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Rationale

This indicator reflects the share of domestic government expenditure in total PHC expenditure. This measure indicates government commitment to primary health care.

Construction

Numerator: Domestic General Government Health Expenditure on Primary Health Care
Denominator: Current Primary Health Care Expenditure
 

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Estimated by WHO using country published health accounts from YEAR, following the SHA 2011 global standard.

Limitations

Currently, it is not feasible to distinguish among non-governmental sources of PHC expenditure, such as out-of-pocket household expenditures on PHC.  This indicator includes expenditure on medical goods that may be serving other services than primary health care services.

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Rationale

This indicator is a measure of financial protection for households seeking primary health care services.

Construction

Numerator: Household Out-of-pocket Expenditure on Primary Health Care
Denominator: Current Primary Health Care Expenditure
 

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Estimated by WHO using country published health accounts, following the SHA 2011 global standard.

Limitations

Currently, data for this indicator are not available.

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Rationale

Contributes to understanding government prioritization towards PHC within the health sector.

Construction

Numerator: Domestic General Government PHC Expenditure 
Denominator: Domestic General Government Health Expenditure
 

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Estimated by WHO using country published health accounts from YEAR, following the SHA 2011 global standard.

Limitations

This indicator includes expenditure on medical goods that may be serving other services than primary health care services.

Full Name

Rationale

This indicator measures the overall investment in PHC in a country in relation to population. It is an important input for PHC service delivery and an important factor affecting the performance of PHC. This is a core indicator of health financing systems. This indicator contributes to the understanding of the current expenditure on primary health care relative to the beneficiary population.

Construction

• Numerator: Total current primary health care expenditure expressed in PPP international dollars
• Denominator: Total population

Current expenditure on PHC is defined as Expenditure on health care providers providing PHC services + Expenditure on PHC preventive services + Proportion of administrative expenditure (based on ratio of PHC services expenditure and non-PHC service expenditure).

Data are presented in purchasing power parity (PPP int. $) to enable international comparison.

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Data are collected using the System of Health Accounts (SHA2011) standards, which were jointly developed by WHO, OECD, and USAID. A working definition for primary health care expenditure has been developed which includes (1) all expenditures for PHC service providers; (2) expenditures for PHC preventive services; and (3) a proportion of administrative expenditures (based on ratio of PHC services expenditure and non-PHC service expenditure).

Limitations

The SHA2011 standards were not designed to collect PHC expenditure information, and there is no explicit PHC expenditure category in its data set. Thus, the estimates are based on a “working definition” for PHC expenditure based on SHA2011 expenditure codes of health care providers and health care functions. The PHC expenditures may be underestimated due to inability to identify the PHC curative services provided by higher-level facilities, such as secondary or tertiary hospitals.

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Rationale

To effectively provide essential health services, health facilities must have available minimum levels of equipment, including a weighing scale, stethoscope, sphygmomanometer, and thermometer. In addition, health centers and hospitals should have available sterilizing equipment and a refrigerator.

Construction

Numerator: Number of pieces of equipment on the defined list available and functioning at a facility

Denominator: Total number of pieces of equipment on the defined list

The specific list of equipment facilities are assessed against varies depending on the data source. We chose to include values from SARA and SDI facility assessments where available, recognizing that there are slight definitional differences.

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Service Delivery Indicators (SDI) includes the following items in its assessment: thermometer, stethoscope, weighing scale, blood pressure apparatus, refrigerator, and sterilization equipment. For additional details, click here.

Service Availability and Readiness Assessment (SARA) includes the following items in its assessment: thermometer, stethoscope, adult scale, child scale, blood pressure apparatus, and a light source. For additional details, click here.

Limitations

Different health facility assessments note the availability of different sets of equipment, making this indicator more complicated to standardize across methods. The availability of minimum equipment is a point-in-time indicator and does not reflect whether facilities have the resources and capacity required to maintain minimum equipment levels over time. Further, it does not reflect provider ability or knowledge to use the equipment appropriately.

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Rationale

Preparing the health workforce to work towards the attainment of a country's health objectives represents one of the most important challenges for its health system. Methodologically, there are no gold standards for assessing the sufficiency of the health workforce to address the health care needs of a given population and, given the variability in definitions and roles of community and traditional health workers across different contexts, no clear guidelines on the number of community and traditional health workers needed.

Construction

Numerator: Total number of community and traditional health workers  

Denominator: Total population of country (expressed per 1,000 population)

Expressed as density of nurses and midwives per 1,000 population.

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Global Health Observatory (GHO). Population is derived from United Nations Population Division's World Population Prospects database. Community and traditional health worker counts are derived from: population censuses, labor force and employment surveys, health facility assessments and routine administrative information systems (including reports on public expenditure, staffing and payroll as well as professional training, registration and licensure). Read more here. 

