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HEALTH
Dr. Navya Sri. S
1st year Post graduate
Bangalore medical college and research institute.
CONTENTS
Introduction
Definition
Development of indicators
Characteristics
Uses
Classification of Indicators of Health
Evaluation of indicator
Summary
References
INTRODUCTION
Definition of health: A state of complete physical, mental and social
wellbeing, and not merely an absence of disease or infirmity ( WHO ).
How healthy is a given community?
For the health administrator, nothing could be more valuable than to
have, at his command, one or more measuring roads to help him in his task
and also in assessing his specific problems relating to the health of people, in
designing his plans to deal with these, in guiding his administration and in
evaluating his scheme- WHO
What is a indicator ?
In WHOs guidelines for health programme evaluation they are defined as
variables which help to measure changes.
Difference between an indicator and index?
Indicator : anything that indicates ( revealing or diagnostic ), which could be any
counted or measured variable
Ex. IMR, MMR
Index: scaled composite variable
Ex : PQLI, HDI
Reliable the results should be the same when measured by different people in similar
circumstances.
Sensitive they should be sensitive to changes in the situation concerned.
Specific they should reflect changes only in the situation concerned.
Feasible they should have the ability to obtain data when needed.
Relevant they should contribute to the understanding of the phenomenon of interest. (As a
strategic endeavour, the Ministry of Health & Family Welfare (MoHFW), GoI, launched Mission
Indradhanush in December 2014 to achieve more than 90% full immunization coverage in the
country in a period of five years.)
USES OF INDICATORS
TYPES OF INDICATORS
Mortality indicators
Morbidity indicators
Disability rates
Nutritional status indicator
Health care delivery indicators
Utilization rates
Contd..
Measures of mortality
CRUDE DEATH RATE ( CDR ): The number of deaths in a defined community in a year per
1000 population in the middle of year ( i.e. on 1st July ).
CDR = Total deaths in a defined community or defined area in a year X 1000
Mid- year population ( 1st July ) of that community or defined area
INDIA 7 Rural- 7.5
Urban- 5.6
( Source : SRS- 2014 )
Karnataka- 7 Rural-8
Urban-5.2
CDR is useful for making quick estimates of load of mortality in a given population
Gives the relative importance of the disease as a cause of mortality in the community.
Ex: CSMR due to pulmonary tuberculosis for a ten year period of 1 st Jan 1991 to 31st
December 2000 in entire India
CSMR= Total death due to pulmonary tuberculosis in India during
1 Jan1991 to December 31st 2000
X 1000
Population of India as on 1st Jan 1996
Current mortality rate due to Tb is 19/ lack population ( burden of tuberculosis in India
-2013 )
The maternal mortality ratio should not be confused with the maternal
mortality rate (whose denominator is the number of women of
reproductive age), which reflects not only the risk of maternal death per
pregnancy or birth but also the level of fertility in the population. The
maternal mortality ratio (whose denominator is the number of live births)
indicates the risk once a woman becomes pregnant, thus does not take
fertility levels in a population into consideration.
Maternal mortality rate: India- 12.4, Karnataka- 8.1
Contd.
Infant mortality rate ( IMR ) : number of deaths among children less than 1
year in a year
1000 live births in the same year in the same area
It is one of the most universally accepted indicators of health status not only of infants,
but also of whole population and of the socio-economic conditions under which they
live.
The infant mortality rate is a sensitive indicator of the availability, utilization and
effectiveness of health care, particularly perinatal care.
Infant mortality rate India- 40, Karnataka- 31
Rural- 44 , urban 27
Highest MP and Assam 54
Lowest- Kerala -6
( Source : SRS- 2014 )
MORBIDITY INDICATORS
Morbidity indicators are used to supplement mortality data to describe the health
status of a population.
Morbidity measures can be either in the form of incidence and prevalence
INCIDENCE: Number of new cases of specific disease during a given
period of time
X 1000
Population at risk during that period
Eg. The incidence of Tuberculosis in India is 171 per 100000.
PREVALENCE
MEASURES OF FERTILITY
Epidemiological measures of fertility are extensively used in fields of
Contd
General fertility rate : Number of live births in a given area during a year
1000 mid year population of females in reproductive
age groups ( 15- 45 yr. ) in that area, during that year.
Age specific fertility rate ( ASFR ) : Number of live births to women in specified
age group ( 20- 25 yrs) in given area, given year per 1000 mid year population of
females in age group of ( 20-25 )
Identifies age group of women having highest reproductive potential, so that
family planning measures can be directed towards such groups
Contd.
Contd
DISABILITY RATES
EVENT- TYPE Indicators
No of days of restricted activity
Bed disability days
aids)
Work loss days within a specified period
( ADL )
2) Utilization rates
Relationship exits between utilization of health care services and health needs and status
Utilization is also affected by factors such as availability and accessibility of health
services and attitude of an individuals towards his health and health care system.
Proportion of infants who are fully immunized against EPI diseases.- 77.3% ( 2012 )
Proportion of pregnant women who receive ANC or have deliveries supervised by
trained birth attendant.
ANC coverage- 37%
Delivery conducted by skilled personnel (%)- 52% ( 2008-12)
% of family using various methods of family planning.
Bed occupancy rate ( i.e. avg daily in- patient census/ avg number of beds )
Bed turn over ratio
ENVIRONMENTAL INDICATORS
Indicators relating to pollution of air and water, radiation, solid wastes,
noise, exposure to toxic substances in food or drink.
