Evidence and Information for Policy The World Health Survey Health System Metrics Glion, September 2006

Evidence and Information for Policy Q uestions raised by policy makers How well is our health system doing? How do we know if we are making progress? How well are we doing given the resources? Where are the main problems? What can and should be fixed? What will it cost? What is the best use of limited (additional) resources? How well is our health system doing? How do we know if we are making progress? How well are we doing given the resources? Where are the main problems? What can and should be fixed? What will it cost? What is the best use of limited (additional) resources?

Evidence and Information for Policy Goals of Health Systems Performance Assessment Provide national decision-makers and the public with sound evidence:  to inform strategic decisions on health sector reform and health system organization e.g. financing arrangements, regulation of private providers  to inform implementation of programmes by local, regional and national managers  to monitor progress towards national targets for health and health systems Provide national decision-makers and the public with sound evidence:  to inform strategic decisions on health sector reform and health system organization e.g. financing arrangements, regulation of private providers  to inform implementation of programmes by local, regional and national managers  to monitor progress towards national targets for health and health systems

Evidence and Information for Policy Stewardship (oversight) Financing (collecting, pooling and purchasing) FUNCTIONS THE SYSTEM PERFORMS GOALS / OUTCOMES OF THE SYSTEM Health Fair financial contribution Responsiveness (to people’s non medical expectations) Creating resources (investment and training) Delivering services (provision) The WHO health system framework INPUTSINPUTS Coverage Provider Performance

Evidence and Information for Policy The World Health Survey Objectives develop a low cost means of providing data  that is valid, relevant, reliable and comparable  on outcomes, functions & inputs to health systems  to supplement the information provided by HIS

Evidence and Information for Policy The World Health Survey Objectives build the evidence base necessary for policy-makers  to routinely monitor if health systems are achieving the desired goals  and in some countries, to assess if the increase in health resources is having the desired effect

Evidence and Information for Policy World Health Survey 71 SURVEYS in 71 countries Household - long : 53 Household - short: 14 CATI : 4 The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO All rights reserved

Evidence and Information for Policy World Health Survey Content 1. Health Expenditure and Economic status 2. Measurement of Health States 3. Risk Factors 4. Mortality 5. Coverage 6. Responsiveness 7. Health System Goals 1. Health Expenditure and Economic status 2. Measurement of Health States 3. Risk Factors 4. Mortality 5. Coverage 6. Responsiveness 7. Health System Goals

Evidence and Information for Policy  Information on health care spending  Provides reliable figures for health care fraction of household expenditure  Provides an alternative way of estimating or validating permanent income data  Information on health care spending  Provides reliable figures for health care fraction of household expenditure  Provides an alternative way of estimating or validating permanent income data World Health Survey Household Health Expenditure

Evidence and Information for Policy  protection from catastrophic health expenditure  access to health services  reduction of financial burden of paying for health services  protection from catastrophic health expenditure  access to health services  reduction of financial burden of paying for health services World Health Survey Health Insurance

Evidence and Information for Policy Baseline data on national healthy life expectancies and inequalities in healthy life expectancies in absolute terms and by income groups Health is a multidimensional experience Difficulty in 8 domains of functioning based on an international framework Valuation of health states to combine measurement across domains Baseline data on national healthy life expectancies and inequalities in healthy life expectancies in absolute terms and by income groups Health is a multidimensional experience Difficulty in 8 domains of functioning based on an international framework Valuation of health states to combine measurement across domains Health State Description World Health Survey Health State Description

Evidence and Information for Policy World Health SurveyCoverage Do those with health care needs get the necessary health interventions?  DETERMINANTS: What determines the coverage ?  BARRIERS: What are the barriers preventing coverage ?

Evidence and Information for Policy Catastrophic expenditure and impoverishment

Evidence and Information for Policy Out of pocket payment

Evidence and Information for Policy Coverage

Evidence and Information for Policy Coverage

Evidence and Information for Policy Responsiveness problems communicating

Evidence and Information for Policy World Health Survey Future steps Strengthen Health Information Systems by  Supplementing vital registration systems  Combining census, surveys and service data  Incorporating private sector and public sector data  Improving survey methods by including measurements and biomarkers  Improving methods for small area assessment Strengthen Health Information Systems by  Supplementing vital registration systems  Combining census, surveys and service data  Incorporating private sector and public sector data  Improving survey methods by including measurements and biomarkers  Improving methods for small area assessment

Evidence and Information for Policy Acknowledgement Xu Ke Paul Kowal Saba Moussavi Nirmala Naidoo Amit Prasad Emese Verdes Xu Ke Paul Kowal Saba Moussavi Nirmala Naidoo Amit Prasad Emese Verdes