Limitations

The classification of health workers is based on criteria for vocational education and training, regulation of health occupations, and the activities and tasks involved in carrying out a job, i.e. a framework for categorizing key workforce variables according to shared characteristics. While much effort has been made to harmonize the data to enhance comparability, the diversity of health worker roles and information sources means that considerable variability remains across countries and over time in the coverage and quality of the original data. Some figures may be underestimated or overestimated when it is not possible to distinguish whether the data include health workers in the private sector, double counts of health workers holding two or more jobs at different locations, workers who are unpaid or unregulated but performing health care tasks, or people with a health-related education working outside the health care sector (e.g. at a research or teaching institution) or who are not currently engaged in the national health labour market (e.g. unemployed, migrated, retired or withdrawn from the labour force for personal reasons).

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Rationale

To effectively provide essential health services, health facilities must have available minimum levels of essential drugs.

Construction

Numerator: Number of unexpired drugs on the defined list of which a facility has at least one available

Denominator: Total number of drugs on the defined list, which includes tracer medicines for children and mothers identified by the World Health Organization

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

The specific list of drugs facilities are assessed against varies depending on the data source. We chose to include values from SARA and SPA facility assessments where available, recognizing that there are slight definitional differences.

Service Availability and Readiness Assessment (SARA). SARA is a health facility assessment tool designed to assess and monitor the service availability and readiness of the health sector and to generate evidence to support the planning and managing of a health system. SARA is designed as a systematic survey to generate a set of tracer indicators of service availability and readiness. Click here to learn more about what is included in SARA surveys. Read more here. 

Service Provision Assessment (SPA). SPA is a survey is a health facility assessment that provides a comprehensive overview of a country’s health service delivery. It collects information on the overall availability of different facility-based health services in a country and their readiness to provide those services. Click here to learn more about what is included in SPA surveys. Read more here.

The list of essential drugs is derived from the WHO Model List of Essential Medicines.

Limitations

Different health facility assessments note the availability of different sets of essential drugs, making this indicator more complicated to standardize across methods. In addition, the list must reflect the national standards. The availability of essential drugs is a point-in-time indicator and thus does not reflect whether facilities have the resources and capacity required to maintain essential drugs stock levels over time, nor does it measure frequency of stock-outs. Further, it does not reflect provider ability or knowledge to administer drugs appropriately.

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Rationale

To effectively provide essential health services, health facilities must have available sufficient clean water, electricity, and improved sanitation services.

Construction

Numerator: Number of facilities that report, and enumerator confirms, having electricity, clean water, and improved sanitation

Denominator: Number of facilities surveys

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Service Availability and Readiness Assessment (SARA). SARA is a health facility assessment tool designed to assess and monitor the service availability and readiness of the health sector and to generate evidence to support the planning and managing of a health system. SARA is designed as a systematic survey to generate a set of tracer indicators of service availability and readiness. Click here to learn more about what is included in SARA surveys.

Service Delivery Indicators (SDI). SDI is a set of health indicators that examine health workers’ effort and ability, as well as the availability of key inputs and resources that contribute to the functioning of a health facility. Data are derived from facility surveys. Click here to learn more about what is included in SDI surveys.

Service Provision Assessment (SPA). SPA is a survey is a health facility assessment that provides a comprehensive overview of a country’s health service delivery. It collects information on the overall availability of different facility-based health services in a country and their readiness to provide those services. Click here to learn more about what is included in SPA surveys.

Limitations

Different health facility assessments evaluate clean water, electricity and sanitation services differently.

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Rationale

Facility density is primarily an indicator of outpatient service access and may indicate the accessibility of primary health care facilities. Health centers were selected because they are often the first contact point that many individuals have with the PHC system.

Construction

Numerator: Total number of health centers

Denominator: Total population of country (expressed per 100,000 population)

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Global Health Observatory (GHO). Information is collected directly from country focal points from ministries of health through the baseline country survey on medical devices 2013 update, conducted by HQ/HIS/EMP/PAU. The population data was obtained from World Population Prospects 2012 Revision (2013 medium estimates). Read more here. 

Limitations

This indicator does not take into account the size or capacity of the facilities. Additionally, the density of health centers and health posts is often reported as an average and therefore doesn’t reflect the equity of distribution of health centers and health posts throughout the country.

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Rationale

Facility density is primarily an indicator of outpatient service access, and may indicate the accessibility of primary health care facilities. Health posts were selected because they are often the first contact point that many individuals have with the PHC system.

Construction

Numerator: Total number of health posts

Denominator: Total population of country (expressed per 100,000 population)

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Global Health Observatory (GHO). Information is collected directly from country focal points from ministries of health through the baseline country survey on medical devices 2013 update, conducted by HQ/HIS/EMP/PAU. The population data was obtained from World Population Prospects 2012 Revision (2013 medium estimates) (GHO, accessed August 2015). Read more here. 

Limitations

This indicator does not take into account the size or capacity of the facilities. More developed health systems may not utilize health posts as a primary point of contact. As a result, those systems may have low density on this measure. Additionally, the density of health centers and health posts is often reported as an average and therefore doesn’t reflect the equity of distribution of health centers and health posts throughout the country.

Full Name

Rationale

Preparing the health workforce to work towards the attainment of a country's health objectives represents one of the most important challenges for its health system. Methodologically, there are no gold standards for assessing the sufficiency of the health workforce to address the health care needs of a given population. It has been estimated however, in the World Health Report 2006, that countries with fewer than 23 physicians, nurses and midwives per 1,000 population generally fail to achieve adequate coverage rates for selected primary health care interventions as prioritized by the Millennium Development Goals framework.

