Regional Core Health Data Initiative

Andrea GergerHealth Analysis and Information Project, PAHO/HSD/HA

Regional Advisory Committee on Health Statistics MeetingHavana, Cuba, 26-28 March 2012

Regional Core Health Data Initiative

Regional Core Health Data Initiative

• a standard information platform on the health situation and trends in the countries of the Region of the Americas

• a collective effort • ‘Collection and Use of Core Health Data’ • Cross Organizational Team (COT) on Core Data

and Country Profiles

• Mandates & Goals• Norms & Standards

• Methodological Tools

• Mandates & Goals• Norms & Standards

• Methodological Tools

• Geographic Information System (GIS)• Basic Indicators Brochure

• Table Generator• RHO

• Geographic Information System (GIS)• Basic Indicators Brochure

• Table Generator• RHO

DemandDemand Information AxesInformation Axes ProductsProducts

Management

and Strategic

Planning

Management

and Strategic

Planning

Technical Cooperation

Technical Cooperation

Resource Mobilization

Resource Mobilization

Information Dissemination

Information Dissemination

• Programming, M&E of Technical Cooperation activities at Country Offices and HQ

• Programming, M&E of Technical Cooperation activities at Country Offices and HQ

• Preparation of Projects • Preparation of Projects

• Technical Information• Public Information

• Technical Information• Public Information

HEALTH COREDATA

HEALTH COREDATA

REFERENCE DOCUMENTS

REFERENCE DOCUMENTS

Country Profiles• Health in the Americas

• Annual Report • PAHO Epidemiological Bulletin

Country Profiles• Health in the Americas

• Annual Report • PAHO Epidemiological Bulletin

Regional Core Data Initiative

• PAHO Strategic Plan • BWP for Countries & HQ• Health Agenda for the Americas• Long term planning

• PAHO Strategic Plan • BWP for Countries & HQ• Health Agenda for the Americas• Long term planning

Goals• Technical cooperation – mandates• Define policies and strategies• M & E• Monitor health situation and health systems

performance• Collect, analyze, disseminate information

Data base description: main variables, time series and admin level

• PAHO Basic Health Indicator Database– 114 indicators for 48 countries/territories +

definitions– Admin level: country– Time series: 1995 - present– categories:

• Demographic, by sex • Socioeconomic• Mortality, by sex • Morbidity and risk factors • Access, resources and coverage

Sources RCHDI

indicadores fuentes

demográficos estimaciones NNUU y Oficina del Censo de EUAsocioeconomicos estimaciones Banco Mundial, FAO, UNESCOmortalidad base de datos de mortalidad de cada paísmorbilidad datos del pais vía programa técnico de la OPSrecursos, acceso, cobertura datos del país vía programa técnico de la OPS

Online data entry - Countries

Online data Entry – PAHO Projects

Monitoring in HSD/HA

New requested indicators

• Hypertension prevalence• Diabetes mellitus prevalence• Under-five mortality • Proportion of hospital deliveries • Prenatal care, minimum 4 visits

Mortality Rates• Countries with observed mortality:

Chile, Canada, USA, Mexico, Costa Rica, Cuba, Puerto Rico, Argentina, Barbados, Grenada, Montserrat, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Trinidad and Tobago, UK and US Virgin Islands

• Countries with corrected mortality:Belize, El Salvador, Guatemala, Honduras, Nicaragua, Panama, Dominican Republic, Colombia, Ecuador, Peru, Venezuela, Brazil, Paraguay, Uruguay, Anguilla

* Antigua & Barbuda, Aruba, Bahamas, Dominica, Cayman Islands, Guyana, Jamaica, Suriname, Turks and Caicos

PAHO Statistical Brochure

Country Health Profiles

• To analyze relevant and strategic health information for informed decision-making in public health

• To generate knowledge of the health status of countries and contribute to decision-making processes at both national and international level

• Cross-sectional descriptive and time series analysis of strategic health indicators

• To facilitate the evaluation by country of the extent of coverage and quality of health information analyzed and to provide impetus for its improvement.

