Vital Statistics and Data Management for Evidence Health Situation and Trend Assessment

1. Vital Statistics and Data Management for EvidenceHealth Situation and Trend Assessment Workshop on Civil Registration and Vital Statistics in UNESCWA Region, Cairo, Egypt, 3-6 December 2007 By Dr Samuel Mikhail EMRO/WHO

2. Content • Introduction • vital statistics • The country's / EMRO system • Appropriate use of health statistics • Vital Statistics and discrepancies • Barriers and constraints • Discrepancies on Country’s / UN Estimates • Unification of Database – Inter-country – inter-UN organizations

3. Introduction:- Policies and programmes to combat diseases and injuries should be based on current information about he nature and extent of health problems, their determinants, and how the impact of such diseases and injuries is changing, both with respect to magnitude and distribution in populations. - priorities for health research should, in part at least, be based on a thorough assessment of the relative importance of various diseases and injuries affecting the population's health

4. - commonly used data for meeting these needs, and related needs for health policy, are statistics on the number of people who die, by age and sex, and on the causes of those deaths, classified according to a standard set of medical criteria. - Almost all countries have legislation that establishes vital registration systems to collect and collate statistics on who dies from what cause.. - Indeed, such systems are still inoperative for a large proportion of the world's population, especially in countries with high burdens of disease.- There's a lack of information on causes of death in many developing countries nevertheless Eastern Mediterranean Region countries, which draw the attention for the urgent need of the WHO and other international health agencies to take a lead in redressing this situation.

5. - World health statistics has been collatedfrompublications and database produced by WHO’s technical programmes and regional member states . • - The core set of indicators was selected on the basis of their relevance to global health, the availability and quality of the data, and the accuracy and comparability of estimates . • - The statistics for the indicators are derived from an interactive process of data collection, compilation, quality assessment and estimation occurring among WHO’s technical programmes and its Member States. • - The core of indicators do not aim to capture all relevant aspects of health but to provide a comprehensive summary of the current status of a population’s health and the health system at country level.

6. - These indicators include : mortality outcomes, morbidity outcomes ,risk factors, coverage of selected health interventions, health systems, inequalities in health, and demographic and socioeconomic statistics. • - World health statistics will be updated regularly ,and it includes the most recent estimates and time-series of relevant health statistics .

7. The vital statistics • Variables • Definitions • Concepts • Ensuring comparability

8. Data request Data request EMRO/EST unit Countries Ministry of Health Technical Units (programs) Regional 0ffice Revised Data Data Refined data with priority for Technical Unit data Resent for approval Regional Health Database Final data revised and approved by countries Approved Country profiles & different reports The current level of existence and functioning of the country's / EMRO systemData Pooling

9. Monitoring progress: appropriate use of health statistics- For monitoring, it is important to distinguish between corrected and predicted statistics. - Corrected statistics use adjustments made for known biases and, if needed, are based on a systemic reconciliation of data from multiple sources using established, transparent methods.- This mismatch was created partly by the demand for more timely statistics and partly by the lack of data and good measurement strategies for certain statistics.- It is crucial for the international community to invest in data collection and use indicators that are valid, reliable and comparable - the international community must also have well-defined measurement strategies for monitoring progress and evaluating health programmes.

10. The civil registration systems of many countries are not well functioning leading to difficulties and challenges when faced with the need of reliable source of statistics especially on vital events. For efficiently and effectively functioning health systems and for countries to be able to identify with their health needs, complete and reliable information on births and deaths by age, sex and cause are needed as are other recordings of vital events on a continuous and complete bases. • The result of such systems is an unstable impact upon decision making, policy formulation, and measurement of health programs. • Furthermore, differences in definitions and concepts of vital events and registration provide difficulty with comparability. Hence, the international standards & guidelines developed by the United Nations need to be applied so that universal comparison is possible.

11. Barriers and constraints:-In many countries and programs; definitions, classifications and method of calculation do not entirely conform to the WHO or international standards.- People (even in statistical offices) still mix between year of estimate and year of reporting. - Delay of reporting the updated and published data either from some countries or UN technical units.- Many countries impose upon the indicators figures by using the same figures which were implied for many years ago for updating recent years.- Countries generally derive their estimates from reported services which are not always available and accurate.- Most countries do not cover the data on various types of government and private health services.