Construction

Numerator: Total number of nurses and midwifery personnel

Denominator: Total population of country (expressed per 1,000 population)

Expressed as density of nurses and midwives per 1,000 population.

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Global Health Observatory (GHO). Population is derived from United Nations Population Division's World Population Prospects database. Nurse and midwife counts are derived from: population censuses, labor force and employment surveys, health facility assessments and routine administrative information systems (including reports on public expenditure, staffing and payroll as well as professional training, registration and licensure). Read more here. 

Limitations

The classification of health workers is based on criteria for vocational education and training, regulation of health occupations, and the activities and tasks involved in carrying out a job, i.e. a framework for categorizing key workforce variables according to shared characteristics. While much effort has been made to harmonize the data to enhance comparability, the diversity of health worker roles and information sources means that considerable variability remains across countries and over time in the coverage and quality of the original data. Some figures may be underestimated or overestimated when it is not possible to distinguish whether the data include health workers in the private sector, double counts of health workers holding two or more jobs at different locations, workers who are unpaid or unregulated but performing health care tasks, or people with a health related education working outside the health care sector (e.g. at a research or teaching institution) or who are not currently engaged in the national health labour market (e.g. unemployed, migrated, retired or withdrawn from the labour force for personal reasons).

Full Name

Rationale

Preparing the health workforce to work towards the attainment of a country's health objectives represents one of the most important challenges for its health system. Methodologically, there are no gold standards for assessing the sufficiency of the health workforce to address the health care needs of a given population. It has been estimated however, in the World Health Report 2006, that countries with fewer than 23 physicians, nurses and midwives per 1,000 population generally fail to achieve adequate coverage rates for selected primary health care interventions as prioritized by the Millennium Development Goals framework.

Construction

Numerator: Total number of physicians

Denominator: Total population of country (expressed per 1,000 population)

Expressed as density of physicians per 1,000 population.

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Global Health Observatory (GHO). Population is derived from United Nations Population Division's World Population Prospects database. Physician counts are derived from: population censuses, labor force and employment surveys, health facility assessments and routine administrative information systems (including reports on public expenditure, staffing and payroll as well as professional training, registration and licensure). Read more here. 

Limitations

The classification of health workers is based on criteria for vocational education and training, regulation of health occupations, and the activities and tasks involved in carrying out a job, i.e. a framework for categorizing key workforce variables according to shared characteristics. While much effort has been made to harmonize the data to enhance comparability, the diversity of health worker roles and information sources means that considerable variability remains across countries and over time in the coverage and quality of the original data. Some figures may be underestimated or overestimated when it is not possible to distinguish whether the data include health workers in the private sector, double counts of health workers holding two or more jobs at different locations, workers who are unpaid or unregulated but performing health care tasks, or people with a health related education working outside the health care sector (e.g. at a research or teaching institution) or who are not currently engaged in the national health labour market (e.g. unemployed, migrated, retired or withdrawn from the labour force for personal reasons).

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Rationale

To effectively provide essential health services, health facilities must have available minimum levels of vaccines, including but not limited to measles, DPT, oral polio, and pneumococcal.

Construction

Numerator: Number of unexpired vaccines from the defined list available in a facility

Denominator: Total number of vaccines on the defined list

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

The specific list of vaccines facilities are assessed against varies depending on the data source. We chose to include values from SARA, SDI, and SPA facility assessments where available, recognizing that there are slight definitional differences.

Service Availability and Readiness Assessment (SARA): SARA is a health facility assessment tool designed to assess and monitor the service availability and readiness of the health sector and to generate evidence to support the planning and managing of a health system. SARA is designed as a systematic survey to generate a set of tracer indicators of service availability and readiness. Click here to learn more about what is included in SARA surveys.

Service Delivery Indicators (SDI). SDI is a set of health indicators that examine health workers’ effort and ability, as well as the availability of key inputs and resources that contribute to the functioning of a health facility. Data are derived from facility surveys. Click here to learn more about what is included in SDI surveys.

Service Provision Assessment (SPA). SPA is a survey is a health facility assessment that provides a comprehensive overview of a country’s health service delivery. It collects information on the overall availability of different facility-based health services in a country and their readiness to provide those services. Click here to learn more about what is included in SPA surveys.

Limitations

Different health facility assessments note the availability of different sets of essential vaccines, making this indicator more complicated to standardize across methods. In addition, the list must reflect the national standards. The availability of vaccines is a point-in-time indicator and thus does not reflect whether facilities have the resources and capacity required to maintain vaccine stock levels over time, nor does it measure frequency of stock-outs.

Full Name

Rationale

Delivery of high-quality care requires the presence of competent providers who provide evidence-based clinical care. Clinical vignettes can be used to evaluate a provider’s clinical approach on a set of tracer conditions, including (i) malaria with anemia; (ii) diarrhea with severe dehydration; (iii) pneumonia; (iv) pulmonary tuberculosis; (v) diabetes; (vi) post-partum hemorrhage; and (vii) neonatal asphyxia.