Maternal Mortality Ratio / 100 000 lb

reported to PAHO

Infant Mortality Rate / 1 000 lb

reported to PAHO

Birth Information System• Birth database of the Americas, started 2009• Data exploration phase• Standardization of variables, quality and

coverage• Generate indicators based from birth

databases (low birth weight, prenatal visits, % of c-section, maternal age,…)

• Analysis & Dissemination• Reported data for immediate action

PAHO birth database - 2010

Mother

Residence of mother

Civil status

Age

Education level

Ethnicity/race

Prenatal visits

Newborn

Sex

Weight

Gestational age

Birth

Date of birth

Place of birth

Gestational age

Prenatal visits

Place of delivery

Type of delivery

Birth Data Availability

• Analisis de disponibilidad aquí? Aquí

• Pueda estar con fatima o aqui

Main data quality problems• Availability • Definitions and interpretations • Sources: data between countries/within are from

different sources: survey, administrative registry, estimates

• Coverage: Data do not cover all sectors • Under-registration: e.g. low birth-weight, births,

deaths, infant and maternal deaths • Inconsistency (e.g. IMR, MMR, U5M)

Challenges• Data quality • Uncoordinated data requests to countries

(duplicated, not integrated)• Increased data collection efforts within PAHO• Missing instance to coordinate

2012-2013 agenda

• New RCDHI strategy to Directing Council 2013• COT support (renewed key indicators) • Basic Indicators guide• Databases redesign and management • Technical cooperation focus on data quality

Mortality Indicator Review- RCHDI

Purpose of mortality indicators at PAHO hqs

• Study relevant and strategic data for decision-making in public health based on evidence in the countries

• Assist managers, health professionals, population in general to access principal cause of death and know the regional profile, compare with other countries, evolution in time, coverage and quality

RCHDI mortality indicatorsCORE TIME DATA DESAGGREGATION LEVELSDATA MORTALITY INDICATORS INTERVAL by by

NEW CODE REFERENCE by age sex AND

Total sex group age group

C.10.0.9 Annual proportion of under-5 registered deaths due to acute diarrheal diseases (ADD) by year Y

C.11.0.9 Annual proportion of under-5 registered deaths due to acute respiratory infections (ARI) by year YC.13 Overall mortality (all causes) (1,000 pop) by 3-year period/single year Y M; F G1 G1C.15 Mortality due to communicable diseases by 3-year period/single year Y M; F G1 G1C.16 Mortality due to tuberculosis by 3-year period/single year Y M; FC.17 Mortality due to HIV/AIDS by year Y M; FC.19 Mortality due to diseases of the circulatory system by 3-year period/single year Y M; F G1 G1C.20 Mortality due to ischemic heart disease by 3-year period/single year Y M; F G2 G2C.21 Mortality due to cerebrovascular disease by 3-year period/single year Y M; F G2 G2C.23 Mortality due to neoplasms (tumors), all type by 3-year period/single year Y M; F G1 G1C.25 Mortality due to malignant neoplasms (tumors), all type by 3-year period/single year Y M; F G1 G1C.26 Mortality due to malignant neoplasms of the lung, trachea, and bronchus by 3-year period/single year Y M; F G2 G2C.49 Mortality due to malignant neoplasms of cervix uteri by 3-year period/single year Y F G3 G3C.50 Mortality due to malignant neoplasms of corpus uteri by 3-year period/single year Y F G3 G3C.51 Mortality due to malignant neoplasms of uteri, unspecified parts by 3-year period/single year Y F G3 G3C.28 Mortality due to malignant neoplasms of the female breast by 3-year period/single year Y F G3 G3C.29 Mortality due to malignant neoplasms of the digestive organs and peritoneum by 3-year period/single year Y M; F G2 G2C.31 Mortality due to external causes by 3-year period/single year Y M; F G1 G1C.32 Mortality due to accidents, excluding transport accidents by 3-year period/single year Y M; F G4 G4

C.33 Mortality due to all transport accidents by 3-year period/single year Y M; F G4 G4

C.38 Mortality due to land transport accidents by 3-year period/single year Y M; F G4 G4

C.43 Mortality due to motor vehicle traffic accidents by 3-year period/single year Y M; F G4 G4C.34 Mortality due to suicide and self-inflicted injuries by 3-year period/single year Y M; F C.35 Mortality due to homicide by 3-year period/single year Y M; F C.36 Mortality due to cirrhosis and cronic liver disease by 3-year period/single year Y M; F G3 G3C.37 Mortality due to diabetes mellitus by 3-year period/single year Y M; F G2 G2

