1. Indicators ROUTINE HEALTH INFORMATION SYSTEMS MODULE 2:
A Curriculum on Basic Concepts and Practice
MODULE 2:
Indicators and Data Collection and Reporting
SESSION 1:
Indicators
The complete RHIS curriculum is available here: routine-health-information-systems/rhis-curriculum

2. SESSION 1 : Learning Objectives
Participants will be able to:
Define and identify relevant health indicators
Mention 5 characteristics of good indicators
Identify factors to consider while selecting indicators
Give examples of good indicators
At the end of the session, participants should be able to define indicators, mention characteristics of good indicators, and identify criteria for the selection of sound indicators.

3. What Are Health Indicators?
With the goal of good health in mind, think of an indicator as “…a measure that helps quantify the achievement of a goal.” ―Mark Friedman
We use indicators in daily life, sometimes without realizing it. They are the clues, signs, and markers as to how close we are to our path and how much things are changing. For example, if you drive a car and the gas gauge shows you are low on gas, it is not actually the gas you are looking at but rather the gas gauge, which is an “indicator” of the amount of gas you have.

4. An Indicator Is ……. a variable (its value changes)…
that measures (objective calculation of value)…
key elements of a health intervention (program, service, or project)
(inputs/processes, outputs, outcomes, impact)
An indicator is a variable that measures one aspect of a health intervention, progam, or project. Let’s take a moment to go over each piece of this definition.
First, the purpose of indicators typically is to show that health programs, or health interventions are carried out as planned or that a health program activity or intervention has caused a change or difference in something else. Therefore, an indicator of that change will be something that we reasonably expect to vary. Its value will change from a given or baseline level at the time the program begins to another value after the program and its activities have had time to make their impact felt, when the variable, or indicator, is calculated again.
Second, an indicator is a measurement. It measures the value of the change in meaningful units for program management: a measurement that can be compared to past and future units and values. A metric is the calculation or formula that the indicator is based on. Calculation of the metric establishes the indicator’s objective value at a point in time.
Third, an indicator focuses on a single aspect of a health intervention, program, or project. It may be an input, an output, or an overarching objective, but its related metric will be narrowly defined in a way that captures that aspect as precisely as possible.
A full, complete, and appropriate set of indicators for a given project, program, or intervention in a given context with given goals and objectives will include at least one indicator for each significant aspect of program activities.

5. Types of Health Indicators
INPUTS AND PROCESSES
OUTPUTS
OUTCOMES
IMPACT
Availability of drugs per care level
Basic equipment per activity type
Number of staff per category and per capita
Number of drug shortages
Number of surgical or obstetrical acts done
Number of children immunized
Number of new cases in the facilities
Hospital bed occupation rate
Full immunization rate interventions
Incidence and prevalence of certain diseases, such as HIV, malaria, TB
Number of TB cases detected
Life expectancy at birth
Infant mortality
Prevalence of malnourished children under 5
The general concept of health can be construed broadly to encompass indicators of all measurable aspects of health and the health sector.
The World Heath Organization’s Monitoring, Evaluation and Review framework organizes health indicators in four components. Within each component, categories of indicators are defined that allow the measurement of health at many levels:
Indicators of inputs and processes are broad, affecting many other parts of the health sector.
Indicators that fall under outputs and outcomes tend to be quite specific to a particular health topic, and may respond quickly to changes and progress in the health sector.
Impact indicators, which are slower to respond to policy, program, and practice changes, are important to provide a snapshot of the health of a population.
The components of the monitoring, evaluation, and review framework can also be loosely linked to the type of data that are used.
Outcomes and impact indicators tend to be calculated using individual- or household-level data.
Inputs and processes or outputs are often calculated using subnational-level data.
Certain inputs and processes indicators, such as total health expenditure, are calculated at the national level.
Source: Adapted from WHO. Global reference list of 100 core health indicators. Retrieved from

