Compilation of Health Indicators

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United Nations Statistical Institute for Asia and
the Pacific (SIAP) Asian Development Bank
(ADB) Country Training Workshops on MDGs and Use
of Administrative Data Systems for Statistical
Purposes RETA6356 Improving Administrative Data
Sources for the Monitoring of MDGIs

• Compilation of Health Indicators

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1. Introduction

• 1.2 What is Health Statistics?
• 3) Health statistics and health-related
  information
  
• Health Statistics

Social, economic (food, safe water, sanitation,
environment, education, working condition)
Lifestyle (Smoking,drinking, Sleeping, knowledge
on health etc.)
Death
Morbid condition
Health services
Background data (size and characteristics of
population)
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1. Introduction

• 1.4 Main uses of the health statistics
• a) National health plan

1) To observe the current state and various
features of health conditions of the
population in national and regional levels.
2) To identify the problems to be solved by the
various programs to improve health conditions
of the community.
3) To evaluate the impact of the health services
being implemented by various organizations and
in various regions.
4) To prepare the most effective health plans in
national and regional levels.
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2. Morbidity Statistics

• 2.3 Definition of statistical terms
• 1. Endemic disease and related diseases

a) Endemic disease is one that affects the
population of a certain locality almost
constantly.
In contrast, b) Epidemic disease is one that
breaks out suddenly affecting the population
of wider areas almost simultaneously and
disappears after some time. Some infectious or
communicable diseases are often epidemic.
c) Pandemic disease epidemic disease that breaks
out suddenly in many countries.
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2. Morbidity Statistics

• 2.4 Basic indicators for morbid condition
• 1. Measures of morbidity
• 2. Basic units for the Indices

a) Frequency----Incidence and prevalence b)
Duration----Average duration of sickness c)
Severity---- Case fatality rate or fatality ratio
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2. Morbidity Statistics

• 2.4 Basic indicators for morbid condition
• 3. Prevalence rate and Incidence rate
•  
•   A?
  ?
•  
•   B ? ?
• C?
  ?
• D?
  ?
•  
• Time0
  time t 
•      

a) Frequency of morbidity is expressed through
the incidence rate and prevalence rate. The
concept of incidence and prevalence are
illustrated as follows
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2. Morbidity Statistics

• 2.4 Indicators for morbid condition
• ? Incidence Rate
• The incidence rate is expressed as a ratio
  between the number of new events and the
  population at risk.
• ? Point Prevalence Rate
• The prevalence rate at a specified time
  point is computed by
•  

b) Formulas of the rates
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2. Morbidity Statistics

• 2.4 Indicators for morbid condition
•   ? Period Prevalence Rate
• The prevalence rate during a specified
  period is computed by
• where,
• k is a conveniently chosen constant such
  as 100, 1,000 or 100,000.

b) Formulas of the rates
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3. Mortality Statistics

• 3.1 Mortality statistics are?
• 3) Important demographic indicators

There are some demographic indicators to
represent the health status of a population
life expectancy at birth and infant mortality
rate.
a) Life expectancy at birth
Number of years which a new born would live if
the prevailing patterns of mortality at the
time of its birth, were to last throughout
its life. ?This indicator is obtained from the
life table which gives the probability of
dying/ surviving at each age. ?The life
expectancy at birth is considered to be highly
instrumental as an indirect summary of the
mortality picture ?It, hence, is popularly used
as an index of the health status in a country
or in a community.
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3. Mortality Statistics

• 3.1 Mortality statistics are?
• 3) Important demographic indicators

b) Infant mortality rate
Annual number of deaths of infants (under one
year of age) per 1,000 live births. Foetal
deaths are excluded.
? A popular summary indicator This is the
probability of dying between birth and one
year of age, and a popular summary indicator
of the status of health care and medical
facilities of a country. Reason the infants
are required most careful cares from these
health or medical facilities.
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4. Statistics on Resources of Health Services

• 4.1 Statistics on Resources of Health Services
  are.