Construction

Numerator: Total number of relevant history and examination questions asked by the provider

Denominator: Total number of relevant history and examination questions that should have been asked by the provider

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Service Delivery Indicators (SDI). SDI is a set of health indicators that examine health workers’ effort and ability, as well as the availability of key inputs and resources that contribute to the functioning of a health facility. Data are derived from facility surveys. Click here to learn more about what is included in SDI surveys.

Limitations

The limitation of clinical vignettes is that they measure a provider’s abilities in a theoretical scenario, but do not capture “real world” phenomena. They are designed to approximate and isolate aspects of the decision-making process that occur in real world settings (i.e., assess the provider “know-do” gap). Other approaches to evaluate adherence to guidelines include use of standardized patients, patient reporting, and observations of clinical encounters.

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Rationale

Pneumonia is a leading cause of child illness and mortality. The strategy for ending preventable child deaths from pneumonia and diarrhea includes a focus on encouraging appropriate care seeking, a key link to receiving appropriate treatment. A number of strategies and programmes to improve care seeking have been developed and implemented in a number of countries.

Construction

Numerator: Number of children (0-59 months) with suspected pneumonia in the two weeks preceding the survey taken to an appropriate health provider
Denominator: Number of children (0-59 months) with suspected pneumonia in the two weeks preceding the survey
 

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Demographic and Health Survey (DHS). DHS is a nationally-representative household survey that provides data for a wide range of monitoring and impact evaluation indicators in the areas of population, health, and nutrition. Standard DHS surveys have large sample sizes (usually between 5,000 and 30,000 households) and typically are conducted about every 5 years, to allow comparisons over time. Read more here.

Multipler Indicator Cluster Survey (MICS). MICS is a household survey that produces internationally comparable, rigourous data with a focus on women and children. Read more here. 

Limitations

Results are taken from surveys and as a result are subject to recall bias and limitations due to survey design.

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Rationale

From the perspective of a patient visiting a health facility, caseload is a critically important measure impacting wait time and access to providers. From a provider perspective, caseload is a central component of total workload and measure of efficiency and productivity. A shortage of providers may cause patient caseload to rise and potentially compromise service quality and reduce provider motivation.

Construction

Numerator: Number of outpatient visits recorded in outpatient records in the health facility three months prior to the survey

Denominator: Number of days the facility was open during the three-month period and the number of health workers who conduct patient consultations

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

A lack of international agreement exists on the ideal provider caseload.

Service Delivery Indicators (SDI). SDI is a set of health indicators that examine health workers’ effort and ability, as well as the availability of key inputs and resources that contribute to the functioning of a health facility. Data are derived from facility surveys. Click here to learn more about what is included in SDI surveys.

Limitations

Caseload does not measure the full workload experienced by a provider, which includes administrative work and other non-clinical activities. It also does not capture the quality of care.

Full Name

Rationale

Delivery of high-quality care requires the presence of competent providers who provide evidence-based clinical care. Clinical vignettes can be used to evaluate a provider’s clinical approach on a set of tracer conditions, including (i) malaria with anemia; (ii) diarrhea with severe dehydration; (iii) pneumonia; (iv) pulmonary tuberculosis; (v) diabetes; (vi) post-partum hemorrhage; and (vii) neonatal asphyxia.

Construction

Numerator: For each clinical case, a score of one is assigned for each clinical case if the diagnosis is mentioned. The numerator is the sum of the total number of correct diagnoses identified. Where multiple diagnoses were provided by the clinician, the diagnosis is coded as correct as long as it is mentioned, irrespective of what other alternative diagnoses were given.

Denominator: Total number of clinical cases tested.

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Service Delivery Indicators (SDI). SDI is a set of health indicators that examine health workers’ effort and ability, as well as the availability of key inputs and resources that contribute to the functioning of a health facility. Data are derived from facility surveys. Click here to learn more about what is included in SDI surveys.

Limitations

The limitation of clinical vignettes is that they measure a provider’s abilities in a theoretical scenario, but do not capture “real world” phenomena. They are designed to approximate and isolate aspects of the decision-making process that occur in real world settings. However, making the correct diagnosis does not ensure the provision of appropriate care (the “know-do” gap). Other approaches to evaluate adherence to guidelines include use of standardized patients, patient reporting, and observations of clinical encounters.

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Rationale

Immunization is an essential component for reducing under-five mortality. Immunization coverage estimates are used to monitor coverage of immunization services and to guide disease eradication and elimination efforts. Measuring the gap between DTP1 and DTP3 reflects continuity within a health system, including the system’s ability to capture and follow up with patients.

Construction

This indicator is constructed from two separate measures. 

Numerator: [DTP1 Immunization Coverage - DTP3 Immunization Coverage]

Denominator: DTP1 Immunization Coverage . 

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

WHO/UNICEF. The WHO and UNICEF regularly report and release updated immunization coverage data related to the Global Vaccine Action Plan.