6. EXAMPLE: Indicators for Reproductive, Maternal, and Child Health Monitoring
INPUTS AND PROCESSES
Health financing
expenditure per target population (children, women, etc.)
General government
expenditure on health as a percentage of general government expenditure
Health workforce
midwives, per population
Governance
presence of key policies to promote maternal and child health
Information
births registered
deaths registered (with cause)
OUTPUTS
Service access and readiness
facilities that offer and meet tracer criteria for basic and comprehensive obstetric care, per pregnant women
caesarean section rate in rural populations
facilities that offer and meet tracer criteria for child health services, per 1000 children
OUTCOMES
Coverage of interventions
antenatal care
births attended by skilled health personnel
immunization coverage
family planning needs satisfied
children with diarrhea receiving oral rehydration therapy
children with fever receiving antimalarials
insecticide-treated bednet use
antiretroviral prophylaxis among HIV- positive pregnant women
vitamin A supplementation among children
postnatal care
Risk factors and behaviours
contraceptive prevalence
access to safe water
access to improved sanitation
low birth weight among newborns
early initiation of breastfeeding
children who are stunted or underweight
IMPACT
Health status
under-5 mortality
maternal mortality ratio
child mortality by major cause of death, by sex and age
Financial risk protection
out-of-pocket payments as a percentage of total health expenditure
This is an example of a package of health indicators for reproductive, maternal, and child health monitoring. To represent this broad health topic, indicators were chosen from all components of the monitoring, evaluation, and review framework. Typically, the best indicators of progress in a priority health topic are those that are identified by countries rather than imposed from outside sources; indicators selected by a country may be of greater relevance to the needs of that country.
Note that the general approach to monitoring health will be the same regardless of the health indicators that are selected.
Source: Adapted from Monitoring, evaluation and review of national health strategies: a country-led platform for information and accountability. Geneva, World Health Organization, 2011.

7. Health status Risk factors Service coverage Health systems
Indicator Domains
Health status
Risk factors
Service coverage
Health systems
Indicators can also be classified according to domains
Health status: examples
Life expectancy at birth
Malaria mortality rate
Risk factors: examples
Children under 5 years of age who are stunted
Population using safely managed sanitation services
Service coverage: examples
Antenatal coverage
Tuberculosis case detection rate
Health systems: examples
Hospital bed density
Total current expenditures on health (% of gross domestic product)
Source: Adapted from WHO. Global reference list of 100 core health indicators Retrieved from

8. What Is the Rationale for Health Indicators?
Indicators are vital in health interventions because, when collected and used regularly, they can:
Provide a reference point for health intervention planning, management, and reporting
Allow managers of health interventions to assess trends and identify problems
Act as early warning signals for corrective action
In addition, indicators are meant to provide valid and reliable ways to measure over time the following:
Performance: the effective or efficient operation of an activity
Example: “Percentage of health facilities that reached their coverage targets for DPT3”
Achievement: the successful accomplishments of an activity, project, or program
Example: “Percentage of HIV-positive pregnant women who received antiretroviral drugs”
Accountability: responsibility for performance and/or achievements of an activity, project, or program
Example: “Percentage of clinics complying with national guidelines for sexually transmitted infections”
As useful as indicators are as an entity, not all indicators are useful for measuring performance of your health interventions or services. Like measures, it takes practice to understand which will provide the best information for your healthcare delivery.

9. What Makes an Indicator “SMART” ? (Characteristics of Good Indicators)
Specific: Indicator is concrete, detailed, focused, and well defined
Measurable: Indicator tells how many or how much and can be measured with identified measurement sources
Agreed upon: Stakeholders vested in a specific M&E question should agree that the indicator is relevant
Relevant: Indicator generates data that can answer the question of interest
Timebound: Indicator specifies time frame of what it is measuring
In order for indicators to be useful, they need to represent accurate and reliable measures. To accomplish this, indicators should adhere to a set of criteria. Like objectives, indicators also need to be SMART (as explained in this slide).

