1. Development of Core Public Health Indicators for Decision Making. The PAHO’s Experience Carlos Castillo-Salgado, Special Advisor, Forum for Public Health in the Americas, PAHO/WHO “Health & Biomedical Data & Metadata”. Panel 7.1 Atibaia, SP. Brazil. May 9, 2007

2. Forum for Public Health in the Americas. RCHDI: Background The Regional Core Health Data Initiative was launched in 1995 Core Health Data is a minimum set of data and indicators required to characterize the health situation of the Region, Sub-Regions and individual countries The set involves 117 core indicators, disaggregated into 401 basic data /country This minimum set of core indicators allows the monitoring of specific public health goals in the Region of the Americas. Special emphasis given to track the inequalities in health and the monitoring of the Millennium Development Goals The Regional Core Health Data Initiative was launched in 1995 Core Health Data is a minimum set of data and indicators required to characterize the health situation of the Region, Sub-Regions and individual countries The set involves 117 core indicators, disaggregated into 401 basic data /country This minimum set of core indicators allows the monitoring of specific public health goals in the Region of the Americas. Special emphasis given to track the inequalities in health and the monitoring of the Millennium Development Goals

3. Forum for Public Health in the Americas. Goals of the Core Health Data/Country Profile Initiative To orient better health strategic policies To facilitate priority setting in the health sector To improve the evaluation of technical cooperation in each of the countries and programs To assist the countries in developing investment strategies or special programs for more effective health polices and services To facilitate the mobilization of financial resources. To orient research priorities To periodically produce reports on health trends in each country and the Region as a whole To orient better health strategic policies To facilitate priority setting in the health sector To improve the evaluation of technical cooperation in each of the countries and programs To assist the countries in developing investment strategies or special programs for more effective health polices and services To facilitate the mobilization of financial resources. To orient research priorities To periodically produce reports on health trends in each country and the Region as a whole

4. Forum for Public Health in the Americas. Development Assumptions An open access and Web-based application and graphical interface was the best solution to handle the system outputs and its distribution in the Americas. The multi-tier client/server model was the best architecture to put together all the components of the Core Health Data System and to implement the communication platform with the other PAHO Health Technical Information Systems. The Internet infrastructure in the Member States was predicted to be improved over the next years. The system could be adapted for subregional or/and subnational levels in some of the countries. An open access and Web-based application and graphical interface was the best solution to handle the system outputs and its distribution in the Americas. The multi-tier client/server model was the best architecture to put together all the components of the Core Health Data System and to implement the communication platform with the other PAHO Health Technical Information Systems. The Internet infrastructure in the Member States was predicted to be improved over the next years. The system could be adapted for subregional or/and subnational levels in some of the countries.

5. Forum for Public Health in the Americas. Contents Data/Information Types The 117 indicators selected are grouped into the following subjects areas: Demographic (10) Socioeconomic (10) Mortality (31) Morbidity and Risk Factors (30) Resources/Services/Coverage (36) –The values, when pertinent, are desegregated by sex and age group. Data/Information Types The 117 indicators selected are grouped into the following subjects areas: Demographic (10) Socioeconomic (10) Mortality (31) Morbidity and Risk Factors (30) Resources/Services/Coverage (36) –The values, when pertinent, are desegregated by sex and age group.

6. Forum for Public Health in the Americas. Core Health Data Information System Multi-dimensional Table Generator (Tabulator) Dimensions Time. Years Indicator. Dissagregation Space/Geo. Country/Subregion Dimensions Time. Years Indicator. Dissagregation Space/Geo. Country/Subregion

7. Forum for Public Health in the Americas.

8. Specific objectives –Establish sets of consistent, updated, accessible basic data –Articulate institutions for strengthening data and its review –Implement mechanisms to improve information production –Promote consensus on concepts and methods for data use –Promote exchange with other information subsystems –Contribute to the study un explored aspects or of known relevance for the understanding of the health profiles Products –Information system available via Internet –Country brochure (published since 1997), with a central topic since 2000 (infant mortality, violence, the elderly) –Support to Health situation rooms (different levels) –Other publications on concepts and applications Institutions involved –Several agencies of the Ministry of Health, IBGE, FUNASA, IPEA, CONASSEMS, ABRASCO, Public health schools of USP, FIOCRUZ, PAHO, others Specific objectives –Establish sets of consistent, updated, accessible basic data –Articulate institutions for strengthening data and its review –Implement mechanisms to improve information production –Promote consensus on concepts and methods for data use –Promote exchange with other information subsystems –Contribute to the study un explored aspects or of known relevance for the understanding of the health profiles Products –Information system available via Internet –Country brochure (published since 1997), with a central topic since 2000 (infant mortality, violence, the elderly) –Support to Health situation rooms (different levels) –Other publications on concepts and applications Institutions involved –Several agencies of the Ministry of Health, IBGE, FUNASA, IPEA, CONASSEMS, ABRASCO, Public health schools of USP, FIOCRUZ, PAHO, others RIPSA. Inter-agential Network in Health Information. Brazil

