Health policy

National Health Act proclaimed by the President

At least 10 of the 12 chapters of the National Health Act (Act No 61 of2003) will come into effect on 2 May 2005 after the Act was proclaimed by President Thabo Mbeki in the Government Gazette published yesterday. (18 April)


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World Health Organization

A useful list of public health definitions compiled by the World Health Organisation. 


1. Explicable, understandable (Oxford Pocket Dictionary, 1992) Being responsible, answerable, liable, amenable, chargeable (Roget’s International Thesaurus, 1963). 2. Obligation to demonstrate that work has been conducted in compliance with agreed rules and standards or to report fairly and accurately on performance result vis-a-vis mandated roles and/or plans(OECD). Accountability is the means used to hold persons/entities responsible for their actions.


A reflection of the willingness of surveillance staff to implement the system, and the end users of the data to accept and use the data generated by the system.


Actions performed to produce specific outputs using a given set of resources.


1. A conceptual and strategic framework that spells out goals and objectives, priority themes and key strategies to be addressed by relevant operatives at all levels. It defines, for example, an agreed vision within the context of humanitarian coordination and traces a road map of actions to be undertaken to realize this vision. 2. Support or argument for a cause, policy, etc (Oxford Pocket Dictionary, 1992) 3. Exhortation, patronage, fosterage, championship, testimonial (Roget’s International Thesaurus , 1963).

Affected people

People who are adversely affected by a crisis or a disaster and who are in need of urgent humanitarian assistance.

Age-adjusted mortality rate

Mortality rate that takes into account the age structure of the population to which it refers. Used to compare mortality in populations with very different age structures (ODI/HPN paper 52, 2005, Checchi and Roberts).

Age-sex pyramid

Graph of the sex and age-group distribution of the population. Used in mortality studies to observe possible alterations in the demographics of the population as a result of high mortality or population loss in a particular age group or sex (ODI/HPN paper 52, 2005, Checchi and Roberts).

Age-specific mortality rate

Mortality rate in a specific age group. See under-five mortality rate for an example (ODI/HPN paper 52, 2005, Checchi and Roberts).

Alert threshold

The critical number of cases (or indicator, proportion, rate, etc.) that is used to sound an early warning, launch an investigation at the start of an epidemic and prepare to respond to the epidemic.


A systematic or non-systematic way of gathering relevant information, analysing and making judgment on the basis of the available information.

Baseline assessment

Is an assessment performed during the design phase of a surveillance plan of action. It provides information on the existing situation, forms the basis for the development of the plan of action, and provides baseline data against which prospective changes in the surveillance system are progressively assessed or measured.

Baseline data

Data or measurements collected at the outset of implementation of a surveillance system or of strengthening activities, or a set of indicators that have been identified to monitor and evaluate the performance of a surveillance and response system. For example, the baseline mortality rate (or non-crisis mortality rate) is Mortality rate before the crisis (ODI/HPN paper 52, 2005, Checchi and Roberts).


Reference point or standard against which performance or achievements can be assessed. A benchmark refers to the performance that has been achieved in the recent past by other comparable organizations, or what can be reasonably inferred to have been achieved in the circumstances (OECD).

Bias/Non-sampling error

Systematic error during data collection which results in a distortion of the findings (in mortality studies, an over- or under-estimation of mortality) (ODI/HPN paper 52, 2005, Checchi and Roberts).

Business Continuity

Effective and useful survival. Business continuity is a biological and psychological imperative for individuals ("instinct of survival") and an economic and cultural imperative for communities, at least at local level (see also "social capital"). The imperative can be less evident and weaker once one moves to the national level. It is by definition weak in "new" or "fragile states", and in short-lived institutions, especially in trans-cultural ones. It needs to be fostered by strong leadership, team building, clear mission statements, etc. (Loretti, 2005).

Case definition

Is a set of diagnostic criteria that must be fulfilled in order to identify a case of a particular disease. Case definitions can be based on clinical, laboratory, epidemiological, or combined clinical and laboratory criteria. When a set of criteria is standardized for purposes of identifying a particular disease, then it is referred to as "standard case definition". A surveillance case definition is one that is standardized and used to obtain an accurate detection of all cases of the targeted disease or condition in a given population, while excluding the detection of other similar conditions.

Case-fatality ratio or rate (CFR)

The proportion of cases of a given disease that result in death. Often abbreviated to CFR (ODI/HPN paper 52, 2005, Checchi and Roberts).


Disasters of special magnitude (although there has been no known attempt to quantification, yet). It has a "narrative", descriptive value and, mostly, an advocacy purpose. Conceptually, it relates best to reconstruction activities.

Cause-specific mortality rate

The mortality rate due to a specific disease (e.g. cholera) or phenomenon (e.g. violence) (ODI/HPN paper 52, 2005, Checchi and Roberts)


Utter confusion; formless matter (Oxford Pocket Dictionary, 1992)

Chaos and/or extreme instability

situations of high-mortality risk, where there is the "likelihood of 300% or plus increases in morbidity and mortality" (S. Hansh, 2001).

