited scope - access to palliative care confined only to consumption of opioids. Does not account for palliative care needs for opiates outside of cancer HIV (6%), Progressive non-malignant diseases (66%) Consumption of opioid not defined. >100 countries Survey Global 100 Core Indicators, International Narcotics Control Board, WHO Global Atlas on Palliative Care At the End of Life
7. UHC Service Coverage Index Indicator Name UHC Service Coverage Index Weighted average of 14 tracer indicators across four service coverage categories (Reproductive newborn maternal child health, infectious disease, non-communicable disease, and service capacity and access). Effective coverage, which captures the extent to which those in need of health services receive quality care that obtains the desired result, was the guiding principle for choosing tracer indicators. Strategy/Strategi c Reorienting the model of care/ (1) Defining service priorities based on life course needs Tracer indicators include: Family planning coverage, pregnancy care, Immunization coverage, care seeking for pneumonia, TB cases detected and treated, HIV ART coverage, insecticide treated bed net use (in countries with endemic malaria), improved water and sanitation, prevalence of HTN, prevalence of diabetes, non-use of tobacco, inpatient admission rate, health worker density, access to essential medicines, IHR core capacity index http://www.who.int/healthinfo/universal_health_coverage/uhc_whs2016_technic alnote_may2016.pdf?ua=1 Countries provide a wide range of services for health protection, promotion, prevention, treatment and care, but it is possible to define a set of tracer indicators that provide a good picture of overall service coverage. These tracer indicators can then be combined in a systematic way into an index that summarizes national service coverage with a single numerical value. NCD indicators limited to prevalence, which does not reflect specific service coverage, but often the broader public health. 40-193 countries (availability of data varies with indicators) Various UHC Data Portal; UHC technical note http://www.who.int/healthinfo/universal_health_coverage/uhc_whs2016_technical Note_May2016.pdf?ua=1
8. Percentage of countries with national health technology assessment unit Percentage of countries with national health technology assessment unit based on national level survey Reorienting the model of care/ Defining service priorities based on life course needs : Number of countries with national health technology assessment unit Denominator: total number of countries surveyed Health technology assessment helpful for prioritization, resource allocation, appropriate procurement, and utilization guidance. Does not indicate if HTA mechanisms influence policies on procurement, utilization, etc. Approx. 170 countries Survey Global atlas of medical devices 2014 update
9. Percentage of countries that spend at least 5% of GDP on health and allocate at least 30% of THE to primary care Percentage of countries that spend at least 6% of GDP on health and allocate at least 30% of THE to primary care Reorienting the model of care/ Building strong primary care-based systems : Countries that spend at least 5% of GDP on health and allocate at least 30% of THE to primary care Denominator: All countries Adequate resourcing is essential to promote strong PHC systems. System of Health Accounts is limited in the way expenditures are categorized (by location and type of service) rather than provider type or function Variable methodologies for calculating PHC/PC expenditure between OECD and WHO (LMIC) for 5% GDP and 30% PHC, based upon global commitments and expert opinion respectively. 55 countries (OECD + 30 LMIC) SHA 2011 SHA2011, PHCPI, OECD
10. Ambulatory service utilisation** Strategic Direction Number of outpatient visits per person per year Reorienting the model of care/ Shifting towards more outpatient and ambulatory care : Total number of outpatient department visits per person per year. Denominator: Total population Allows comparison of access to outpatient services. Provides insight into orientation of health system. Population characteristics may affect utilisation (i.e. conflict settings versus stable population). 36 OECD, high income countries RHMIS, Population based health surveys Global 100 Core Indicators, OECD ** Could be included in a potential service utilization ratio
11. Hospital discharge rates** An inpatient discharge is the release of a patient who was formally admitted into a hospital for treatment and/or care and who stayed for a minimum of one night (see definition for hospital inpatient discharges below). Only the total number of inpatient discharges in all hospitals is requested (no breakdown by diagnostic categories). Reorienting the model of care/ Shifting towards more outpatient and ambulatory care : Number of hospital discharges Denominator: Population Calculation: N/D * 100,000 Indicator of health system performance and quality of care. Readmissions associated with increased costs and poor patient outcomes. Does not account for other important utilization characteristics such as length of stay, reason for admission, bed occupancy, etc. No direct conclusions can be drawn about appropriateness of care. 105 countries RHMIS, Population based health surveys Global 100 Core Indicators ** Could be included in a potential service utilization ratio