9. Forum for Public Health in the Americas. RIPSA: Basic Indicators Internet System

10. Forum for Public Health in the Americas. Core Health Information: New Paradigm of information as an Essential Public Good – Information and Health Situation Analysis as the First Essential Public Health Function. –Health Information for planning, implementation, and evaluation of public health policies and programs at the local level. –Distributions and not only national averages. Level of Aggregation of information and effective use of health information and vital statistics. –Integrated open networks of health and socio-economic information. Assessment and monitoring of health inequalities and health impact assessment. – Information and Health Situation Analysis as the First Essential Public Health Function. –Health Information for planning, implementation, and evaluation of public health policies and programs at the local level. –Distributions and not only national averages. Level of Aggregation of information and effective use of health information and vital statistics. –Integrated open networks of health and socio-economic information. Assessment and monitoring of health inequalities and health impact assessment.

11. Forum for Public Health in the Americas. Results of the 2005 survey to evaluate the impact of the RCDI in 37 countries. Core Data Products Which Core Data Products are periodically updated and distributed?

12. Forum for Public Health in the Americas. Specific open-access outputs of the Regional Core Health Data Initiative Annual Regional brochure “Health Situation in the Americas: Basic Indicators” Integrated Health Information System Glossary and Technical Notes for each Indicator Atlas of Basic Indicators Country Health Profiles Web-based RCHDI Information Platform Annual Regional brochure “Health Situation in the Americas: Basic Indicators” Integrated Health Information System Glossary and Technical Notes for each Indicator Atlas of Basic Indicators Country Health Profiles Web-based RCHDI Information Platform

13. Forum for Public Health in the Americas. Suggested mechanisms and operational instruments for improving RCHDI –Interagency Working Group (technical coordination) –Interdisciplinary technical committees (methodological- operational analysis and validation procedures ) –Indicators management committees (data production and coordination for open access) –Technical Secretariat (process definition, proposals and follow-up) –Indicators Matrix and Technical Sheets for analyses –Common data and indicators database and open interoperable information systems –Interagency Working Group (technical coordination) –Interdisciplinary technical committees (methodological- operational analysis and validation procedures ) –Indicators management committees (data production and coordination for open access) –Technical Secretariat (process definition, proposals and follow-up) –Indicators Matrix and Technical Sheets for analyses –Common data and indicators database and open interoperable information systems

14. Forum for Public Health in the Americas. Results of the 2005 survey to evaluate the impact of the RCHDI in 37 countries. Challenges and Recommendations Challenges for implementing and maintaining RCDI: Lack of sufficient trained human resources Limited access to some information or health data Limited political support and financing in some countries Need for more use and analysis Recommendations to improve RCDI by countries: Improving flow of information between countries and PAHO/WHO offices and headquarters (change of flow paradigm) Greater promotion and open dissemination of information in the Ministry of Health, other health and academic groups, public Reduce the political restrictions for sharing timely information Challenges for implementing and maintaining RCDI: Lack of sufficient trained human resources Limited access to some information or health data Limited political support and financing in some countries Need for more use and analysis Recommendations to improve RCDI by countries: Improving flow of information between countries and PAHO/WHO offices and headquarters (change of flow paradigm) Greater promotion and open dissemination of information in the Ministry of Health, other health and academic groups, public Reduce the political restrictions for sharing timely information

15. Forum for Public Health in the Americas. Thanks! How to contact us: Forum for Public Health in the Americas Pan American Health Organization 525 23rd. St., NW Washington, DC 20037 Tel (202) 974-3327 Fax: (202) 974-3641 Email: forum@paho.orgforum@paho.org www.paho.org Forum for Public Health in the Americas Pan American Health Organization 525 23rd. St., NW Washington, DC 20037 Tel (202) 974-3327 Fax: (202) 974-3641 Email: forum@paho.orgforum@paho.org www.paho.org