Limitations

Given the prevalence of global support for immunization efforts, a high coverage rate of DTP3 immunization may be reflective of strong support from vertical programming in some countries. As such, DTP3 coverage alone is not necessarily a proxy for primary care health system performance.

Full Name

Rationale

This indicator reflects user-reported geographic access barriers complements measures of other barriers to access. Geographic access is a critical component of health services access, and extensive distance traveled to receive treatment can have detrimental effects on the utilization and effectiveness of health services.

Construction

Numerator: Number of women who report the distance to the health facility as a big problem in getting medical advice or treatment when sick

Denominator: Number of women interviewed

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Demographic and Health Survey (DHS). DHS is a nationally-representative household survey that provides data for a wide range of monitoring and impact evaluation indicators in the areas of population, health, and nutrition. Standard DHS surveys have large sample sizes (usually between 5,000 and 30,000 households) and typically are conducted about every 5 years, to allow comparisons over time. Read more here.

Limitations

This indicator captures access barriers due to need to travel for care but depending on how questions are asked, it may not capture barriers to access that are related to cost of transport or travel to obtain medicines required following diagnosis.

Full Name

Rationale

Financial access is a critical component of health services access. This indicator reflects user-reported access barriers and is a complement to measurement of overall out-of-pocket expenditures on health. Access barriers due to cost can have detrimental effects on the utilization of health services.

Construction

Numerator: Number of women who report specific problems in accessing health care when they are sick due to issues related to getting money for treatment

Denominator: Number of women interviewed

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Demographic and Health Survey (DHS). DHS is a nationally-representative household survey that provides data for a wide range of monitoring and impact evaluation indicators in the areas of population, health, and nutrition. Standard DHS surveys have large sample sizes (usually between 5,000 and 30,000 households) and typically are conducted about every 5 years, to allow comparisons over time. Read more here.

Limitations

This indicator captures access barriers due to treatment costs, but it may not capture financial barriers to access that are related to transport or medicines required following diagnosis.

Full Name

Rationale

Having health professionals present in facilities is a necessary condition for delivering health services. Staff absenteeism is also a reflection of the quality of organization and management processes within a health facility.

Construction

Numerator: Number of health professionals that are not off duty who are absent from the facility on an unannounced visit

Denominator: Ten randomly sampled workers who are supposed to be on duty at the facility on the day of the assessment. (Health workers doing fieldwork—mainly community and public health workers—are counted as present.)

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Service Delivery Indicators (SDI). SDI is a set of health indicators that examine health workers’ effort and ability, as well as the availability of key inputs and resources that contribute to the functioning of a health facility. Data are derived from facility surveys. Click here to learn more about what is included in SDI surveys.

Limitations

Having providers present in facilities is necessary but not sufficient for delivery of quality health services, which is dependent on other aspects of service delivery including provider competence and motivation, and availability of equipment.

Full Name

Rationale

Treatment success is an indicator of the performance of national TB programs. It also serves as a proxy for a number of aspects of successful service delivery within a health system, including diagnostic and treatment accuracy and the system’s ability to capture and follow up with patients over time.

Construction

Numerator: Number of TB cases registered in a specified time period that were successfully treated with or without bacteriological evidence of success

Denominator: Total number of TB cases registered in the same period

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Global Health Observatory (GHO). Preferred data sources include patient record and surveillance systems.

Limitations

This indicator measures only public-sector TB programs and does not include results from private-sector treatment programs or facilities. Therefore, in countries with strong private-sector TB programs, these results do not reflect the totality of the TB treatment success rate. Further, this indicator does not capture the system’s ability to identify new TB patients.

Full Name

Rationale

Antenatal care coverage is an indicator of access and use of health care during pregnancy. The antenatal period presents opportunities for reaching pregnant women with interventions that may be vital to their health and wellbeing and that of their infants. Receiving antenatal care at least four times, as recommended by WHO, increases the likelihood of receiving effective maternal health interventions during antenatal visits.

Construction

Numerator: The number of women aged 15-49 surveyed with a live birth in a given time period who received antenatal care four or more times from any provider
Denominator: Total number of women aged 15-49 with a live birth in the same period
 

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

UNICEF. UNICEF compiles empirical data from DHS, MICS and other national household surveys. Available survey data on this indicator usually do not specify the type of provider; therefore, in general, receipt of care by any provider is measured. At the global level, data from facility reporting are not used. Before data are included into the global databases, UNICEF undertakes a process of data verification that includes correspondence with field offices to clarify any questions regarding estimates.

Limitations

Receiving antenatal care during pregnancy does not guarantee the receipt of interventions that are effective in improving maternal health (effective coverage). Although the indicator for “at least one visit” refers to visits with skilled health providers (doctor, nurse, or midwife), “four or more visits” usually measures visits with any provider because national-level household surveys do not collect provider data for each visit. In addition, standardization of the definition of skilled health personnel is sometimes difficult because of differences in training of health personnel in different countries (UNICEF). Recall error is a potential source of bias in the data.

Full Name

Rationale

All women should have access to skilled care during pregnancy and childbirth to ensure prevention, detection and management of complications. Assistance by properly trained health personnel with adequate equipment is key to lowering maternal deaths. 