12. Access to palliative care at community or PHC level Indicator Name Availability of PHC or community based palliative care General availability of palliative care in community or home-based care, or primary health care in the public health system Reorienting the model of care/ (1) Defining service priorities based on life course needs/(2) Shifting towards more outpatient and ambulatory care : Countries who have a yes for this indicator responded "generally available" to the question "Indicate the availability of palliative care for patients with NCD in the public health system: in primary health care" or "Indicate the availability of palliative care for patients with NCD in the public health system: in community or home-based care". Denominator: All respondent countries Access to palliative care is an essential component of an effective health system. Palliative care provided in other service delivery settings not included 194 countries Facility assessment Global Atlas of Palliative Care http://www.thewhpca.org/resources/global-atlas-on-end-of-life-care
13. Access to integrated palliative care Indicator Name Availability of integrated palliative care 4a) Countries where hospice-palliative care services are at a stage of preliminary integration into mainstream service provision. This group of countries is characterised by: the development of a critical mass of palliative care activism in a number of locations; a variety of palliative care providers and types of services; awareness of palliative care on the part of health professionals and local communities; the availability of morphine and some other strong pain-relieving medicines; limited impact of palliative care upon policy; the provision of a substantial number of training and education initiatives by a range of organisations; and interest in the concept of a national palliative care association. 4b) Countries where hospice-palliative care services are at a stage of advanced integration into mainstream service provision. This group of countries is characterised by: the development of a critical mass of palliative care activism in a wide range of locations; comprehensive provision of all types of palliative care by multiple service providers; broad awareness of palliative care on the part of health professionals, local communities and society in general; unrestricted availability of morphine and all other strong pain-relieving medicines; substantial impact of palliative care upon policy, in particular upon public health policy; the development of recognised education centres; academic links forged with universities Reorienting the model of care/(1) Defining service priorities based on life course needs/(2) Shifting towards more outpatient and ambulatory care : Countries who have attained level 4a or 4b integration of palliative care services as defined above. Denominator: All respondent countries Access to palliative care is an essential component of an effective health system, increased levels of integration imply increased access and increased performance of service delivery. Does not evaluate quality of services received >150 countries Survey Global Atlas of Palliative Care http://www.thewhpca.org/resources/global-atlas-on-end-of-life-care
14. Mental health outpatient treatment Indicator Name Number of countries and territories that have increased the rate of consultations through mental health outpatient treatment facilities above the global average of X/100,000 population. The indicator measures the establishment of ambulatory and outpatient mental health facilities. Reorienting the model of care/ Shifting towards more outpatient and ambulatory care (A) : the number of mental health consultations in ambulatory or outpatient facilities in one year. (B) Denominator: the total population (general population) Calculation: (A/B) x 100,000 The calculation should exclude hospitalized patients, including those in general hospitals, community residential facilities, and in partial hospitalization (sameday hospitalization) services. This is in line with the operational criteria of the WHO s Assessment Instrument for Mental Health Systems (WHO- AIMS). This indicator is essential for monitoring the transformation of mental health care; it is based WHO s Global Mental Health Action Plan 2013-2020. The indicator is important for monitoring the transition from an asylum-hospitalbased model of care for people with mental disorders to an outpatient-based model that is decentralized, community-based, and linked to the primary health care services. Limited to mental health outpatient/ambulatory reorientation, rather than broader services reorientation. 86 countries Self-assessment process WHO-AIMS (World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS))
