|Reproductive Health Indicators for Global Monitoring: A Report of an Interagency Technical Meeting (WHO - OMS, 1997, 22 p.)|
For the past fifteen years WHO has been monitoring and evaluating progress in implementing the global strategy for health for all adopted by its Member States in 1979. Consequently it has gained considerable experience in selecting, and using global health indicators for the purpose of monitoring global health development. The primary objectives of this monitoring and evaluation process are:
· to follow all aspects of the implementation of the global health for all strategy and to report on progress made and problems encountered to WHO governing bodies
· to foster, induce and support, at national level, the practice of periodically evaluating the implementation of national strategies for health for all with the aim of strengthening the managerial process for national health development
· to collect, validate, analyse and disseminate national data of international significance.
In practice, the coverage of data received to generate global indicators has been disappointing. For 58% of the indicators selected for the third monitoring (1994) data were only received from countries representing less than 25% of the world population. Several reasons are given for these poor returns. Some indicators were obsolete and others were poorly defined, with no internationally accepted definition. Insufficient resources were mobilized, both nationally and internationally, for such an important exercise. The lack of political support and visibility may have lead some national counterparts to consider the exercise as an administrative duty rather than as an opportunity to learn from the past in order to plan better for the future.
In light of the above WHO revised and reduced the indicators for the third evaluation (1997) according to strict selection criteria which included the need for indicators that are:
· robust, relevant and useful - that is they can and will be used by policy makers and are acceptable as national indicators
· generated through data collection methods which do not require efforts from institutional levels that have no use for them
· generated through procedures which are sustainable by the national and international administrations responsible.
Several UN institutions have shown keen interest in identifying suitable indicators for the purpose of monitoring various aspects of health development. WHOs mandate is to act as the directing and coordinating authority on international health work. In WHOs experience indicators proposed by UN institutions for the purpose of health development, monitoring or evaluation should be:
· defined and selected according to strict criteria paying particular attention to their usefulness to national decision-makers
· supported by methodology sheets
· reviewed and discussed with sister organisations
· promoted as part of strengthening national health information systems
· proposed to information specialists with the active participation and support of national decision-makers
· put in perspective with indicators needed to monitor different aspects of health development.
UNICEFs experiences with monitoring progress towards the goals and objectives set out in the World Summit for Children Declaration and Plan of Action provide additional insights into selecting and using global indicators.
The Plan of Action called for each country to, establish appropriate mechanisms for the regular and timely collection, analysis and publication of data required to monitor social indicators related to the well-being of children. Sixty indicators were developed to monitor the goals, 11 were related to reproductive health.
The burden of collecting such a volume of information soon became apparent, particularly considering the paucity of reliable, current national data for goal-indicators. To reduce the information needs to specific areas critical to the survival and development of each child, 13 mid-decade goals were adopted. Prompted by the need to report progress towards these goals by mid-decade UNICEF, in collaboration with other agencies including WHO, UN Statistical Office, and the U.S. Centers for Disease Control, developed and promoted national sample household surveys world-wide to collect the required data. These surveys, which have come to be known as Multiple-Indicator Cluster Surveys (MICS), were intended to produce nationally representative and statistically robust estimates, of sufficient quality to withstand international scientific scrutiny. They were designed as an integral component of national capacity building for programmatic action and policy review in each of the goal areas. They were also intended to foster inter-sectoral collaboration in the process.
A standardized questionnaire and survey methodology, including sampling guidelines, were developed in late 1994 and were documented in A Practical Handbook for Multiple Indicator Surveys (Monitoring Progress Toward the Goals of the World Summit for Children).
The guidelines in the Handbook are flexible and framed in a way to be relevant to a range of country situations; but they are only guidelines. Thus the surveys have been adapted locally, with respect to sample size and design, the number of modules included, and other areas of inquiry.
As of July 1997, some 59 countries had conducted MICS surveys. Forty-six final reports and 5 preliminary reports are currently available at UNICEF headquarters. Nearly half of the MICS surveys were conducted in Sub-Saharan Africa (29 surveys), with seventeen in West Africa. In Latin America, only two MICS surveys were conducted. Some countries, such as China and India have implemented these surveys at the sub-national level. In India some 200 MICS have been conducted at the state level.
The level of survey activity is a good indication of the poverty of current data on these important indicators. The MICS initiative has gone a long way to redressing this problem. Quite apart from international goal monitoring, the survey results are expected to be extremely useful at the level of national policy reviews, mobilization of action and national capacity building in programme monitoring.