10. Characteristics: Relevant
Answers the question of interest: too many indicators have been defined without being based upon a specific information need
Linked to a public-health impact or to achieving the objectives needed for impact
Example: Childhood vaccines program
Indicator: % of infants receiving measles vaccine (coverage)
Example: Program to increase access to ORS for childhood diarrhea through community-based distributors (CBDs)
Indicator: # of ORS packets distributed in past month by CBDs
Because the purpose of a monitoring and evaluation (or M&E) plan and the indicators developed for it is to monitor a program, indicators should be linked to the program activities. If the indicator is related to factors the program is not attempting to affect, no useful information for the program will result from collecting and reporting this indicator. To be most useful, indicators should be designed to inform specific decisions that need to be made within a program.
Discussion
Most often indicators do not pertain to the program activities or desired outcomes
For example, In a program consisting only of condom promotion and distribution, an indicator to measure the number of sex partners in the past 4 months would not provide information that would help monitor the program. It does provide information to programs aiming to decrease risky behavior, but this particular behavior is not addressed by the program activities, so it is irrelevant.
In a nutrition program using community-based distributors to improve access to oral rehydration therapy for children with diarrhea, an indicator measuring distribution of ORS by clinics would not be relevant. Although it might be interesting to know in relation to their program activities, it does not contribute to program monitoring.

11. Characteristics: Specific
Or “valid” = measures a specific disease, service provided, practice, or task
Validity or specificity may be the most important characteristic of a good indicator. A valid indicator is one that accurately measures the phenomenon (the task, behavior, or practice) that it is designed to capture. The indicator provides direct and focused information about the target or result it aims to measure. The validity of an indicator is an attribute that can only be assessed in the context of considering the result or phenomenon it is aiming to measure.
Sometimes valid indicators that could be selected or designed for particular important services may be impossible to use for practical reasons, such as costs or other material or logistical obstacles that may prevent collecting all of the data that would be necessary. In that case, the next best thing is a proxy indicator. A proxy indicator is one that does not capture the exact concept or single aspect of your activity’s result, but instead aims to measure a concept that approximates the true or ideal indicator. Your RHIS strategic plan should make sure to note where you will be using proxy indicators and the reasons. It may become possible later to collect other data and construct a valid indicator for that service in its place. On the other hand, if uncertainty exists about data collection for some results, it may be prudent to think of proxy indicators for which the data may be easier or cheaper to collect.
An example of a proxy indicator of HIV incidence for women in a given population could be “HIV prevalence among women ages years old”
Indicator measures what it is intended to measure: provides direct information about the result it intends to measure
If indicator not “feasible,” sometimes need to use “proxy indicator”

12. Specificity (or Validity): Class Activity
Is the number of antenatal care (ANC) visits a valid indicator of a focused ANC package?
Is the maternal mortality ratio a valid indicator of the impact of a family planning program on women’s health?
Is the number of children who received the DTP3 vaccine a valid indicator of immunization coverage?
Participants may consider the following examples.
Example 1: Is “ANC visits” a valid indicator of focused ANC?
(Answer: number of ANC visits is not generally thought to be a very valid measure of focused ANC. Number of ANC visits only indicates the frequency of pregnant women’s ANC attendance. Focused ANC’s aim is to give holistic individualized care to each woman to help maintain the normal progress of her pregnancy through timely guidance and advice. Thus, it may be good to know the type of services the pregnant women received during their series of ANC .
Example 2: Is the maternal mortality ratio a valid indicator of the impact of a family planning program on women’s health? Why or why not? What might be a more valid indicator? (Answer: Although family planning programs often intend to reduce maternal mortality, the maternal mortality ratio is not a valid measure of the impact of a family planning program on women’s health. While family planning programs contribute to reducing maternal mortality, numerous other factors, such as prenatal care, a referral system, access to hospital care, and transportation also influence the ratio. What might be a more valid indicator? In this case, the result itself needs narrowing, to focus on a particular effect of family planning programs on women’s health, before a valid indicator to capture and measure that effect can be determined.)