15. Percentage of health facilities with EHR as high or very high Country response to global e-health survey regarding, Use national EHR system, Proportion of facilities using national EHR system at primary, secondary, and tertiary levels. Options include: [ ] Low less than 25% [ ] Medium more than 25%; less than 50% [ ] High more than 50%; less than 75% [ ] Very high more than 75% Reorienting the model of care/innovating and incorporating new technologies Number of countries who responded that use of national EHR was high or very high Denominator All surveyed countries Monitors use of national EHR to facilitate information accessibility, monitoring, evaluation, etc. Accounts for national EHR only. Self-reported. 124 countries surveyed Survey Third Global Survey on ehealth - 2015 http://www.who.int/goe/survey/goe_2015_survey_en.pdf?ua=1
16. Percentage of countries with at least 1 telehealth programme operating nationally Country response to global e-health survey as national level (pilot through established) for teleradiology, teledermatology, telepathology, telepsychiatry, or remote patient monitoring Reorienting the model of care/innovating and incorporating new technologies Number of countries who responded that use of national telehealth capacities were established Denominator All surveyed countries Monitors use of national EHR to facilitate information accessibility, monitoring, evaluation, etc. Does not assess appropriateness, effectiveness, efficiency of programme 124 countries surveyed Survey Third Global Survey on ehealth - 2015 http://www.who.int/goe/survey/goe_2015_survey_en.pdf?ua=1
17. % countries with at least 1 mhealth programme operating nationally in each subcategory Country response to global e-health survey at national level (pilot through established) for accessing/providing health services, Accessing/providing health information, or collecting health information Reorienting the model of care/innovating and incorporating new technologies Number of countries who responded that use of national mhealth programmes was national Denominator All surveyed countries Monitors use of national mhealth capacity including accessing/providing health services, Accessing/providing health information, or collecting health information Does not assess appropriateness, effectiveness, efficiency of programme 124 countries surveyed Survey Third Global Survey on ehealth - 2015 http://www.who.int/goe/survey/goe_2015_survey_en.pdf?ua=1
18. Medical equipment (density per million population) Indicator Name Medical equipment (density per million population) Medical equipment (density per million population) disaggregated by device (MRI, CT, PET, Nuclear medicine, mammography, linear accelerator, tele cobalt unit, radiotherapy) Reorienting the model of care/ Innovating and incorporating new technologies : Number of device Denominator: Total population Calculation: N/D * 1,000,000 Use of technology, though adequate thresholds have not been developed by disease burden, a sense of the density per million relative to other countries, could be used to determine the level of incorporation of medical technology and devices. Does not indicate appropriate utilization. Approx. 170 countries Survey Global atlas of medical devices 2014 update
19. TB treatment success rate* Percentage of TB cases successfully treated (cured plus treatment completed) among TB cases notified to the national health authorities during a specified period. Coordinating services within and across sectors/ Coordinating care for individuals : Number of TB cases registered within a specified period which were successfully treated Denominator: Total number of TB cases registered in the same period Treatment success is an indicator of the performance of national TB programmes. Limited to those registered and treated within national TB programme. Does not refer to TB MDR cases in definition of TB cases. 191 countries TB register and related quarterly reporting system (or electronic TB register) Global 100 Core Indicators * Could be a component of a continuity of care index
20. Antenatal care coverage* Percentage of women aged 15 49 years with a live birth in a given time period who received antenatal care, four times or more. Coordinating services within and across sectors/ Coordinating care for individuals Number of women aged 15-49 with a live birth in a given time period who received antenatal care four or more times Denominator - Total number of women aged 15 49 years with a live birth in the same period Allows comparison of access to antenatal care for a defined population; provides opportunities to deliver interventions to pregnant women that could benefit their health and wellbeing Indicator does not provide information on nature or quality of care received. 121 countries (194 countries with estimates) Household surveys Global Core 100 Indicators * Could be a component of a continuity of care index