1) Scope Statistics on resources associated
with the health services usually cover a
wide variety of data on ? Medical
establishments, their equipment and other
facilities, ? The service activities, ?
Health manpower, ? Financial resources, and
so on.
2) Importance Statistics of this kind are
important for health administration and for
assessing its effectiveness in delivering the
required health and medical facilities to the
population.
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4. Statistics on Resources of Health Services

• 4.2 Medical establishments
• 1) Hospital and clinic

Medical establishments are divided into two
categories hospital and clinic.
A distinction between hospitals and clinics
should be made, because a wide variety of
medical establishments actually exists in
terms of their size, characteristics and
functions for international comparison too.
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4. Statistics on Resources of Health Services

• 4.5 Main Indicators on the health services
• 1) Population-bed ratio

? Calculation method The availability of
hospital services may be roughly measured by
the number of hospital beds divided by the
appropriate population. Such a population-bed
ratio can be expressed either as population
per bed or beds per population.
? The ratios for administrative areas These
ratios calculated for various administrative
areas of the country would be more
meaningful and hence more useful, for
planning and administrative purposes.
? Catchments area Note for subnational
area---definition of population as a catchments
area.
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4. Statistics on Resources of Health Services

• 4.5 Main Indicators on the health services
• 2) Inpatient admission rate
• 3) Average length of stay
• 4) Bed occupancy rate

It is the number of patients per 10,000 of the
population (mid- year) admitted to hospitals
during a specified reference period (a year).
It is given by dividing the total number of
inpatient days during a specific reference
period of time with the total number of
admissions or discharges during the same period.
It is calculated by dividing the average number
of occupied beds per day during a specific
reference period of time (e.g. a calendar year)
by the number of beds at the middle of the
period or at the end of the period. It is
expressed in terms of per cent.
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4. Statistics on Resources of Health Services

• 4.5 Main Indicators on the health services
•  5) Outpatients services
• 6) Others

It is given by the number of visits to
(consultations at) health care facilities,
including re-visits.

• ? Daily average number of occupied beds,
• Data on hospital equipment availability
• Data laboratory facilities,
• ? Data specialist care facilities (including
  dental care) etc.

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4. Statistics on Resources of Health Services

• 4.6 Health manpower
• Ex. Physicians per population
• (The constant may alternatively
• be 10,000 or 1,000.)
• Population per physician

1) Persons included in the health manpower
Health manpower data would consist of statistics
on physicians (including practitioners of
traditional medicine), dentists, nurses and
midwives who provide the major proportion of
direct medical services, and members of the
allied health profession, such as pharmacists
and clinical laboratory technicians.
2) Ratio to the total population The statistical
information would be expressed as a ratio to the
total population, while spatial distribution
of the indicators usually are given.
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4. Statistics on Resources of Health Services

• 4.6 Health Manpower
• 3) Classification of health manpower

a) Two broad categories ? Those who provide the
major portion of direct personal services,
are physicians, dentists, nurses, etc., and ?
Members of the allied health profession are
pharmacists, laboratory technicians, etc.
b) ISCO Further detailed breakdowns can be
made on the basis of ISCO (the International
Standard Classification of Occupation issued
by the International Labour Office.)
In the ISCO system, the category of 0-6/0-7
Medical, dental, veterinary and related
workers is divided into the seventeen unit
groups. These unit groups are further classified
into detailed subgroups by their specialization
and other characteristics.
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4. Statistics on Resources of Health Services

• 4.7 Financial resources

Financial resources for health services would
reflect provisions in budgets of national/
local governments, as well as private sector
expenditures on health.
Indicators frequently used ? Total expenditure
on health as of GDP, ? Per capita
expenditure on health at official exchange rate
(US), ? Public expenditure on health as of
total expenditure on health, ? Private
expenditure on health as of total expenditure
on health, ? Public expenditure on health as
of general government expenditure.
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5. Nutrition and Lifestyles
Measurements on nutrition can be considered from
two aspect 1) food availability and
consumption, 2) the nutritional status of
people. This is closely related to
peoples lifestyles, particularly dietary habits.