Child mortality rate

The number of children under five years of age dying per 1000 live births in a given year (ODI/HPN paper 52, 2005, Checchi and Roberts).

Civil defence organization

Any organization that, under the control of a government, performs the functions enumerated in paragraph 61 of Additional Protocol I to the Geneva Conventions of 1949.

Civil military cooperation (CIMIC)

The coordination and cooperation, in support of the mission, between a military commander and civil actors, including the national population and local authorities, as well as international, national and non-governmental organizations and agencies.


In the context of the Humanitarian Reform, a cluster is a group of agencies, organizations and/or institutions interconnected by their respective mandates, that works together towards common objectives. The purpose of the clusters is to foster timeliness, effectiveness and predictability while improving accountability and leadership.

Cluster sampling

A sampling design commonly used in retrospective mortality surveys when comprehensive lists of individual households cannot be obtained. Clusters are groups of households of which the first is chosen at random, and the remainder by a rule of proximity (e.g. second closest). In a cluster mortality survey, 30 or more clusters are usually sampled from the target study population, and each cluster usually contains at least 30 households (ODI/HPN paper 52, 2005, Checchi and Roberts)

Communities of Practice (CoPs)

Communities of practice develop naturally as people with common interests share ideas and collaborate (R. McDermott, "Building a support structure for your communities", Knowledge Management Review, 2000:Vol 3:3:5).

Completeness of reporting

Proportion of surveillance reports (or forms) received irrespective of when the reports were submitted. Proportion of reports received based on expected reporting units (if the system includes zero reporting).

Complex Emergency

1. A complex emergency, as defined by the IASC, is “a humanitarian crisis in a country, region or society where there is total or considerable breakdown of authority resulting from internal or external conflict and which requires an international response that goes beyond the mandate or capacity of any single and/or ongoing UN country programme” (Oxford Pocket Dictionary, 1992). 2. Complex political emergency: A situation with complex social, political and economic origins which involves the breakdown of state structures, the disputed legitimacy of host authorities, the abuse of human rights and possibly armed conflict, that creates humanitarian needs. The term is generally used to differentiate humanitarian needs arising from conflict and instability from those that arise from natural disasters (ALNAP).

Confidence interval

A range that expresses the level of approximation, or imprecision, around the point estimate. Also known as a margin of error. 95% confidence intervals are usually presented: we are thus 95% confident that the true population estimate lies within the range of the confidence interval (ODI/HPN paper 52, 2005 , Checchi and Roberts).

Contingency planning

The process of establishing programme objectives, approaches and procedures to respond to situations or events that are likely to occur, including identifying those events and developing likely scenarios and appropriate plans to prepare and respond to them in an effective manner (Inter-Agency Contingency Planning Guidelines for Humanitarian Assistance 2001).

Convenience survey

Survey that is not based on a randomly selected, representative sample, but rather on data from households/individuals that can easily be reached or observed (e.g. people standing in a food-distribution queue) (ODI/HPN paper 52, 2005 , Checchi and Roberts).


1. The systematic utilisation of policy instruments to deliver humanitarian assistance in a cohesive and effective manner. Such instruments include: strategic planning; gathering data and managing information; mobilising resources and assuring accountability; orchestrating a functional division of labour in the field; negotiating and maintaining a serviceable framework with host political authorities; and providing leadership. Sensibly and sensitively employed, such instruments inject an element of discipline without unduly constraining action (Larry Minear, Study on the First Gulf Crisis, 1992). Coordination can be by command, in which strong leadership is accompanied by some sort of authority; by consensus, in which leadership is essentially a function of the capacity to orchestrate a coherent response and to mobilise the key actors around common objectives and priorities; and by default, in the absence of a formal coordination entity involves only the most rudimentary exchange of information and division of labour among the actors (Antonio Donini, UN coordination in Afghanistan, Mozambique & Rwanda, 1996) Ther can be three levels of coordination: among organisations, among functions, and within programmes. Observed that money is important for coordination to be effective, and that in fact governments have the obligation to establish and maintain frameworks for coordination. Also observed that in practice, coordination is effective when structures are agreed first, reinforced by dynamic leadership (Marc Somers; EFCT course material on the mechanics of coordination, 2000).

Cost effectiveness analysis

This form of analysis seeks to determine the costs and effectiveness of surveillance and response strategies and activities. It can be used to compare similar or alternative strategies and activities to determine the relative degree to which they will obtain the desired objectives or outcomes. The preferred strategy or action is one that has the least cost to produce a given level of effectiveness, or provides the greatest effectiveness for a given level of cost.

Country Programme

All types of aid (project and non-project) to one country.


1. A situation that is perceived as difficult. Its greatest value is that it implies the possibility of an insidious process that cannot be defined in time, and that even spatially can recognize different layers/levels of intensity. A crisis may not be evident, and it demands analysis to be recognized. Conceptually, it can cover both preparedness and response ("crisis management"). 2. Time of danger or greater difficulty, decisive turning point (Oxford Pocket Dictionary, 1992).