21. Births attended by skilled personnel* Percentage of live births attended by skilled health personnel during a specified time period Coordinating services within and across sectors/coordinating care for individuals Number of births attended by skilled personnel (doctors, nurses or midwives) trained in providing life-saving obstetric care, including given the necessary supervision, care and advice to women during pregnancy, childbirth and the postpartum period, to conduct deliveries on their own and to care for newborns Denominator - Total number of live births in the same period Postpartum care is an essential component in reducing maternal and neonatal mortality. Indicator allows comparison of access to postpartum care for a defined population. Indicator does not provide information on nature or quality of care received. 121 countries (194 countries with estimates) Household surveys, RHMIS Global 100 Core Indicators, DHS/MICS * Could be a component of a continuity of care index
22. Postpartum care coverage* Percentage of mothers and babies who received postpartum care within two weeks of childbirth (regardless of place of delivery). Coordinating services within and across sectors/ Coordinating care for individuals - Number of mothers and babies who received postpartum care within two days of childbirth Denominator - Total number of women aged 15 49 years with a live birth in the same period. Postpartum care is an essential component in reducing maternal and neonatal mortality. Indicator allows comparison of access to postpartum care for a defined population. Indicator does not provide information on nature or quality of care received. 80 Countries Household surveys, RHMIS Global 100 Core Indicators, DHS/MICS * Could be a component of a continuity of care index
23. Full immunization coverage among one year olds* The percentage of one-year-olds who have received one dose of Bacille Calmette-Guérin (BCG) vaccine, three doses of polio vaccine, three doses of the combined diphtheria, tetanus toxoid and pertussis (DTP3) vaccine, and one dose of measles vaccine. Coordinating services within and across sectors/ Coordinating care for individuals - Number of children aged 12 23 months receiving one dose of BCG vaccine, three doses of polio vaccine, three doses of DTP3 vaccine, and one dose of measles vaccine. Denominator - Total number of children aged 12 23 months surveyed. Immunisation is key to reducing under five mortality. Indicator allows comparison of access to immunisation for children aged 12 23 months. This facilitates service and coverage planning. It is also a proxy marker of continuity of care in a health system. methods may be subject to reporting biases. 105 countries Household surveys, RHMIS Health Equity Monitor: WHO Indicator and Measurement Registry; Data are derived from re-analysis of Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) microdata which are publicly available using the standard indicator definitions as published in DHS or UNICEF documentation. The analysis was done by the International Center for Analysis and Monitoring of Equity in Health and Nutrition based in the Federal University of Pelotas, Brazil. * Could be a component of a continuity of care index
24. Patient referral systems for higher levels of care Percentage of facilities with a formal system for referring sick patients for care and/or accepting referred sick patients Coordinating services within and across sectors/ Coordinating health programmes and providers : Number of facilities with a formal system for referring patients for care and/or accepting referred patients Denominator: Total number of facilities An indicator of health system performance. Formal referral systems facilitate co-ordination and continuity of care between different levels of the health system. Indicator could be subject to reporting bias, i.e. formal system not defined. Does not assess effectiveness or appropriateness of system. None currently recommended as part of core module to start data collection 2017 Facility assessment Health Facility Assessments indicators and methods (Aug 2016)
25. Avoidable admissions Number of hospital admissions with a primary diagnosis of asthma, chronic obstructive pulmonary disease, hypertension, congestive heart failure, and diabetes mellitus among people aged 15 years and over per 100 000 population. (Age standardized) Coordinating services within and across sectors/ Coordinating health programmes and providers : Number of hospital admissions with a primary diagnosis of asthma, chronic obstructive pulmonary disease, hypertension, congestive heart failure, and diabetes mellitus among people aged 15 years and over. Denominator: Total population aged 15 and over Calculation: N/D * 100 000 (age standardized) Common to all five conditions is the fact that the evidence base for effective treatment is well established and much of it can be delivered at a primary care level. A high-performing primary care system can reduce acute deterioration in people living with asthma, COPD or CHF and prevent their admission to hospital. Disease prevalence may explain some, not all, variations in cross-country rates. Differences in coding practices among countries and the definition of an admission may also affect the comparability of data. For example, while the transfer of patients from one hospital to another is required to be excluded from the calculations to avoid double counting, this cannot be fully complied with by some countries. There is also a risk that countries that do not have the capacity to track patients through the system do not identify all relevant admissions due to changes in diagnosis coding on transfer between hospitals. OECD countries, others would require data collection Administrative data OECD Health Care Quality Indicators