13. Characteristics: Measurable
Quantifiable: using available tools and methods
Precise: operationally defined in clear terms and documented in an Indicator Reference Sheet
Reliable: consistently measurable in the same way by different observers
Feasible: the resources (human, physical, financial) needed are available
Speaker Notes
Quantifiable: Because the intention is to calculate the indicators that are defined as part of an M&E plan, it is important to make sure that it is possible to measure these indicators in a quantifiable way. Here are two important questions to answer, in addition to those related to financial and human resources for obtaining the data: Are tools and methods available to collect or calculate this information? If not, can they be developed for this project or program?
Precise: An indicator should be defined in precise, unambiguous terms that clearly describe what is being measured, with a clear definition of the numerator and the denominator. INDICATOR REFERENCE SHEET (show example)
Reliable: Minimization of measurement error is another important characteristic of an indicator. Measurement error is a critical issue, because indicators are used to assess program performance. If changes in indicator values merely reflect recording or transcription errors in their measurement, conclusions about program efficiency or effectiveness will not be accurate
Feasible: Required resources are available
Human: with the required competency (diagnostic capacity)
Physical: with required equipment (TB needs laboratory equipment)
Financial: required $$ (surveys for rare events)

14. Indicator Reference Sheet: Minimum Information
Description
Plan for data collection
Plan for data analysis
Plan for data quality check
Performance table
See also Handout
The description will entail the following: precise definition(s), the unit of measure, the method of calculation, type of disaggregated if needed along with the justification
The plan for data collection will cover successively the data collection method, the data source(s), the timing / frequency of data collection, the estimated cost of collection, the responsible organization/individual(s) and the location of data storage
The plan for data analysis will address the data analysis, the presentation of data, the review of data, and the reporting of data
The plan for data quality check will highlight what is the plan for the initial data quality assessment, indicate the known data limitations and significance (if any), and then will provide actions taken or planned to address data limitations
A performance table sets the rationale for selection of baselines and targets

15. Characteristics: Time Bound
Provides a measurement over periods of interest, with data available for all appropriate intervals
Timeliness considerations:
Reporting schedules
Recall periods
Length of time over which change can be detected
The timeliness of an indicator is crucial, because it affects not only the indicator itself but also the data collection schedule and the reporting schedule, as well. Indicators that are tools for measuring results require data that should be collected after a period sufficient for program activities to have made a measurable impact. Although this may seem obvious or self-evident, many times data collection may be affected by the reporting schedules of others: the government’s, other partners’, and/or headquarters'. So to the extent possible, these logistical factors should be taken into account in indicator design. For instance, if your condom social-marketing partners compile routine statistics every six weeks, it is better not to design an indicator counting condoms distributed in the past 30 days.
Other timeliness factors to take into account would be the periods for which reporting subunits, such as clinics, may compile statistics; the recall period on which surveys should rely on respondents’ memories or retrospective evaluations; the periodicity of existing survey exercises; and the length of time one could reasonably expect change in some variables, such as mortality or fertility rates, over a country’s population.

16. Characteristics: Agreed Upon
Stakeholders vested in a specific M&E question should agree that the indicator is relevant
Agreement between various health-system levels
Agreement between various national health programs and health services managers

