objectives of the meeting health metrics network / who / unicef / macro int. meeting on health...

Objectives of the Meeting

Health Metrics Network / WHO / UNICEF / Macro Int. meeting on Health Surveys

July 10-11 2007, Calverton Maryland

Health surveys meeting10-11 July 2007

ObjectivesObjectives

To discuss how Health Metrics Network and its partners can strengthen the role of health surveys in country health information systems and develop an agenda to increase harmonization and alignment in the field of health surveys.


Four Specific objectivesFour Specific objectives

Specific objectivesPotential outcomes

(1)

Start a process for the development of a standard set of core modules for key areas of public health significance, including guidelines about content, mode and frequency of application

Plan for the development of standardized health survey modules with clear guidelines on their implementation.

(2)

Discuss how to support the development of coordinated country survey programmes that can be integrated into country health information

systems

Review of current approaches proposed and used by HMN and other stakeholder to integrate household surveys into long-term country health information systems

(3)

Discuss current efforts and ways to strengthen country capacity for analysis and synthesis of data from surveys and other sources to inform policy

Plan for HMN and partners to engage in this area in a more systematic way

(4)

Discuss key gaps in public health knowledge that can be addressed using surveys, notably on causes of death, health transition and local coverage

More clarity on the needs, role, feasibility and efficiency of cause of death surveys, health examination surveys and local coverage surveys and

agreement on the way forward


Survey modulesRegular survey, variable contents


Module AModule AModule AModule AModule AModule AModule AModule AModule A

shortModule A

Module Jlong

Module Hlong

Module Elong

Module A

0 2 4 6 8 ..10

………………….………………Years…………….………………………..


Specific objective 1Health survey modules

Specific objective 1Health survey modules


(1)

Start a process for the development of a standard set of core modules for key areas of public health significance, including guidelines about content, mode and frequency of application

Plan for the development of standardized health survey

modules with clear guidelines on their implementation.

(2)

(3)

(4)


Household health surveysCurrent situation – demand side

Household health surveysCurrent situation – demand side

Monitoring MDGs and other major health initiatives

Mortality, prevalence of some conditions, risk factors, coverage; equity

Health transition: complex array of MCH /communicable / non-communicable diseases and conditions

Single disease information: HIV/AIDS, malaria, tobacco, risk factors for NCD etc.


Mortality data collection and reporting by source among 57 low income countries, 1980-2004

Mortality data collection and reporting by source among 57 low income countries, 1980-2004

0

10

20

30

40

50

1980-84 1985-89 1990-94 1995-99 2000-04

Surveys Civil reg.


Household health surveysCurrent situation – supply side

Household health surveysCurrent situation – supply side

Demographic and Health Surveys (DHS): US government

Multiple Indicator Cluster Survey (MICS): UNICEF

Living Standard Measurement Survey (LSMS), CWIQ: World Bank

Reproductive Health Surveys: CDC

Regional survey programmes: PAPCHILD, PAPFAM (Arab League)

National health surveys: OECD, Mexico, Indonesia etc.

World Health Survey (WHS): WHO, single round, aging survey, GCC

Disease-specific surveys: AIS, MIS – US government, Gates, WB, CDC, WHO

Emergency and conflict situations – NGOs, universities, WHO, possibly HNTS


Specific objective 2Harmonization and streamlining

Specific objective 2Harmonization and streamlining


(1)

(2)

Discuss how to support the development of coordinated country survey

programmes that can be integrated into country health information

systems

Review of current approaches proposed and used by HMN and other stakeholder to integrate household surveys into long-term country health information systems

(3)

(4)


Capacity building effortsCapacity building efforts

Survey-specific: analysis and further analysis of DHS, MICS, etc.

Monitoring & Evaluation: indicators, framework, basic analysis, reconciliation of data from multiple sources to multi-level analyses. MEASURE Evaluation

Statistical capacity building programmes: linking health statistical work to the broader efforts – World Bank, STATCAP, UNSD etc.

Estimation processes, reconciling data from different sources, filling data gaps: HIV/AIDS – UNAIDS and partners; child and maternal mortality; immunization coverage; National Burden of Disease studies

Epidemiology


Capacity building: who?Capacity building: who?

Research institutions, universities

Statistical offices

Ministry of Health

NGOs: local and iNGOs

International staff: UN, donor staff

Private sector

Health statistics centers


Specific objective 3Analytical capacity building

Specific objective 3Analytical capacity building


(1)

(2)

(3)

Discuss current efforts and ways to strengthen country capacity for analysis and synthesis of data from surveys and other sources to inform policy

Plan for HMN and partners to engage in this area in a more systematic way

(4)


Gaps in survey contents and methodsGaps in survey contents and methods

Causes of death through verbal autopsy

Addressing the full scale of the health transition: adult and child health; communicable and non-communicable diseases; acute and chronic conditions – health examination surveys

Local surveys: quality assurance, sampling costs and quality, data processing, data analysis and dissemination


Specific objective 4Filling gaps in knowledge

Specific objective 4Filling gaps in knowledge


(1)