Crude mortality rate (CMR)

Mortality rate among all age groups and due to all causes. Often abbreviated to CMR (ODI/HPN paper 52, 2005, Checchi and Roberts).

Death rate

Equivalent to mortality rate (some authors prefer the former) (ODI/HPN paper 52, 2005, Checchi and Roberts).

Design effect

Phenomenon caused by cluster sampling, and which increases the sampling error or imprecision. Households/individuals within a cluster resemble each other because of their proximity, thus resulting in an overall loss in sampling variability (ODI/HPN paper 52, 2005, Checchi and Roberts).

Disability-Adjusted Life Years (DALY)

The Disability Adjusted Life Year or DALY is a health gap measure that extends the concept of potential years of life lost due to premature death (PYLL) to include equivalent years of ‘healthy’ life lost by virtue of being in states of poor health or disability. The DALY combines in one measure the time lived with disability and the time lost due to premature mortality. One DALY can be thought of as one lost year of ‘healthy’ life and the burden of disease as a measurement of the gap between current health status and an ideal situation where everyone lives into old age free of disease and disability (WHO).


1. A serious disruption of the functioning of a community or a society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources (ISDR). 2. Situation or event, which overwhelms local capacity, necessitating a request to national or international level for external assistance (CRED). 3. A term describing an event that can be defined spatially and geographically, but that demands observation to produce evidence. It implies the interaction of an external stressor with a human community and it carries the implicit concept of non-manageability. The term is used in the entire range of risk-reduction activities, but it is possibly the least appropriate for response.

Disasters and Natural Hazards

In the 2005 Secretary-General Report “Relief to Development”, the expression “natural disasters” was purposedly not used, as it conveys the mistaken assumption that disasters occurring as a result of natural hazards are wholly “natural”, and therefore inevitable and outside human control. Instead, it is widely recognized that such disasters are the result of the way individuals and societies relate to threats originating from natural hazards. The nature and scale of threats inherent in hazards vary. The risks and potential for disasters associated with natural hazards are largely shaped by prevailing levels of vulnerability and measures taken to prevent, mitigate and prepare for disasters. Thus, disasters are, to a great extent, determined by human action, or lack thereof. The expression “disasters associated with natural hazards” should therefore be used, in line with the Hyogo Framework for Action adopted at the World Conference on Disaster Reduction held in January 2005 in Kobe (Hyogo, Japan). Natural Hazards comprise phenomena such as earthquakes; volcanic activity; landslides; tsunamis; tropical cyclones and other severe storms; tornadoes and high winds; river floods and coastal flooding; wildfires and associated haze; drought; sand/dust storm; infestations.


A factor that directly influences or causes changes (R.Kent from the UK Ministry of Defence, March 2003).

Early warning system

A communicable disease surveillance and response system designed to detect as early as possible any departure from the usual or normally-observed frequency or phenomenon.


1. The process through which activities are undertaken at the most appropriate level and with the most valuable ececution (GIGNOS, 2004) 2. A measure of the extent to which a specific intervention, procedure, regimen, or service, when deployed in the field in routine circumstances, does what it is intended to do for a specific population; a measure of the extent to which a health care intervention/activity fulfills its objectives.


Emergency is a term describing a state. It is a managerial term, demanding decision and follow-up in terms of extra-ordinary measures (Oxford Pocet Dictionary, 1992). A "state of emergency" demands to "be declared" or imposed by somebody in authority, who, at a certain moment, will also lift it. Thus, it is usually defined in time and space, it requiresthreshold values to be recognized, and it implies rules of engagement and an exit strategy. Conceptually, it relates best to Response.

Emergency preparedness

Actions taken in anticipation of an emergency to facilitate rapid, effective and appropriate response to the situation (Inter-Agency Contingency Planning Guidelines for Humanitarian Assistance 2001).

Emergency threshold

Mortality rate above which an emergency is said to be occurring. Usually taken as a crude mortality rate of 1 per 10 000 per day, or as an under-five mortality rate of 2 per 10 000 per day (ODI/HPN paper 52, 2005, Checchi and Roberts).


The occurrence in a community or region of cases of an illness, specific health-related behaviour, or other health-related events clearly in excess of normal expectancy. The community or region and the period in which the cases occur are specified precisely. The number of cases indicating the presence of an epidemic varies according to the agent, size, and type of population exposed, previous experience or lack of exposure to the disease, and time and place of occurrence.

Epidemic threshold

Is the critical number or density of susceptible hosts required for an epidemic to occur. The epidemic threshold is used to confirm the emergence of an epidemic so as to step-up appropriate control measures.

Equity in health

Equity in health implies that everyone should have a fair opportunity to attain his or her full health opportunity, and that no one should be disadvantaged from achieving this potential (EURO European Centre for Health Policy, ECHP, Brussels, 1999).