Construction

Numerator: Number of interviewed women whose last birth was attended by skilled personnel 
Denominator: Total number of interviewed women who had one or more live births in the five years preceding the survey 
 

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Global Health Observatory (GHO). Data for global monitoring are reported by UNICEF and WHO. These agencies obtain the data from national sources, both survey (e.g., Demographic Health Survey) and registry data. 

Limitations

This indicator may not adequately capture women’s access to good quality care, particularly when complications arise. In order to effectively reduce maternal deaths, skilled health personnel should have the necessary equipment and adequate referral options. 
Standardization of the definition of skilled health personnel is sometimes difficult because of differences in training of health personnel in different countries. 
Recall error is another potential source of bias in the data. In household surveys, the respondent is asked about each live birth for a period up to five years before the interview. The respondent may or may not know or remember the qualifications of the attendant at delivery. 
 

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Rationale

Cervical cancer screenings are considered an effective way to identify cervical, and other types, of cancers before they develop. Screening for cervical cancer is also a useful means to identify the presence of sexually transmitted diseases, included human papillomavirus, which, if left undetected, can often lead to cervical cancer. 

Construction

Numerator: Number of female respondents aged 30-49 who report ever having a screening test for cervical cancer
Denominator: Number of female respondents aged 30-49
 

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org .

Data Source Notes

STEPS, WHO. The STEPwise approach to non-communicable disease risk factor surveillance (STEPS) focuses on obtaining core data at each level on the established risk factors that determine the major disease burden. It is based on survey data and may be supplemented by physical and biometric data. Read more here.

Limitations

Potential bias through self reporting may be a limitation, including mistakenly assuming any pelvic exam was a test for cervical cancer. Limited validity of survey instruments is also a limitation. 

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Diarrhea is a leading cause of child illness and mortality. The percentage of children under five with diarrhea receiving oral rehydration and continued feeding is an important indicator of access to health commodities and effective treatment of a common cause of child mortality.

Construction

Numerator: Number of children under 5 years of age with diarrhoea in the two weeks preceding the survey given fluid from ORS packets or pre-packaged ORS fluids and zinc supplement
Denominator: Total number of children aged 0–59 months with diarrhea in the two weeks prior to the survey
 

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

World Development Indicators (World Bank), Data are sourced from UNICEF, State of the World’s Children, Child info, and Demographic and Health Surveys.

Limitations

This indicator does not reflect whether oral rehydration salts and continued feeding were given appropriately. Most diarrhea-related deaths are due to dehydration, and many of these deaths can be prevented with the use of oral rehydration salts at home. However, recommendations for the use of oral rehydration therapy have changed over time based on scientific progress, so it is difficult to accurately compare use rates across countries. Until the current recommended method for home management of diarrhea is adopted and applied in all countries, the data should be used with caution.
The prevalence of diarrhea may vary by season. Since country surveys are administered at different times, data comparability is further affected. 
 

Rationale

Use of modern contraception is a critical component of women’s, maternal, and population health. This indicator serves as a proxy for population access to reproductive health services, particularly women’s access, which are frequently delivered through the primary health care system and are essential for meeting many health targets. Demand satisfied with a modern method is SDG indicator 3.7.1.

Construction

Numerator: Number of women of reproductive age (15–49 years old) who are currently using, or whose sexual partner is currently using, at least one modern contraceptive method
Denominator: Total demand for family planning (the sum of contraceptive prevalence (any method) and the unmet need for family planning)
 

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Demographic and Health Survey (DHS). DHS is a nationally-representative household survey that provides data for a wide range of monitoring and impact evaluation indicators in the areas of population, health, and nutrition. Standard DHS surveys have large sample sizes (usually between 5,000 and 30,000 households) and typically are conducted about every 5 years, to allow comparisons over time. Read more here. 

Limitations

In some surveys, the lack of probing questions, asked to ensure that the respondent understands the meaning of the different contraceptive methods, can result in an underestimation of contraceptive prevalence. Sampling variability may be an issue, particularly when contraceptive prevalence, modern methods is measured for a specific subgroup (according to method, age-group, level of educational attainment, place of residence, etc.) or when analyzing trends over time. This indicator is a measure of both service coverage and fertility preferences and, as such, no target exists.

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Managing diabetes is important to prevent long-term damage to vital organs, including the kidneys, eyes, heart and nerves as well as increase the risk of stroke and kidney disease.  

Construction

Numerator: Number of adults with diabetes mellitus, on medication with blood pressure controlled (Capillary whole blood value: < 6.1 mmol/L (110mg/dl))

Denominator: Adult population with diabetes mellitus (age range differs by country)

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

STEPS, WHO. The STEPwise approach to non-communicable disease risk factor surveillance (STEPS) focuses on obtaining core data at each level on the established risk factors that determine the major disease burden. It is based on survey data and may be supplemented by physical and biometric data. Read more here.

Limitations

Diabetes control should be coupled with non-pharmacological methods, including weight loss, and reduced alcohol and salt consumption. 

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Immunization is an essential component for reducing under-five mortality. Immunization coverage estimates are used to monitor coverage of immunization services and to guide disease eradication and elimination efforts.

