Health • “Astate of complete physical, mental & social wellbeing, and not merely an absence of disease or infirmity” (WHO). • Amplified to include the ability to lead a “socially and economically productive life” • Health cannot be measured in exact measurable forms. • illness (or lack of health), consequences of ill-health (morbidity, mortality) & economic, occupation & domestic factors that promote ill health.
Indicators WHO defines Indicators as: “variables which measure change”
Indicators of Health • Health Indicator is a variable, susceptible to direct measurement, that reflects the state of health of persons in a community. • Indicators help to measure the extent to which the objectives and targets of a programme are being attained.
Characteristics • Valid– actually measure that they are supposed to measure • Reliable – results should be the same when measured by different people in similar circumstances • Sensitive – sensitive to changes in the situation concerned • Specific– reflect changes only in the situation concerned • Feasible – have the ability to obtain data when needed • Relevant– contribute to the understanding of the phenomenon of interest
Classification of Indicators of Health • Mortality Indicators • Morbidity Indicators • Disability Rates • Nutritional Indicators • Health Care Delivery Indicators • Utilization Rates • Indicators of Social And Mental Health • Environmental Indicators • Socio-economic Indicators • Health Policy Indicators • Indicators of Quality of Life • Other Indicators
Mortality Indicators • Crude Death Rate • Infant mortality rate • Child Mortality Rate • Maternal Mortality Rate • Disease Specific Death Rate
Year of potential life lost Year of life lost through premature death. • Death which occurs before the age to which a dying person could have expected to survive (75 yrs).
Morbidity Indicators Incidence • Number of new events or cases occurring in a defined population, during a specified period of time. • Ex: Incidence of TB (new sputum+ve cases) is 168 per 100000 population per year. Prevalence • The total number of all individuals who have an attribute or disease at a particular time divided by population at risk of having attribute or disease at this point of time or midway through the period. • Ex: Prevalence of TB (sputum+ve in population) is 249 per 100000 population .
Morbidity Indicators • Notification rate • Attendance rates at OPDs and at health centers. • Admission, Readmission and discharge rates. • Duration of stay in hospital • Spells of sickness or absence from work or school.
Disability Rates Disability Rates are of two categories • Event type Indicators - number of days of restricted activity - bed disability days - work-loss days within a specified period • Person type Indicators - limitation of mobility - limitation of activity: basic activity of daily living
Disability Rates HALE(Health Adjusted Life Expectancy) 1. life expectancy at birth but includes an adjustment for time spent in poor health. • Number of years in full health that a newborn can expect to live based on current rates of ill-health and mortality. • HALE FOR INDIA IS 53 YEARS.
Nutritional Status Indicators • Positive health indicator Anthropometric measurements ofpre-school children • Weight • Height • Mid-arm circumference • Growth Monitoring of children • Prevalence of low birth weight
Health Care Delivery Indicators • Equity of distribution of health resources in different parts of the country and of the provision of health care • Doctor-population Ratio – 1/1700 (Norm 1/1000) • Nurse-population ratio – 0.8/1000 (Norm 1/500) • Doctor- nurse ratio • Population-bed Ratio – 8.9/10000 • Population per PHC/sub center
UTILIZATION RATES • Actual coverage is expressed as the proportion of people in need of a service who actually receive it in a given period, usually a year. • Depends on availability & accessibility of health services and the attitude of an individual towards health care system • Direct attention towards discharge of social responsibility for the organization in delivery of services
Environmental Indicators • Reflect quality of physical and biological environment in which diseases occur and people live. • most important: that measuring the proportion of population having access to safe drinking water and sanitation facilities. • explains the prevalence of communicable diseases
contd…. • Health status indicators • Low birth weight • Nutritional status and psychosocial development of children • Infant mortality • Child mortality rate (1-4yrs) • Life expectancy at birth • Maternal mortality rate • Disease specific mortality • Morbidity – incidence and prevalence • Disability prevalence