1. The systematic assessment of the relevance, adequacy, progress, efficiency or effectiveness of a policy, programme or project, in relation to its intended aims and objectives (EURO European Centre for Health Policy, ECHP, Brussels, 1999). 2. The process of determining the merit, worth or value of something or the product of that process (Scriven, 1991: p139). 3. A systematic and impartial examination of humanitarian action intended to draw lessons to improve policy and practice and enhance accountability (ALNAP). 4. The systematic and objective assessment of an on-going or completed project, programme or policy, its design, implementation and results. The aim is to determine the relevance and fulfillment of objectives, development efficiency, effectiveness, impact and sustainability. Evaluation also refers to the process of determining the worth or significance of an activity, policy or programme. * Evaluation in some instances involves the definition of appropriate standards, the examination of performance against those standards, an assessment of actual and expected results and the identification of relevant lessons. (OECD)

Excess mortality, excess mortality rate

Mortality above what would be expected based on the non-crisis mortality rate in the population of interest. Excess mortality is thus mortality that is attributable to the crisis conditions. It can be expressed as a rate (the difference between observed and non-crisis mortality rates), or as a total number of excess deaths (ODI/HPN paper 52, 2005, Checchi and Roberts).


Mathematical attempt to extend the findings of a mortality study to a population and/or period that was not represented by the sample (ODI/HPN paper 52, 2005, Checchi and Roberts).

Failing states

1. In political science, ‘failing state’ means a state which is not able to maintain internal security. 2. In economic terms, a failing state is a low-income country in which economic policies, institutions and governance are so poor that growth is highly unlikely. The state is failing its citizens because even if there is peace they are stuck in poverty (L. Chauvet and P. Collier, 2005).


Ability of the surveillance system to adapt to changing needs, incorporate new diseases, leave out less important diseases, change reporting frequency, change or modify data source.


A possible threat of source of exposure to injury, harm or loss, e.g. conflict, natural phenomena (Inter-Agency Contingency Planning Guidelines for Humanitarian Assistance 2001).


1. Health is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity (WHO Constitution). 2. The extent to which an individual or a group is able to realize aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources as well as physical capabilities (Health Promotion: A Discussion Document, Copenhagen: WHO 1984). 3. A state characterized by anatomic, physiologic and psychological integrity; ability to perform personally valued family, work and community roles; ability to deal with physical, biologic, psychological and social stress a feeling of well-being; and freedom from the risk of disease and untimely death (J. Stokes et al. "Definition of terms and concepts applicable to clinical preventive medicine", J Common Health, 1982; 8:33-41). 4. A state of equilibrium between humans and the physical, biologic and social environment, compatible with full functional activity ( JM. Last, Public Health and Human Ecology, 2nd ed. Stamford, CT: Appleton and Lange, 1997).

Health as a Bridge for Peace (HBP)

Term coined in the 1980s by the Pan American Health Organization. It is a multidimensional and dynamic concept, based on the integration of peace-building concerns and strategies into health relief and health sector development in post-conflict transitions.

Health determinants

The personal, social, cultural, economic and environmental factors that influence the health status of individuals or populations (EURO European Centre for Health Policy, ECHP, Brussels, 1999).

Health impact assessment

A combination of procedures, methods and tools by which a policy, programme or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population (EURO European Centre for Health Policy, ECHP, Brussels, 1999).

Health impacts

The overall effects, direct or indirect, of a policy, strategy, programme or project on the health of a population (EURO European Centre for Health Policy, ECHP, Brussels, 1999).

Health outcomes

Changes in current of future health status of individuals or communities that can be attributed to antecedent actions or measures (EURO European Centre for Health Policy, ECHP, Brussels, 1999).

Health status

The state of health of a person or population assessed with reference to morbidity, impairments, anthropological measurements, mortality, and indicators of functional status and quality of life (EURO European Centre for Health Policy, ECHP, Brussels, 1999).


1. A person who seeks to promote human welfare (Oxford Pocket Dictionary, 1992). 2. Humane, benevolent, beneficent, kind, good, considerate, compassionate, sympathetic, understanding, merciful, lenient, gentle, generous, magnanimous, public-spirited, unselfish, Philanthropic, altruistic, charitable, welfare, N.Philantropist, altruist, benefactor, do-gooder, Good Samaritan, social reformer (Penguin Concise Thesaurus).

Humanitarian Assistance

Humanitarian assistance is aid to a stricken population that complies with the basic humanitarian principles of humanity, impartiality and neutrality. Assistance can be divided into three categories based on the degree of contact with the stricken population: 1. Direct Assistance is the face-to-face distribution of goods and services. 2. Indirect Assistance is at least one step removed from the population and involves such activities as transporting relief goods or relief personnel. 3. Infrastructure Support involves providing general services, such as road repair, airspace management and power generation that facilitate relief, but are not necessarily visible to or solely for the benefit of the stricken population.

