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Objectives of the Meeting

Objectives of the Meeting. Health Metrics Network / WHO / UNICEF / Macro Int. meeting on Health Surveys July 10-11 2007, Calverton Maryland. Objectives.

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Objectives of the Meeting

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  1. Objectives of the Meeting Health Metrics Network / WHO / UNICEF / Macro Int. meeting on Health Surveys July 10-11 2007, Calverton Maryland

  2. Objectives • 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.

  3. Four Specific objectives

  4. Survey modulesRegular survey, variable contents Module A Module A Module A Module A Module A Module A Module A Module A Module A short Module A Module J long Module H long Module E long Module A 0 2 4 6 8 ..10 ………………….………………Years…………….………………………..

  5. Specific objective 1Health survey modules

  6. 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.

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

  8. 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

  9. Specific objective 2Harmonization and streamlining

  10. Capacity 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

  11. 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

  12. Specific objective 3Analytical capacity building

  13. Gaps 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

  14. Specific objective 4Filling gaps in knowledge

  15. Standardized health survey modules Health surveys meeting Calverton Md 10/11 July 2007

  16. 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

  17. Survey modulesShort and long versions Short Long Module A Module A Module J long Module A Module A Module H long Module A Module A Module E long Module A Module A Module A Module A short Module A

  18. Survey modulesTypes of survey Comprehensive survey MCH survey Module J Module I Module G Duration and complexity of survey Module H Module G Module F Module F Module E Module C Single topic survey Module D Module C Module B Module E Module B Module A Module A Module A

  19. Survey modulesRegular survey, variable contents Module A Module A Module A Module A Module A Module A Module A Module A Module A short Module A Module J long Module H long Module E long Module A 0 2 4 6 8 ..10 ………………….………………Years…………….………………………..

  20. 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

  21. Selection 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

  22. Possible 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

  23. 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

  24. Example 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

  25. Process • 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

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