17. Common Indicator Metrics
Counts # of providers trained # of condoms distributed Calculations: percentages, rates, ratios % of facilities with trained provider Index, composite measures Index on infection control and prevention DALY (disability-adjusted life years) Thresholds Presence, absence Predetermined level or standard
Indicators can have a number of types of metrics:
They can be simple counts of things (for example, the number or providers trained or the number of condoms distributed), or they can involve calculations (for example, the proportion of facilities with a trained provider, maternal mortality ratio, total fertility rate).
They can also be more complex, such as an index comprising the sum of scores on six quality outcomes or the DALY (disability-adjusted life year). The DALY has become a commonly used measurement for the burden of disease to show the total amount of healthy life lost, whether from premature mortality or from some degree of disability, during a given period. These are just some examples of types of metrics used for indicators. As such, DALYs for a disease or health condition are calculated as the sum of the Years of Life Lost (YLL) due to premature mortality in the population and the Years Lost due to Disability (YLD) for people living with the health condition or its consequences:

18. Factors to Consider When Selecting Indicators
Logic/link to framework
Programmatic needs/information for decision making
Resources
External requirements (government, donor, headquarters)
Data availability
Standardized indicators
Alignment with national and international standards
In an ideal world, indicators judged to be the highest quality and most useful would be the ones selected and used to monitor and evaluate program activities. However, in the real world and in field settings, many other factors may intervene. Links to the program activities, as shown through frameworks, is important, as are the needs of the program for decision making. Ideal indicators may not be practical; the feasibility of certain indicator designs can be constrained by data availability and financial and human resources. Requirements and needs of donors, the government, organization headquarters, and others may need priority.
Some examples of these considerations are:
Availability of data: Some data may be considered privileged information by agencies, projects, or government officials. Data may be available only on aggregated levels or may be already calculated in indicators that may not be ideal for your program or activities.
Resources: Ideal indicators might require collecting data to calculate an unknown denominator, or national data to compare with project area data, or tracking lifetime statistics for an affected and/or control population, etc. The costs of collecting all of the appropriate data for ideal indicators typically is prohibitive. Human resources and technical skills, particularly for evaluation, may be constraints, as well.
Programmatic and external requirements: Indicators may be imposed from above by those not trained in M&E techniques. Reporting schedules may not be synchronized (e.g., fiscal year vs. reporting year). Different stakeholders’ priorities may diverge.
Discussion:
Ask: In your experience, what factors, other than desire to select the best and most appropriate indicators, has affected the selection of M&E indicators? Give specific examples.

19. Common Pitfalls in Indicator Selection
Indicators not linked to program activities
Poorly defined indicators
Indicators that cannot realistically be collected
Process indicators to measure outcomes and impacts
Indicators that are insensitive to change
Too many indicators
There are some common mistakes that people make when trying to create or select indicators. Often, indicators are not linked to program activities or are poorly defined. Selecting indicators that do not exist and cannot realistically be collected means that indicators will not be reported.
Process indicators are sometimes used to measure outcomes and impacts. Some indicators are not very sensitive to change―for example, after prevalence becomes low, many measures of transmission intensity change very little.
Probably the easiest pitfall to avoid is having too many indicators. Having too many indicators makes it difficult to collect high-quality data and to interpret the data that you have.

20. Pitfalls in Selecting Indicators
Indicators not linked to program activities
Intermediate result (IR): Expanded access to malaria treatment services
Activities: Train providers in current clinical protocols
Inappropriate indicator: % of facilities with adequate conditions to provide care
Better indicators: # of clinicians trained; % of facilities with a trained provider
The program is not aiming to affect facility conditions, only provider skills.
Let’s review the common pitfalls in selecting indicators in more detail.
One of the common pitfalls in selecting indicators is to choose one that the program activities cannot affect. Here is an example that actually occurred. A program planned to train healthcare providers on prevention and treatment services in an effort to expand access to services. The authors of this M&E plan reviewed some of the standard indicator documents and selected some indicators that seemed important. Specifically, they wanted to report the proportion of healthcare facilities with adequate conditions to provide care. However, many things go into that proxy indicator, including supervision, supplies and equipment availability, and the drafting of appropriate treatment protocols―several things that the program does not intend to address directly. In trying to use a global indicator, the planners overlooked the fact that this indicator was not related to their program activities. A better indicator would have been the number of clinicians trained or the number of facilities with a trained provider.
Ideally, indicators will provide feedback to the program so that changes can be made to activities to more effectively or efficiently reach program objectives. If an indicator is not affected by program activities, not only is the indicator measuring something irrelevant but also it is measuring something that cannot be useful for the program.