Humanitarian Cease-fire

Cease-fires agreed to by the protagonists in an armed conflict to allow the provision of health and humanitarian assistance, such as immunization campaigns and food supplies.

Impact assessment

The dictionary definition of an impact is an "effect of influence" and of assessment is the "estimation of size, quality, value" (EURO European Centre for Health Policy, ECHP, Brussels, 1999).


Humanitarian assistance should be provided without discriminating as to ethnic origin, gender, nationality, political opinions, race or religion. Relief of the suffering must be guided solely by needs and priority must be given to the most urgent cases of distress.

Imprecision/Sampling error

Phenomenon whereby there is a lot of uncertainty or approximation around a point estimate obtained from a sample (it does not apply to surveillance data which reflect the entire population, or to studies in which each household is interviewed). Imprecision is reflected in the width of the confidence interval around the point estimate. There is always some imprecision in a result based on a sample. The degree of imprecision of a mortality estimate is determined by sample size, length of the recall period, sampling design and design effect (if any), and the mortality rate itself (ODI/HPN paper 52, 2005, Checchi and Roberts).


1. A quantitative or qualitative variable that allows the verification of changes (OECD-DAC/RBM, 2000). 2. Quantitative or qualitative factor or variable that provides a simple and reliable means to measure achievement, to reflect the changes connected to an intervention, or to help assess the performance of a development actor (OECD). 3. Variable that helps to measure change, directly or indirectly (Tafwik A.M.Khoja, 2002). 4. Information in a consistent format that points to a current status, trend or need for action (Wideman Comparative Glossary of Project Management, V.3.1)

Infant mortality rate

Number of infants below one year of age dying per 1000 live births in a given year (ODI/HPN paper 52, 2005, Checchi and Roberts).


Unpredictability (Oxford Pocket Dictionary, 1992).

International Health Regulations (IHR)

An agreed code of conduct adopted by the World Health Assembly in May 2005 to protect against the spread of serious risks to public health and, the unnecessary or excessive use of restrictions in traffic or trade. The IHR 2005 came into force on 15 June 2007.


Ability of a system to use the parts, or equipment, of another system (Webster Dictionary).


Mathematical process by which mortality-rate findings are applied to the entire population that the study is representative of, so as to obtain total numbers of deaths or percentages of the population that died over the recall period investigated (ODI/HPN paper 52, 2005, Checchi and Roberts).


Conducted jointly with the partner or other donors.


Knowledge is something that all organisations possess and use to varying degrees. Its content can range from explicit knowledge, which can generally be expressed in the form of rules for decision making, to tacit or intuitive knowledge, which is expressed through decision making and the exercise of judgement (H. Willmott and D. Snowden, "Knowledge management: promises and pitfalls", Mastering Management, 1998:8:17-22).

Knowledge management

The production, mediation, and use of knowledge… the management of intellectual capital (OECD 2000:70).

Maternal mortality ratio

Number of women dying of pregnancy-related causes out of 100000 live births in a given year (ODI/HPN paper 52, 2005, Checchi and Roberts).

Mid-period population/Mid-point population

Estimated population at risk at the middle point of the recall period. Used in the routine simplified expression of mortality rate (ODI/HPN paper 52, 2005, Checchi and Roberts).


Key events or markers that show progress in implementation of activities and the related achievements.

Military and Civil Defense Assets (MDCA)

Relief personnel, equipment, supplies and services provided by foreign military and civil defence organizations for international humanitarian assistance.


1. The regular observation, surveillance, or checking of changes in a condition or situation, or changes in activities. 2. A continuing function that uses systematic collection of data on specified indicators to provide management and the main stakeholders of an ongoing development intervention with indications of the extent of progress and achievement of objectives and progress in the use of allocated funds (OECD).

Mortality rate

Number of deaths occurring in a given population at risk during a specified time period (also known as the recall period). In emergencies, usually expressed as deaths per 10000 persons per day; alternatively, as deaths per 1000 persons per month or per year (ODI/HPN paper 52, 2005, Checchi and Roberts).


Humanitarian assistance should be provided without engaging in hostilities or taking sides in controversies of a political, religious or ideological nature.


Standard, pattern or type (Oxford Pocket Dictionary, 1992).


Of or establishing a norm (Oxford Pocket Dictionary, 1992).

Notifiable disease

A disease that, by statutory requirements, must be reported to the public health authority in the pertinent jurisdiction when a diagnosis is made. A disease deemed of sufficient importance to public health to require that its occurrence be reported to health authorities.

Organisational forgetting

Organisational forgetting includes both purposeful unlearning of dominant logics as well as accidental loss of useful knowledge (P. DeHolan and N. Phillips, Organisational Forgetting, 2001).


The immediate result of implementing surveillance and response activities.


Cumulative time spent by each individual at risk in the population. Used in the formal expression of mortality rates, and necessary when comparing mortality rates in periods that are different in length for each individual in the population (e.g. before versus after arrival to a camp) (ODI/HPN paper 52, 2005, Checchi and Roberts).