Construction

Numerator: Number of children of aged 12 months surveyed who have received three doses of the combined diphtheria, tetanus toxoid and pertussis vaccine in a given year 
Denominator: Total population of children aged 12 months surveyed
 

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Global Health Observatory (GHO). The WHO and UNICEF regularly report and release updated immunization coverage data related to the Global Vaccine Action Plan. Read more here. 

Limitations

Given the prevalence of global support for immunization efforts, a high coverage rate of DTP3 immunization may be reflective of strong support from vertical programming in some countries. As such, DTP3 coverage alone is not necessarily a proxy for health system performance.

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Hypertension is a serious condition that plays a role in a variety of adverse health outcomes, including heart attack, stroke and early death. Control of hypertension has been found to significantly decrease the risk of adverse health outcomes. 

Construction

Numerator: Number of adults with hypertension, on medication with blood pressure controlled (Systolic BP </= 140, diastolic BP </= 90) 
Denominator: Adult Population with hypertension (age range differs by country)
 

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org .

Data Source Notes

STEPS, WHO. The STEPwise approach to non-communicable disease risk factor surveillance (STEPS) focuses on obtaining core data at each level on the established risk factors that determine the major disease burden. It is based on survey data and may be supplemented by physical and biometric data. Read more here. 
Demographic and Health Survey (DHS). is a nationally-representative household survey that provides data for a wide range of monitoring and impact evaluation indicators in the areas of population, health, and nutrition. Standard DHS surveys have large sample sizes (usually between 5,000 and 30,000 households) and typically are conducted about every 5 years, to allow comparisons over time. Read more here. 
 

Limitations

Hypertension control should be coupled with non-pharmacological methods, including weight loss, reduced alcohol and salt consumption, and lowered stress. 

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ART has been shown to reduce HIV-related morbidity and mortality among people living with HIV and to reduce transmission of HIV. Effective provision of ART can be a marker of how well a health system reaches marginalized populations with higher HIV prevalence.

Construction

Numerator: Number of adults and children who are currently receiving ART at the end of the reporting period
Denominator: Estimated number of adults and children living with HIV
 

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Global Health Observatory (GHO). GHO data on receipt of ART can be collected from facility-based ART registers or drug supply management systems. To estimate the denominator, a standard modelling HIV estimation method, such as in the Spectrum model, is recommended. Read more here.

Limitations

The indicator permits monitoring trends in coverage but does not attempt to distinguish between different forms of antiretroviral therapy or to measure the cost, quality or effectiveness of, or adherence to the treatment regimen provided. These will each vary within and between countries and are liable to change over time.
The indicator measures the number of people provided with medication but does not measure whether the individual took the medication thus it is not a measure of adherence.
 

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Rationale

This indicator combines case detection rate with treatment success rate to estimate how well the system is detecting and successfully treating TB cases. Treatment success is an indicator of the performance of national TB programs. It also serves as a proxy for a number of aspects of successful service delivery within a health system, including diagnostic and treatment accuracy and the system’s ability to capture and follow up with patients.

Construction

Numerator: Number of new and relapse cases notified and treated in a given year
Denominator: Number of estimated incident cases in the same year
 

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Estimates of TB incidence are produced through a consultative and analytical process led by WHO and are published annually. These estimates are based on annual case notifications, assessments of the quality and coverage of TB notification data, national surveys of the prevalence of TB disease, and information from death (vital) registration systems. Estimates of incidence for each country are derived, using one or more of the following approaches depending on available data:

1. incidence = case notifications/estimated proportion of cases detected;
2. incidence = prevalence/duration of condition;
3. incidence = deaths/proportion of incident cases that die.

These estimates of TB incidence are combined with country-reported data on the number of cases detected and treated, and the percentage of cases successfully treated, as described above.
 

Limitations

The proposed data source for this indicator measures only public sector TB programs and does not include results from private-sector treatment programs or facilities. Therefore, in countries with strong private-sector TB programs, the results do not reflect the totality of the TB treatment success rate.

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Rationale

ITNs are a form of personal protection that has been shown to reduce malaria illness, severe disease, and death due to malaria in endemic regions. In community-wide trials in several African settings, ITNs have been shown to reduce the death of children under 5 years from all causes by about 20%.

Construction

Numerator: Number of people in malaria-endemic areas who slept under an ITN
Denominator: Total number of people in malaria endemic areas
 

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

Demographic Health Study (DHS). Data compiled by WHO from Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS), and Malaria Indicator Surveys. Data on the number of ITNs delivered by manufacturers to countries are compiled by Milliner Global Associates, and data on the number of ITNs distributed within countries are reported by National Malaria Control Programs. Read more here.

Limitations

Survey data is subject to recall bias and the estimate of total bed net usage is derived from a model.

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Rationale

Measuring how many people die each year and why they died is one of the most important means – along with gauging how diseases and injuries are affecting people – for assessing the effectiveness of a country’s health system. Cause-of-death statistics help health authorities determine their focus for public health actions.