OTHER INDICATORS:

Proportion of death underregistration (by 3-year period)

Proportion of registered deaths due to symptoms, signs, and ill-defined conditions

Rate Ratio homicide mortality male:female (by 3-year period)Male homicide rate, corrected (by 3-year period)

G1 G2 G3 G4<1 yo 45-64 yo 35-44 yo <15 yo1-4 yo 65+ yo 45-64 yo 15+ yo

5-14 yo 65+ yo

15-44 yo45-64 yo65+ yo

Age-groups

G1 G2 G3 G4<1 yo 45-64 yo 35-44 yo <15 yo1-4 yo 65+ yo 45-64 yo 15+ yo

5-14 yo 65+ yo

15-44 yo45-64 yo65+ yo

Indicators and ICD-10 codes     

CORE  

DATA MORTALITY INDICATORS ICD-10 CODES

NEW CODE  

C.10.0.9 Annual proportion of under-5 registered deaths due to acute diarrheal diseases (ADD) A00-A09

C.11.0.9 Annual proportion of under-5 registered deaths due to acute respiratory infections (ARI) J00-J22

C.13 Overall mortality (all causes) (1,000 pop) all causes A00-Y89

C.15 Mortality due to communicable diseases A00-B99,G00-G03,J00-J22

C.16 Mortality due to tuberculosis A15-A19

C.17 Mortality due to HIV/AIDS B20-B24

C.19 Mortality due to diseases of the circulatory system I00-I99

C.20 Mortality due to ischemic heart disease I20-I25

C.21 Mortality due to cerebrovascular disease I60-I69

C.23 Mortality due to neoplasms (tumors), all type C00-D48

C.25 Mortality due to malignant neoplasms (tumors), all type C00-C97

C.26 Mortality due to malignant neoplasms of the lung, trachea, and bronchus C33-C34

C.49 Mortality due to malignant neoplasms of cervix uteri C53

C.50 Mortality due to malignant neoplasms of corpus uteri C54

C.51 Mortality due to malignant neoplasms of uteri, unspecified parts C55

C.28 Mortality due to malignant neoplasms of the female breast C50

C.29 Mortality due to malignant neoplasms of the digestive organs and peritoneum C15-C26,C48

C.31 Mortality due to external causes V01-Y89

C.32 Mortality due to accidents, excluding transport accidents W00-X59

C.33 Mortality due to all transport accidents V01-V99

C.38 Mortality due to land transport accidents V01-V89

C.43 Mortality due to motor vehicle traffic accidents

V02-V04(.1-.9), V09.2,V09.3,V12-V14(.3-.6), V19(.4-.6),V20-V28(.3-.9), V29-

V78(.4-.9),V80(.3-.5), V81.1,V82.1,V83-V86(.0-.3), V87(.0-.8),V89.2,V89.9

C.34 Mortality due to suicide and self-inflicted injuries X60-X84

C.35 Mortality due to homicide X85-Y09

C.36 Mortality due to cirrhosis and cronic liver disease K70,K73,K74,K76

C.37 Mortality due to diabetes mellitus E10-E14

Group Work

• One hour group work: define rapporteur

• Each group: 10 minutes to report back

Questions• Analyze the relevance of current cause of

death data• Analyze the relevance of current age-groups

• Recommend the inclusion/exclusion of cause of death data and age-groups

• Group 1 – infectious diseases: Eartha Groenfelt, Cassia Buchalla, Paul Ricketts, Affette McCawBinns, Sarah Quesnel, Carolina Danovaro, Aiza Gauna, Juan Eugenio Hernandez

• Group 2 – chronic diseases: Rafael Lozano, Gerardo Martinez, Bastiaan Van’t Hoff, Danuta Rajs, J Chique, Aline Jimenez, Magda Ruiz, Eduardo Zacca

• Group 3 – external causes: Beatriz Plaza, Lina Sofia Palacios, Elida Marconi, Ana Nogales, Luis Manuel Torres, Heloisa DiNubila, Josette Iribedra, Miguel Angel Martinez

Group Work

• One hour group work

• 10 minutes to report back