Planning assumptions

The key elements of a scenario that form the basis for developing a contingency plan (Inter-Agency Contingency Planning Guidelines for Humanitarian Assistance 2001).

Point estimate

Most likely value for the parameter of interest (e.g. crude mortality rate) obtained through a sample survey. A point estimate should always be accompanied by a confidence interval (ODI/HPN paper 52, 2005, Checchi and Roberts).


1. A set of statements or commitments to pursue courses of action aimed at achieving defined goals of public or private institutions (EURO European Centre for Health Policy, ECHP, Brussels, 1999).

Population-proportional sampling

Approach to selection of clusters or households to be sampled, whereby more populous sections of the study area are allocated proportionately more clusters or households (ODI/HPN paper 52, 2005, Checchi and Roberts).

Positive predictive value of case definition (PPVcd)

Ability of the case definition to identify real cases or the proportion of true cases of the disease that meet the case definition.

Positive predictive value of detecting outbreaks/ cases (PPVdo)

Ability of the surveillance system to detect real alerts, i.e. confirmed alerts (after verification)/all alerts detected.


1. Activities and measures taken in advance to ensure effective response to the impact of hazards, including the issuance of timely and effective early warnings and the temporary evacuation of people and property from threatened locations (ISDR) 2. Pre-disaster activities, including an overall strategy, policies, and institutional and management structures, that are geared to helping at-risk communities safeguard their lives and assets by being alert to hazards and taking appropriate action in the face of an imminent threat or the actual onset of a disaster (OCHA-WFP).

Priority diseases

Are diseases/conditions that have been identified to be of important/major public health concern.

Programmes, projects

In order to implement policies, any number of programmes and projects may be developed. • A programme is usually a set of actions/projects designed for a specific purpose (for example a child welfare programme, or tobacco control programme). • A project is usually more narrowly defined, although in terms of resources used it may be larger or smaller than a programme (for example, the building of an oil refinery, or a small training course might both be defined as projects). (EURO European Centre for Health Policy, ECHP, Brussels, 1999).

Proportionate mortality

Fraction of all deaths due to a specific cause (ODI/HPN paper 52, 2005, Checchi and Roberts).

Public health emergency

A public health emergency (the condition that requires the governor to declare a state of public health emergency) is defined as "an occurrence or imminent threat of an illness or health condition, caused by bio terrorism, epidemic or pandemic disease, or (a) novel and highly fatal infectious agent or biological toxin, that poses a substantial risk of a significant number of human facilities or incidents or permanent or long-term disability (WHO/DCD, 2001). The declaration of a state of public health emergency permits the governor to suspend state regulations, change the functions of state agencies.

Quality assurance

System of procedures, checks, audits and corrective actions to ensure that all testing, sampling, analysis, monitoring and other technical and reporting activities are of the highest achievable quality.

Quality control

The supervision and control of all operations involved in a process usually involving sampling and inspection, in order to detect and correct systematic or excessively random variations in quality.

Real time

The deployment of a staff member or consultant into an ongoing operation to evaluate events as they unfold.

Recall bias

Bias due to imperfect recall by questionnaire respondents of events in their households. Usually results in an under-estimation of mortality (ODI/HPN paper 52, 2005, Checchi and Roberts).

Recall period

Period of interest in the measurement of a mortality rate, i.e. the interval of time to which the mortality rate in a given population refers (ODI/HPN paper 52, 2005, Checchi and Roberts).


1.Decisions and actions taken after a disaster with a view to restoring or improving the pre-disaster living conditions of the stricken community, while encouraging and facilitating necessary adjustments to reduce disaster risk (ISDR). 2. Longer-term effort to (a) reconstruct and restore the disaster-stricken area, e.g. through repairing or replacing homes, businesses, public works, and other structures; (b) deal with the disruption that the disaster has caused in community life and meet the recovery-related needs of victims; and (c) mitigate future hazards (K. Tierney, Disaster Preparedness and Response: Research Findings and Guidance from the Social Science Literature, University of Delaware Disaster Research Center, Preliminary Paper 193, 1993).

Relief and emergency humanitarian assistance

Relief operations are intended to respond to the immediate need to save lives, limit extraordinary suffering, prevent further injury to the population or damage to the society. Normally, these are operations of short duration. However, in complex emergencies when states are unstable or have failed, and the society has lost its ability to respond, protracted humanitarian emergencies requiring a sustained international presence can exist.

Reporting bias

Bias due to (often intentional) under- or over-reporting of information, such as number of deaths or household size (ODI/HPN paper 52, 2005, Checchi and Roberts).


Ability of the system to accurately describe the occurrence of a health-related event by place and person over time in a given population.

