Transcript The World Health Survey Health System Metrics Glion, 28-29 September 2006 Evidence and Information for Policy.

The World Health Survey
Health System Metrics
Glion, 28-29 September 2006
Evidence and Information for Policy
Questions raised by policy
makers
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How well is our health system doing?
How do we know if we are making progress?
How well are we doing given the resources?
Where are the main problems?
What can and should be fixed?
What will it cost?
What is the best use of limited (additional)
resources?
Evidence and Information for Policy
Goals of Health Systems
Performance Assessment
Provide national decision-makers and
the public with sound evidence:
to
inform strategic decisions on health
sector reform and health system
organization e.g. financing
arrangements, regulation of private
providers
to inform implementation of
programmes by local, regional and
national managers
to monitor progress towards national
targets for health and health systems
Evidence and Information for Policy
The WHO health system framework
GOALS / OUTCOMES OF THE
SYSTEM
FUNCTIONS THE SYSTEM PERFORMS
Stewardship
(oversight)
I
N
Creating resources
(investment and
training)
Coverage
Responsiveness
(to people’s non
medical
expectations)
P
U
T
S
Health
Delivering
services
(provision)
Financing
(collecting, pooling
and purchasing)
Provider
Performance
Fair financial
contribution
Evidence and Information for Policy
The World Health Survey
Objectives
develop a low cost means of providing data

that is valid, relevant, reliable and comparable
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on outcomes, functions & inputs to health systems

to supplement the information provided by HIS
Evidence and Information for Policy
The World Health Survey
Objectives
build the evidence base necessary for
policy-makers
to routinely monitor if health systems
are achieving the desired goals

and in some countries, to assess if the
increase in health resources is having
the desired effect

Evidence and Information for Policy
World Health Survey
71 SURVEYS in 71 countries
Household - long :
53
Household - short:
14
CATI :
4
The boundaries and names shown and the designations used on this map do not
imply the expression of any opinion whatsoever on the part of the World Health
Organization concerning the legal status of any country, territory, city or area or of
its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted
lines on maps represent approximate border lines for which there may not yet be
full agreement.
© WHO 2002. All rights reserved
Evidence and Information for Policy
World Health Survey
Content
1. Health Expenditure and Economic status
2. Measurement of Health States
3. Risk Factors
4. Mortality
5. Coverage
6. Responsiveness
7. Health System Goals
Evidence and Information for Policy
World Health Survey
Household Health Expenditure

Information on health care spending

Provides reliable figures for health care fraction
of household expenditure

Provides an alternative way of estimating or
validating permanent income data
Evidence and Information for Policy
World Health Survey
Health Insurance

protection from catastrophic health
expenditure

access to health services

reduction of financial burden of paying for
health services
Evidence and Information for Policy
World Health Survey
Health State Description
• Baseline data on national healthy life
expectancies and inequalities in healthy life
expectancies in absolute terms and by
income groups
• Health is a multidimensional experience
• Difficulty in 8 domains of functioning based on
an international framework
• Valuation of health states to combine
measurement across domains
Evidence and Information for Policy
World Health Survey
Coverage
Do those with health care needs
get the necessary health interventions?
 DETERMINANTS:
 BARRIERS:
What determines the coverage ?
What are the barriers preventing
coverage ?
Evidence and Information for Policy
Catastrophic expenditure and
impoverishment
Percentage of HH's w ith catatrophic expenditure and
im poverishm ent
% Impoverished
20
% Catastrophic
17.3
15
10.9
8.3
10
7.8
7.2
7.5
5
2.6
0
0.1
0
0
1st (poorest)
2nd
3rd
4th
5th(richest)
Income Quintile
Evidence and Information for Policy
Out of pocket payment
Structure of health paym ents by quintile
Inpatient
Outpatient
Traditio nal
Drugs
Other
100%
80%
60%
40%
20%
0%
1st (poorest)
2nd
3rd
4th
5th(richest)
Income Quintile
Evidence and Information for Policy
Coverage
Comparison of Antenatal Care 4+ visits and GNP Status
0
.2
.4
.6
.8
WHS 2003 and World Bank
Low
Middle Low
Middle High
High
Evidence and Information for Policy
Coverage
Self Reported Diagnosis for Cataracts and Treatment
Cataracts Need
Cataracts Covered
35
30
25
20
15
10
5
Al
M
l
au
rit
iu
So
s
ut
h
Af
ric
a
N
am
ib
ia
Ke
ny
a
Sw
az
ila
nd
Et
hi
op
ia
G
ha
na
Zi
m
ba
bw
e
M
al
aw
i
Za
m
bi
a
0
Countries
Evidence and Information for Policy
Responsiveness
problems communicating
Poor
AFR-D
50
WPR-B
40
Non-poor
AFR-E
30
SEAR-D
AMR-B
20
10
SEAR-B
0
AMR-D
EUR-C
EMR-B
EUR-B
EMR-D
EUR-A
Evidence and Information for Policy
World Health Survey
Future steps
Strengthen Health Information Systems by
Supplementing
Combining
vital registration systems
census, surveys and service data
Incorporating
private sector and public sector
data
Improving
survey methods by including
measurements and biomarkers
Improving
methods for small area assessment
Evidence and Information for Policy
Acknowledgement
Xu Ke
Paul Kowal
Saba Moussavi
Nirmala Naidoo
Amit Prasad
Emese Verdes
Evidence and Information for Policy