21. Pitfalls in Selecting Indicators
Data needed for indicator not available
Inappropriate indicator: % of days per quarter that service delivery points have stockout of drugs
Data issue: Information on stockouts may not be collected daily
Better indicator: % of service delivery points that had a stockout of drugs at some time during the past quarter
If relying on routine data, an indicator definition must depend on how data are collected (see Session 2) in this module.
Another common mistake is to select an indicator that relies on routine data without verifying that the data are available as you defined it. Here is another “real world” example.
A program working on drug supply selected an indicator collecting information on stockouts by the number of days any stockouts occurred. When the information collected at the health facilities was checked, it was found that information about the number of days when drug stockouts occurred was unavailable. Instead, the facilities collected the number of stockouts per quarter. In addition, there were interpretation issues related to what the proportion of days means for more than one service delivery point. (Would it have been the average proportion of days per quarter when there was a stockout?) So this indicator was changed to account for the fact that information on stockouts is collected as a yes/no variable as well as to better represent the intended result of the program.

22. Pitfalls in Selecting Indicators
Indicator does not accurately represent desired outcome
IR: Access to effective treatment among children <5 years old with malaria
Inappropriate indicators: % of children <5 years old who received artemisinin-based combination therapies (ACTs); % of people who received ACTs for malaria infection who are children <5
Better indicator: % of children <5 years old who were diagnosed with malaria in the past 2 weeks who received ACTs
What does it mean if inappropriate indicators increase? Decrease? Do they reflect the desired program effect?
This example also comes from an actual experience. In this example, the problem with the inappropriate indicators was not readily evident to the authors of the M&E plan. The details of each indicator’s definition must be considered.
Discussion
For the first indicator labeled as inappropriate on the slide, what are the implied numerator and denominator?
In the first inappropriate indicator, the definition is:
Numerator: Number of children <5 years old who received ACTs
Denominator: Number of children <5 years old
In other words, this indicator tells us, of all the children under five, how many received treatment. The denominator is all children under five, but ultimately we only want to know the percentage of children who received treatment among those who actually had malaria. With this indicator, the percentage of children who received ACTs could go down, because the prevalence of malaria has declined or because fewer children are getting treatment for malaria. This makes it difficult to interpret this indicator, and also does not addressed the desired outcome of the program.
For the second inappropriate indicator, what are the numerator and denominator?
Numerator: Number of people who received ACTs for malaria infection who are children <5
Denominator: Number of people who received ACTs
Notice that in this indicator, the denominator “people who received ACTs” is very different than the first indicator. In other words, this indicator tells us, of all the people receiving ACTs, how many are children under five? Again, let’s consider the possible interpretations if change in this indicator is observed. If the indicator increases over time, that might be because fewer people overall are receiving treatment, but the number of children receiving treatment has not changed. Or, it could be because there is an increase in the number of children receiving treatment―the desired effect of the program. If the indicator decreases, that might be because more people overall are receiving treatment or because fewer children are infected with malaria or because there are fewer children.
In addition to the interpretation difficulties with the first two options presented above, they also do not represent the intended effect of the program. A better indicator would be the % of children <5 years old who were diagnosed with malaria in the past 2 weeks who received ACTs. Interpretation is not complicated by factors unrelated to this intermediate result, such as a decrease in malaria prevalence among children or the number of people receiving ACTs.
The definition of this indicator is:
Numerator: Number of children <5 years old who were diagnosed with malaria in the past 2 weeks who received ACTs
Denominator: Number of children <5 years old who were diagnosed with malaria in the past 2 weeks