Resident Coordinator and Humanitarian Coordinator

The Resident Coordinator is the head of the UN Country Team. In a complex emergency, the Resident Coordinator may be designated as the Humanitarian Coordinator. If one of the UN agencies is designated the “Lead Agency” they may assume the responsibilities of the Humanitarian Coordinator. In large-scale emergencies, a Humanitarian Coordinator, distinct from the office of the Resident Coordinator and Lead Agency may be appointed. If the emergency affects more than one country, a Regional Humanitarian Coordinator may be appointed. In countries where large multi-disciplinary field operations are in place, the Special Representative of the Secretary-General has authority over the Resident and Humanitarian Coordinator. The decision on who to appoint as Humanitarian Coordinator is made by the IASC.


1. An evaluation of the probability of occurrence and the magnitude of the consequences of any given hazard, i.e. how likely is a hazard and what consequences will it have? (Inter-Agency Contingency Planning Guidelines for Humanitarian Assistance 2001). 2. The risk of a disaster is the probability of a disaster occurring. The evaluation of a risk includes vulnerability assessment and impact prediction taking into account thresholds that define acceptable risk for a given society.

Sample size

Number of clusters/households/individuals that a survey sets out to include, i.e. interview (ODI/HPN paper 52, 2005, Checchi and Roberts).

Sampling design

Method by which households to be sampled are selected within the target population (ODI/HPN paper 52, 2005, Checchi and Roberts).

Sampling frame

List of households, or sub-sections of the study area/population, used to allocate clusters or select households to be sampled (ODI/HPN paper 52, 2005, Checchi and Roberts).

Sanctuaries of Peace

Health/medical institutions, e.g. hospitals and clinics, not to be affected by war.


An account or synopsis of a possible course of events that could occur, which forms the basis for planning assumptions (for example, a river floods, covering a nearby town and wiping out the local population's crop). Scenario-building is process of developing hypothetical scenarios in the context of a contingency planning exercise (Inter-Agency Contingency Planning Guidelines for Humanitarian Assistance 2001).

Selection bias

Type of bias whereby a specific kind of household is systematically excluded from the survey, and thus not represented in the results. May result in both over- and under-estimation of mortality (ODI/HPN paper 52, 2005, Checchi and Roberts).

Sensitivity in surveillance

The ability of a surveillance or reporting system to detect true health events, i.e. the ratio of the total number of health events detected by the system to the total number of true health events as determined by an independent and more complete means of ascertainment (WHO Protocol for the assessment of national communicable disease surveillance and response systems: Guidelines for the assessment teams).

Sensitivity of case definition

Ability of the case definition to detect all cases of the disease targeted for surveillance.

Sensitivity of detection of cases

Ability of the surveillance system to detect cases, i.e. proportion of cases notified divided by the total number of cases meeting the case definition.

Sensitivity of the detection of outbreaks

Ability of the surveillance system to detect outbreaks.


A high impact, low probability event (R.Kent from UK Ministry of Defence, March 2003)

Simple random sampling

Sampling design whereby an individual sampling frame of households is established, and households to be sampled are selected using random numbers (ODI/HPN paper 52, 2005, Checchi and Roberts).

Situation analysis

Study of a situation which may require improvement. This begins with a definition of the problem and an assessment or measurement of its extent, severity, causes, and impacts upon the community, and is followed by appraisal of interaction between the system and its environment and evaluations of performance.

Slow-onset disaster

Disasters that take a long time to produce emergency conditions, for instance natural disasters such as drought or socio-economic decline, which are normally accompanied by early warning signs (WFP).

Spatial sampling

Approach to selection of clusters or households to be sampled, whereby clusters and/or households are allocated proportionately to surface area within the study area. Alternative to population-proportional sampling (ODI/HPN paper 52, 2005, Checchi and Roberts)

Specificity in surveillance

A measure of how infrequently a system detects false positive health events, i.e. the number of individuals identified by the system as not being diseased divided by the total number of all persons who do not have the disease (Protocol for the assessment of national communicable disease surveillance and response systems: Guidelines for the assessment teams).

Stand By

To be ready or available to act (dictionary). One to be relied on especially in emergencies; one that is held in reserve ready for use On standby: ready or available for immediate action or use (Webster Dictionary)


1. Level of excellence required or specified; average quality; ordinary procedure (Oxford Pocket Dictionary, 1992). 2. Something that serves as a basis for comparison (JM Last, 2001). 3. A statement of expectations; an expected level of performance or quality (T.A.M.K.ibid). 4. A specific statement of the rules and constraints governing the deliverables (W.C.G.P.M, ibid). 5. A specific consensus solution to a repetitive problem (W.C.G.P.M, ibid). 6. Any established or accepted rule, model, or criterion against which comparisons are made (W.C.G.P.M, ibid).


Sampling and analysis of sub-groups or sub-periods (ODI/HPN paper 52, 2005, Checchi and Roberts).

Sudden-onset disasters

Both “natural” disasters (e.g. earthquakes, hurricanes, floods) and man-made or "complex" disasters (e.g. sudden conflict situations arising from varied political factors), for which there is little or no warning (WFP).