Construction

Numerator: Number of 30-year-old-people who would die before the age of 70 years from cardiovascular disease, cancer, diabetes, or chronic respiratory disease, assuming that s/he would experience current mortality rates at every age and s/he would not die from any other cause of death (e.g., injuries or HIV/AIDS).
Denominator: Population aged 30-70
 

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org .

Data Source Notes

Global Health Observatory (GHO). Information is collected directly from country focal points from ministries of health through the baseline country survey on medical devices 2013 update, conducted by HQ/HIS/EMP/PAU. The population data was obtained from World Population Prospects 2012 Revision (2013 medium estimates). Read more here. 

Limitations

Comprehensive uncertainty ranges have not yet been addressed for the GHE cause of death estimates although uncertainty ranges are available for many of the component analyses for specific causes. General guidance on the quality and uncertainty of these cause of death estimates for years 2000-2012 is provided in terms of the quality of data inputs and methods used. 

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Rationale

Equity is an important dimension of PHC systems but is often masked by national level statistics. Large differences in under-five mortality between wealth quintiles may indicate disparities in access to child health care services. 

Construction

Numerator: [Wealth Q5 U5 mortality rate] – [Wealth Q1 U5 mortality rate] 
Denominator: Not applicable 
 

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org .

Data Source Notes

Global Health Observatory (GHO). 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. Data are derived from re-analysis of DHS micro-data which are publicly available using the standard indicator definitions as published in DHS documentation. Read more here. 

Limitations

The reliability of estimates of under-five mortality depends on the accuracy and completeness of reporting and recording of births and deaths. Underreporting and misclassification are common. This indicator reports only socioeconomic quintile differences, and therefore does not capture other aspects of equity. 

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Rationale

Complications during pregnancy and childbirth are a leading cause of death and disability among women of reproductive age in developing countries. The maternal mortality ratio represents the obstetric risk associated with each pregnancy. It is also a Millennium Development Goal Indicator for monitoring Goal 5, improving maternal health. 

This indicator monitors deaths related to pregnancy and childbirth. It reflects the capacity of the health systems to provide effective health care in preventing and addressing the complications occurring during pregnancy and childbirth. 
 

Construction

Numerator: Number of maternal deaths
Denominator: Number of live births (expressed per 100,000 live births)
 

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

UN MMEIG 2015. Data on maternal mortality and other relevant variables are obtained through databases maintained by WHO, UNPD, UNICEF, and the World Bank. Data available from countries vary in terms of the source and methods. Given the variability of the sources of data, different methods are used for each data source in order to arrive at country estimates that are comparable and permit regional and global aggregation. 

Limitations

Vital registration and health information systems in most developing countries are weak, and thus, cannot provide an accurate assessment of maternal mortality. Even estimates derived from complete vital registration systems, such as those in developed countries, suffer from misclassification and underreporting of maternal deaths. 

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Mortality during the neonatal period accounts for a large proportion of child deaths and is considered to be a useful indicator of maternal and newborn neonatal health care. Neonatal mortality rate is a Sustainable Development Goal Indicator for monitoring child health. 

Construction

Numerator: Number of deaths of neonates at ages 0-28 days 
Denominator: Number of live births for a specified year (expressed per 1,000 live births) 
 

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

UN IGME 2015. The Inter-agency Group for Child Mortality of Estimation, which includes representatives from UNICEF, WHO, the World Bank and the United Nations Population Division, produces trends of neonatal mortality with standardized methodology by group of countries depending on the type and quality of source of data available. These neonatal rates are estimates, derived from the estimated UN IGME neonatal rate and infant population from World Population Prospects to calculate the live births; hence they are not necessarily the same as the official national statistics. 

Limitations

The reliability of estimates of neonatal mortality depends on the accuracy and completeness of reporting and recording of births and deaths. Underreporting and misclassification are common. 

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Rationale

Under-five mortality rate measures child survival. It also reflects the social, economic and environmental conditions in which children (and others in society) live, including their health care. Because data on the incidences and prevalence of diseases (morbidity data) frequently are unavailable, mortality rates are often used to identify vulnerable populations. Under-five mortality rate is an MDG indicator.

Construction

Numerator: Deaths among children under 5 years of age 
Denominator: Number of live births (expressed per 1,000 live births). 
 

Notes

The PHCPI Core Indicators rely on third party data. To learn more about our data, please review our methodology note, or e-mail us at info@improvingPHC.org.

Data Source Notes

UN IGME 2015. The Inter-agency Group for Child Mortality of Estimation, which includes representatives from UNICEF, WHO, the World Bank and the United Nations Population Division, produces trends of under-five mortality with standardized methodology by group of countries depending on the type and quality of source of data available. For countries with adequate trend of data from civil registration, the calculations of under-five and infant mortality rates are derived from a standard period abridged life table. For countries with survey data, under-five mortality rates are estimated using the Bayesian B-splines bias-adjusted model. These under-five mortality rates have been estimated by applying methods to all Member States to the available data from Member States that aim to ensure comparability of across countries and time; hence they are not necessarily the same as the official national data.

Limitations

The reliability of estimates of under-five mortality depends on the accuracy and completeness of reporting and recording of births and deaths. Underreporting and misclassification are common. 

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