23. Indicator Systems: How Much Is Enough?
Rule of Thumb
At least one or two indicators per key activity or result (ideally, from different data sources)
At least one indicator for every core activity (such as distribution of insecticide-treated nets, indoor residual spraying, training, behavior change communication)
No more than 8–10 indicators per area of significant program focus
A mix of data collection strategies/sources
A frequent question is “How many indicators should my program have?” The best answer is “That depends.”
What does it depend on? Complexity of goals; costs of data collection and analysis; benefits and practical utilization anticipated for M&E results at the different conceivable levels.
A reasonable rule of thumb might be one or two indicators per result, but that depends on how finely detailed your results may be. You should definitely have at least one or two indicators for every significant activity: remember, M&E’s purpose is to monitor performance and evaluate impacts! However, there is a tendency to go into overkill on indicators; again, keep in mind that the focus of your program is your program. M&E that is not going to be fed back into program management or otherwise used to improve performance, effectiveness, or efficiency is not a sound use of program resources. It is wise to vary the data sources used for indicators―either secondary sources or your own data collection efforts, especially for key results. Any number of unexpected events can occur and disrupt an M&E plan, such as budget cuts, delayed surveys, or civil war, so diversifying data sources is a good strategy to ensure some indicators can be tracked over the life of the project.

24. Choosing the Right Number of Indicators
Indicators are the dashboard of your program.
In a car, the components of the dashboard tell you the most important things you need to know while driving: speed, RPM, fuel level, and oil level. It is no mistake that newer cars have less-crowded dashboards. Too many features distract the driver from focusing on what is most important.
Your program works the same way. You cannot have an indicator for every single thing that your program is doing. Your indicators should reflect only the things that are most important to know. If you have too many indicators, the information will most likely be of lower quality; it will be more difficult to notice important trends or issues that arise; and collecting and analyzing it will be too great a burden on everyone involved in those tasks.

25. Good Indicators Provide information useful for program decision making
Are consistent with international standards and other reporting requirements, as appropriate
Are defined in clear and unambiguous terms
Are nondirectional; “independent”
Have values that are:
Easy to interpret and explain
Precise, valid, and reliable measures
Comparable across relevant population groups, geography, and other program factors, as needed
Good indicators should provide information useful for program decision making. They are consistent with international standards and other reporting requirements, as appropriate. Indicators should be defined in clear and unambiguous terms. They should also be nondirectional, or “independent.” This means that an indicator should not be defined as a percentage increase or decrease. Indicators should also have values that are:
Easy to interpret and explain
Precise, valid, and reliable measures
Comparable across relevant population groups, geography, and other program factors, as needed

26. Change in Indicators over Time Activity: Handout 2.1.1
Share Handout on change in indicators over time.
Participants read the text individually
Discuss in the large group.
Instruction:
1. Share Handout on change in indicators over time.
2. Participants read the text individually.
3. Discuss in the large group.

27. “Not everything that can be counted counts, and not everything that counts can be counted.”
―Albert Einstein

28. Summary: Guiding Principles for Selecting Indicators
Ensure that the indicators are linked to the information needs for health interventions and are able to measure change.
Ensure that standard indicators are used to the extent possible.
Consider the cost and feasibility of data collection and analysis.
Keep the number of indicators to the minimum that are necessary, and include only those needed for program and management decisions or for reporting.
Speaker Notes
In summary, when selecting indicators for your program, please follow the principles in this slide.

29. Q&A

30. ROUTINE HEALTH INFORMATION SYSTEMS
A Curriculum on Basic Concepts and Practice
This presentation was produced with the support of the United States Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement AID-OAA-L MEASURE Evaluation is implemented by the Carolina Population Center, University of North Carolina at Chapel Hill in partnership with ICF International; John Snow, Inc.; Management Sciences for Health; Palladium; and Tulane University. The views expressed in this presentation do not necessarily reflect the views of USAID or the United States government.