• 5.1 Food availability and consumption
• 1. Research on food supply

One of the most important elements of primary
health care is to ensure adequate food supply.
? Primary data on food supply The statistics
of domestic food production, food imports and
exports, and use of foods as animal feed are
required to measure this aspect in a
country as a whole.
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5. Nutrition and Lifestyles

• 5.1 Food availability and consumption
• 1. Research on food supply

? Processing of the primary data 1) From these
data, the net amount of food available for human
consumption is estimated. 2) A food
balance sheet is produced on this basis. 3) Per
capita food supply is quite important indicator
for comparison among geographical units,
both internally and internationally.
? Available data Most of these statistics ,
however, are not obtained from the health
sectors, but the agriculture and commercial
sectors.
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5. Nutrition and Lifestyles

• 5.1 Food availability and consumption
• 2. Investigation of the pattern of food
  consumption and intake of nutrients
• 1) Data collection

?Special statistical household surveys These
data can be obtained from statistical household
surveys which are conducted periodically, to
gather such information together with some
basic data on the nutritional status.
? Method of collecting data on food intake
The food intake of households is studied by
recording the kind and amounts of food items
consumed at each meal. ? Two methods may be
applied for the recording
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5. Nutrition and Lifestyles

• 5.1 Food availability and consumption
• 3. Dietary energy
• 1) Dietary energy supply

Two useful indicators on dietary energy 1)
Dietary energy supply and 2) Minimum dietary
energy requirement
Food available for human consumption, expressed
in kilocalories (Kcal) per capita per day.
? Calculating of food available for human It is
calculated as the food remaining for human use
after the deduction of all non-food
consumption (exports, animal feed, industrial
use, seed and wastage), at the country level.
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5. Nutrition and Lifestyles

• 5.1 Food availability and consumption
• 3. Dietary energy
• 2) Minimum dietary energy requirement

The Minimum dietary energy requirement is
considered adequate to meet energy needs for
light activity and good health, in a
specified age/sex category.
The energy needs for light activity and good
health are determined according to the rule of
each country.
It is expressed in kcal per capita per day.
For a entire population, the minimum energy
requirement is the weighted average of the
minimum energy requirement of the different
age/sex groups in the population.
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5. Nutrition and Lifestyles

• 5.2 The nutritional status
• 4. Anthropometry in children

The height and weight of body are important
measurements for assessing the growth and health
of a child.
1) The height of child It reflects the past
nutritional status. The height thus is a
cumulative indicator of the childs health
in a long term. A small height for age is
considered as indicating stunting.
2) Weight for height Weight is directly related
to height, as a taller child tends to be
heavier than a shorter one. A small weight for
height, i.e. a small weight relative to height is
considered as indicative of wasting.
Deficient nutrition of a short term will affect
weight-for-height, such as with illness with
anorexia or malabsorption, or when a child
goes hungry for several weeks.
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5. Nutrition and Lifestyles

• 5.2 The nutritional status
• 4. Anthropometry in children

3) Indicator to be used for children The
indicator to be used for children under 5 years
of age is the percentage of children whose
weight-for-age and/or height- for-age are
acceptable by national or international standards
for that age and sex. The standard
should be made by studies of the situation of
the countries.
?Acceptable range Nonetheless, the range
between 80 and 120 of the reference value
of the country, or ?2 standard deviation (SD)
from average of this value may be considered
acceptable.
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5. Nutrition and Lifestyles

• 5.2 The nutritional status
• 5. Anthropometry in adult

1) Body mass index (BMI) The body mass index
(BMI) is the most frequently used indicator
of the nutritional status of an adult. It was
originally proposed in the 19th century by A.
Quetelet a Belgian statistician, and has
also been called Qetelets index.
2) an effective indicator of thinness or
overweight The BMI, being computed from
height (in m) and weight (in kg), has
been highlighted during the recent decades as an
effective indicator of thinness or
overweight.
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5. Nutrition and Lifestyles

• 5.2 The nutritional status
• 5. Anthropometry in adult

3) Calculation formula (kg/m2)
4) Example A person is 165cm (i.e.1.65m)
tall and weighs 60kg,