(2)

(3)

(4)

Discuss key gaps in public health knowledge that can be addressed using surveys, notably on causes of death, effective coverage and local coverage

More clarity on the needs, role, feasibility and efficiency of cause of death surveys, health examination

surveys and local coverage surveys and agreement on the way forward

Standardized health survey modules

Health surveys meeting

Calverton Md

10/11 July 2007


Why standardized health survey modules

Why standardized health survey modules

Generate comparable data over time and between populations

Limit the application of poorly tested survey modules and questions, often driven by the flavour of the day

Promote a more flexible system of survey implementation using standardized modules

More critical and systematic assessment of the utility, reliability and validity of survey questions


Survey modulesShort and long versions

Survey modulesShort and long versions

Module AModule A

Module AModule A

Module AModule A

Module AModule AModule A

shortModule A

Module Jlong

Module Hlong

Module ElongModule A

Short

Long


Survey modulesTypes of surveySurvey modulesTypes of survey

Module G

Module F

Module C

Module B

Module A

Module E

Module A

MCH survey

Single topic survey

Module J

Module H

Module I

Module G

Module F Module E

Module D Module C

Module B Module A

Comprehensive survey

Duration andcomplexity of

survey




Module AModule AModule AModule AModule AModule AModule AModule AModule A

shortModule A

Module Jlong

Module Hlong

Module Elong

Module A

0 2 4 6 8 ..10

………………….………………Years…………….………………………..


Survey modulesTopic areas

Survey modulesTopic areas

Mortality– Child mortality; birth history, recent deaths– Adult mortality: sibling survival, recent deaths– Causes of death: medical certificate, verbal autopsy

Morbidity and health states– Self reported measures (domains)– Chronic diseases: algorithms, recall diagnosis; biological test– Acute diseases: recall recent symptoms

Service coverage– MCH preventive interventions: health card, recall– MCH treatment interventions: facility utilization for recent conditions– Chronic conditions: recall treatment use

Risk factors– Child: proxy reporting and biomarkers– Adult: self reported and biomarkers

Health resources– Health expenditure: interviews– Responsiveness health system: self reported perceptions of interactions


Selection survey modules and contentsSelection survey modules and contents

Define a set of minimum standards for inclusion

Standards could include:– public health relevance of the quantity of interest– Ability to phrase the interview questionin multiple languages– ability to accurately measure the quantity of interest through

epidemiological validation studies– high level of reliability proven through surveys.

Should not only apply to interview questions but also to biological and clinical data collection


Possible criteriaPossible criteria

Contents– Minimal set of questions– Expanded set of questions– Key indicators

Evaluation data quality– Measurement issues for quantity of interest– Accuracy at individual level– Accuracy at population level– Heaping and other measures of quality– Biases by determinants

Validation studies– Gold standard– Methodological issues– External validation (plausibility)

External considerations– Surveys versus other methods of data collection

Languages


Example 1: Child mortality module (direct method, birth history)

Example 1: Child mortality module (direct method, birth history)

Relevance– The measurement of age-specific mortality rates in childhood in surveys is a core health indicator for all

countries where measurement of birth and deaths through civil registration systems is not complete.

Indicators– Age-specific mortality rates: under-five mortality per 1,000 live births; neonatal, postneonatal, infant, early

child (1-4 years) mortality rates; rates are usually estimated for five year periods but can be estimated for shorter periods of time if samples are large.

Data collection– All births and deaths over a specified time period prior to the interview; – Full birth history: questions on date of birth, survival status and age at death for all children born to a mother

• Truncated birth history (alternative): as in full birth history

Evidence– Full birth history method:– Empirical evidence of successful application, validation studies?– Truncated birth history

Data quality issues– Omission of births and deaths, more common for neonatal deaths– Displacement of births out of five year period to avoid health section elsewhere in questionnaire– Increased mortality in mothers 15-49 years, e.g. due to HIV/AIDS


Example 2: Maternal and neonatal health preventive interventionsExample 2: Maternal and neonatal health preventive interventions

Relevance– Core set of proven interventions enhancing maternal and neonatal health - define interventions

Indicators– Utilization of care: antenatal care, delivery care, postnatal care– Recall of the contents of the services: health examination received (blood pressure, blood tested for anemia

etc.)– Recall period usually 3 or 5 years

Data needs– For all births (child still alive or not) or pregnancies in a specified number of years prior to the survey - usually,

3 or 5 years– Visit to antenatal care provider, type of provider; number of visits; contents of care– Attendance at delivery, type of provider; place of delivery; complications at delivery– Visit to postnatal care provider, type of provider; contents of care

Evidence review

Data quality issues– Recall problems with number of visits– Recall problems with care contents– Poor definition of what constitutes a postnatal care visit


ProcessProcess

A review committee would need to be established, including technical experts on surveys, measurement etc.

Mandate should be extended to later include biological and clinical tests as well.

WHO / HMN could lead the review process and publish the standards jointly with partners involved

objectives of the meeting health metrics network / who / unicef / macro int. meeting on health...

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