26. Number of countries that have reduced by at least 5% the number of hospitalizations for ambulatory care sensitive conditions Number of countries that have reduced by at least 5% the number of hospitalizations for ambulatory care sensitive conditions. (primary diagnosis of asthma, chronic obstructive pulmonary disease, hypertension, congestive heart failure, and diabetes mellitus among people aged 15 years and over; age standardized) in a given period of time. Coordinating services within and across sectors/ Coordinating health programmes and providers Common to all five conditions is the fact that the evidence base for effective treatment is well established and much of it can be delivered at a primary care level. A high-performing primary care system can reduce acute deterioration in people living with asthma, COPD or CHF and prevent their admission to hospital. Reduction in this rate could be representative of stronger PHC services as well as stronger linkages between hospital care and ambulatory care services for these conditions. Reductions in hospital utilization for ambulatory sensitive conditions must be interpreted in context to ensure that this does not reflect overall reductions in hospitalization rates due to access barriers (financial, geographic, etc.). This should be monitored in conjunction with outcomes (including cause specific morbidity and mortality) for these conditions to ensure that reductions in hospitalization do not reflect poorer care quality. OECD countries, others would require data collection Administrative data OECD Health Care Quality Indicators
27. Completeness of reporting by facilities Percentage of facilities that submit reports within the required deadline Creating an enabling environment/ Strengthening information systems and knowledge management Number of facilities reporting monthly within a time period Denominator Total number of facilities Completeness of reporting provides information for decision making and service planning for patient care. Limited definition no information on content or criteria for reporting. Not available in GHO; would potentially require primary data collection RHMIS Global 100 Core Indicators
28. Routine service improvement activities Percentage of facilities reporting any quality assurance/ quality improvement practices at service or facility level and documentation of review of results observed Creating an enabling environment/ Striving for quality improvement and safety - Number of facilities reporting any quality assurance/quality improvement practices at a service or facility level and documentation of review of results observed Denominator - Total number of facilities Routine service improvement practices can help improve quality of care and is a marker of a high-performing health system. Indicator may be subject to reporting bias, i.e. presence of a service improvement practice in a facility does not establish whether it is effective at improving quality of care. None currently recommended as part of core module to start data collection 2017 Health facility survey; accreditation records Health Facility Assessments indicators and methods (Aug 2016)
29. Health worker density and distribution by cadre Number of health workers per 1,000 population (physicians, nurses and midwives, community health workers, etc.) Creating an enabling environment/ Reorienting the health workforce Number of health workers by population Denominator Total population Calculation: N/D * 1 000 Health workforce matched to population need is a key building block for the formation of an effective health system. Health worker definition may vary by setting could affect comparison. Approx. 90 countries RHMIS HDC HMIS indicator list, GHO
30. Ratio of nursing professionals to physicians Ratio of nursing professionals to physicians Creating an enabling environment/ Reorienting the health workforce Total number of nurses, defined in headcounts Denominator - Total number of physicians, defined in headcounts An effective health workforce provides a balanced mixed skill set in order to deliver effective care. Ideal ratio not defined as populations may have different health workforce needs. In addition, models of care and licensing/accreditation schemes may be prescriptive of these ratios rather than allowing them to be flexible to population needs. May affect comparison and interpretation between settings. 90 countries Labour force surveys Health workforce registry or database WHO National Health Workforce Accounts: A Handbook, GHO, OECD