12. - Some countries derive these data from survey, but since survey questions and definitions differ across countries, the estimate may not strictly comparable. - Most countries do not cover the data on various types of government and private health services.- Several figures related to the same indicator for the same year reported in different values and/or previous values.- Some figures reported from country to various regional office units with different values.- Consistency of the data in some indicators is questionable as it is published by several MOH units with different figures on the same dates.

13. Some figures reported to UN technical units and never been routed to WHO/EMRO and/or routed with different figures. • Some Countries not provide future estimations or projections except on population based country figures while some UN sources do that. • Some Countries not covering, collecting and/or reporting all indicators required all users such as MDG indicators • Some UN technical units might think that some of the national data reported by the countries is not accurate or reliable.

14. Discrepancies on Country’s / UN Estimates

15. Population(000S)

16. Population growth rate

17. Total Fertility Rate

18. Infant Mortality Rate/1000 Live births

19. Under 5 Mortality

20. Maternal Mortality

21. Unification of Database • Database is one of the most powerful and important assets an operator possesses. Unfortunately, it is extremely difficult to gather accurate representations in multinomial, converged network environments where data is often locked away in proprietary systems and fragmented across many database. That’s why all operators urgently need a solution that can harness data, wherever it resides, so they can reduce network complexity and cut the time. And that solution needs to be open and flexible enough to help operators migrate along their strategic path to converged programs. The solutions provide the ability to greatly accelerate the launch and support of revenue-generating programs. The aims of the unification of database: • Provide a conceptual framework of information domains. • establish a common language to improve communication; permit comparisons of data • focus on multi-dimensional aspects of programs • Meet the needs of its different and varied users; and provide a platform for users and developers. • Covering all the basic elements: hence the need for the clearness of terminologies and vocabularies. • Provide a common reference point for reporting and statistical use. • Provide a configuration of data/and or information between the units of the division • moreover,

22. Definitions need to be standardized, - and vital statistic variables need to be chosen. Without these norms there will remain an inconsistency and incomparability between the national registration systems. - Without comparability, national systems will loose out on shared experiences to built and improve upon. The system will just be a system of the nation without possible global interaction.

23. Demographic Indicators • Area sq. km • Population Total • Urban % • Crude birth rate • Crude death rate • Population growth rate • Population <15 years • 65+ years • Dependency Ratio • Total fertility rate

24. Socioeconomic Indicators • Adult literacy rate 15+ years T % • M % • F % • Gross primary school enrollment ratio T % • M % • F % • Gross secondary school enrollment ratio T % • M % • F % • Per capita GNP US$ • Population with access to safe drinking water % • Population with adequate excreta disposal facilities % • Unemployed % • Regular smokers 15+ years T % • M % • F %

25. Health Expenditure Indicators • GDP per capita,US$ Exchange rate • Total Health Expenditure per capita,US$ Exchange rate • General Government Expenditure on Health Per Capita, US$ Exchange rate • Total Health Expenditure as % of GDP • General Government Expenditure on Health as % of Total Health Expenditure • Out Of Pocket as % of Total Health Expenditure • MOH's budget as a % of government budget • Human and Physical Resources Indicators, Rate per 10,000 pop • Physicians • Dentists • Pharmacists • Nursing and midwifery personnel • Hospital beds • PHC units and centers

26. Indicators of Coverage with Primary Health Care services • Population with access to local health services Total % • Urban % • Rural % • Married women (15-49) using contraceptives % • Pregnant women attended by trained personnel % • Deliveries attended by trained personnel % • Infants attended by trained personnel % • Infants fully immunized with BCG % • DPT % • OPV % • Measles Vaccine % • Hepatitis B Vaccine % • Pregnant women given TT2+ %

27. Health Status Indicators • Life expectancy at birth ( years) T • M • F • Newborns with birth weight at least 2500 kg % • Children with acceptable weight for age % • Infant mortality rate per 1000 live births • Probability of dying before reaching 5th birthday per 1000 live births • Maternal mortality ratio per 10 000 live births

29. Thank you