Most useful indicators are measuring the proportion of population having
access to safe water and sanitation facilities.
Ex: % of households with safe water in the home or within 15 min
walking distance from a water stand point or protected well.
India- safe water- 93%
Sanitation- 36%
(Source: WHO- World health statistics 2014 )
SOCIO-ECONOMIC INDICATORS
Health is the result of a complex array of interplay between the human beings and their
environment , including the various array of socio-economic factors.
Expectation of life is the average number of years that will be lived by those born alive
into a population if the current age specific mortality rates persist.
It is a statistical abstraction based on existing age-specific death rates.
Estimated for both sexes separately.
Good indicator of socioeconomic development
It is a commonly used summary measures of the health status of a population.
Life expectancy at birth: 63.5 YEARS
Male: 64 years (WHO Global Health Observatory ,2012)
Female: 68 years
Highest- Kerala-74 yrs
Country with highest life expectancy: Japan- 82.6 years.
Percentage of people below poverty line: commonly used index of overall standard
of living and economic status of country.
Actually means inability to buy adequate food calories which is equivalent of 2400
Kcal/ day in rural and 2100 Kcal/day in urban.
New poverty line recommended by C Rangarajan committee is
Urban areas- Rs.47 per person per day and Rs.32/person/day for rural.
Poverty head count ratio ( PHCR ) is the proportion of population whose per-capita
income/ costumer expenditure is below the official threshold i.e. poverty line
Poverty estimate-India- 21.9% ( 2011-2012 )
Types of SMPH
Summary measures of health
expectancies
HALE ( Healthy life expectancy )
ALE ( Active life expectancy )
DFLE ( Disability free life
expectancy )
QALE ( Quality adjusted life
expectancy )
HALE:
Life expectancy at birth but includes an adjustment for time spent in poor health.
Equivalent number of years in full health that a new born can expect to live based
on current rates of ill health and mortality.
HALE FOR INDIA IS 53 YEARS.
QALY : No of years of life that would be added by intervention.
1.0- perfect health 0.0- death
1 QUALY = 1 Year of life X 1 utility value.
It is a measure of disease burden including both the quality and quantity of life lived.
DFLE ( Syn with ALE ): Avg no of years an individual is expected to live free of
disability if current pattern of mortality and disability continue to apply.
DALY
DALY combines in one measure the time lived with disability and time
Uses of DALY
To assist in selecting health service priorities.
To identify the disadvantaged groups.
Targeting health interventions.
Measuring the results of health interventions.
Providing comparable measures for planning & evaluating programmes.
To compare the health status of different countries.
One DALY is one lost year of healthy life.
Sullivans index
Expectation of life free of disability, computed by subtracting from life
expectancy the probable duration of bed disability and inability to perform
major activities.
Sullivans index= life expectancy- YLD
Expectation of life free of disability
OTHER INDICATORS
Social Indicators:
Population
Family formation
Families & households
Learning & educational services
Learning activities
Distribution of income
Consumption & accumulation
OTHER INDICATORS
Basic Needs Indicators are used by ILO and include calorie
consumption, access to water, life expectancy, deaths due to disease,
illiteracy, doctors and nurses per population, rooms per person, GNP per
capita.
OTHER INDICATORS
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MDG
Goal 1: Eradicate extreme poverty and hunger
Goal 2: Achieve universal primary education
Goal 3: Promote gender equality and empower women
Goal 4: Reduce child mortality
Goal 5: Improve maternal health
Goal 6: Combat HIV/AIDS, malaria and other diseases
Goal 7: Ensure environmental sustainability
Goal 8: Develop a Global Partnership for Development
G4.T5.I13 - Under-5 mortality: Probability of dying between birth and exactly five years of age,
per 1000 live births.
G4.T5.I14 - Infant mortality rate: Probability of dying between birth and exactly one year of
age, per 1000 live births.
G4.T5.I15 - Proportion of 1-yr old children immunized for measles: The percentage of infants
reaching their first birthday fully immunized against measles (1 dose)
EVALUATION OF INDICATORS
DEFINING SMART OBJECTIVES.
Specific: An objective should address a specific target or accomplishment. Which is
SPECIFIC
MEASURABLE
ACHIEVABLE
RELEVANT
TIME-BASED
Attribution
Centrality
Cost-benefit
Robustness
Timing
Availability
Reliability
Sensitivity
Validity
Data to be used
Data to be collected
Instruments used
Who is going to do analysis
SUMMARY
Health not measured directly but using indicators
Indicator should be valid, sensitive, specific, reliable, relevant and feasible
Used in measuring, describing, comparing, identifying health needs and
planning and evaluation of health services
Use of multiple indicators arranged in profiles or patterns used to make
comparisons between areas , regions and nations.
REFERENCE
Park K. Textbook of preventive and social medicine. 23 rd ed. Jabalpur, India: Bhanot; 2011.
p.23-28.
Col Rajvir Bhalwar Public Health and Preventive Medicine The RED BOOK Diamond
Jubilee Edition New light publishers 2008;p 184-196.
SRS bulletin September 2014. Available from Census of India : Sample Registration System
(SRS) Bulletins.
Global health indicators WHO. Available from http://
www.who.int/gho/publications/world_health_statistics/EN_WHS2013_Part3.pdf
Census 2011[online].2011[cited 2011 Sep 19] Available from URL:
http://www.census.gov.in/2011
THANK YOU