Surge capacity

Ability to obtain additional resources when needed during an emergency (US Centers for Disease Control and Prevention).

Surveillance (prospective)

Ongoing collection of epidemiological data, with real-time analysis. Mortality surveillance systems usually rely on home visitors who record deaths in households on a weekly basis (ODI/HPN paper 52, 2005, Checchi and Roberts).

Survey (retrospective)

Study of past mortality in a population using a standardized questionnaire that is administered to the entire population or, more commonly, to a randomly selected sample (ODI/HPN paper 52, 2005, Checchi and Roberts).

Survival bias

Type of selection bias specific to retrospective surveys, whereby households that disappear during the recall period because of the death of all members and consequent disintegration are not represented in the sample. It occurs when high and/or very clustered mortality persists for a long period. Survival bias always results in an under-estimation of mortality (ODI/HPN paper 52, 2005, Checchi and Roberts).

Systematic random sampling

Sampling design whereby an individual sampling frame of households is established, and households to be sampled are selected using a constant sampling step (i.e. every nth household) (ODI/HPN paper 52, 2005, Checchi and Roberts).


1. Thing aimed at; Objective or result aimed at (Oxford Pocket Dictionary, 1992,1992) 2. An aspired outcome that is explicitly stated, e.g. achieve 90% of timeliness of reporting, 100% completeness of reporting, etc. (JM Last, 2001). 3. Degree of achievement referring to a discreet activity (T.A.M.K.ibid).

Timeliness of reporting

Proportion of all expected reports in a reporting system received by a given due date (Protocol for the assessment of national communicable disease surveillance and response systems: Guidelines for the assessment teams).


A discernible pattern of change (R.Kent from UK Ministry of Defence, March 2003).

Under-five mortality rate/U5MR

Number of deaths occurring in a given population of under-five children during a specified time period. Often abbreviated to U5MR (ODI/HPN paper 52, 2005, Checchi and Roberts).


An expression of the degree to which the surveillance data measure the true incidence of cases in the population.


Values denote worth or desirability (EURO European Centre for Health Policy, ECHP, Brussels, 1999).


The degree to which a socio-economic system is either susceptible or resilient to the impact of natural hazards and related technological and environmental disasters. The degree of vulnerability is determined by a combination of several factors including hazard awareness, the condition of human settlements and infrastructure, public policy and administration, and organized abilities in all fields of disaster management. Poverty is also one of the main causes of vulnerability in most parts of the world.

Zero reporting

Reporting of the absence of cases of a disease under surveillance; this ensures that participants have not merely forgotten to report.

Source: World Health Organization (

Private hospitals open to partnerships

The private hospital sector was keen to enter into public-private partnerships with the health department but faced reluctance and red tape in some provinces, Ramesh Bhoola, the chairman of the Hospital Association of SA (Hasa), said this week.

An evaluation of existing part-time district surgeon services and alternative mechanisms for future contracting with general practitioners

Published by: 
UCT Health Economics Unit
The purpose of this research project was to provide information which would contribute to debates about restructuring of the PDS system. In particular, patient satisfaction with current PDS services was evaluated, and the opinions of PDSs and patients about possible changes to the PDS system were surveyed. This was accomplished through exit poll interviews with 638 PDS patients (the user survey) and a questionnaire survey of 58 PDSs (the PDS survey). These surveys were conducted in three provinces, namely the Western Cape, Northern Cape and the Free State.

Improving the quality of primary health care: public and private provision

The quality of primary health care (PHC) delivered to people in developing countries is often poor and coverage is not yet universal. This is despite a focus on the public delivery of comprehensive PHC over the past 20 years. People frequently consult private providers including qualified medical professionals and unqualified health practitioners. A better use of private care providers, therefore, might be a potential solution, including contracting them to provide services on behalf of the public sector.

Monitoring the effect of the new rural allowance for health professionals

Published by: 
Health Systems Trust
This study is the first attempt to assess the effect of the new rural allowance on the motivation and movement of health professionals working in rural areas. Although methodologically limited, the study gives some indication of the likely impact of the funds allocated by Treasury, namely that almost one-third of health professionals working in rural areas say that they have changed their career plans next year as a result of the new allowance. It is difficult to assess whether this is the effect of the RA alone, or in combination with the SSA. Further evaluations will be necessary to assess the longer-term impact of these strategies.

Is democracy good for people's health? A South African perspective

On 7 April 1994, the new South African government inherited 14 independent health departments: one for each of the 10 black homelands one each for the white, brown (mixed descent) and Asian communities and one for black Africans living and working in so called white South Africa. Has the health of the people improved in the decade since democracy? Not according to the health indicators, such as maternal, infant, and perinatal mortality child nutrition tuberculosis prevalence and life expectancy.

World Report on Knowledge for Better Health

Published by: 
World Health Organization
The Report focuses on bridging of the know do gap, the gulf between what we know and what we do in practice, between scientific potential and health realization. The bridging of this gap is central to achieving the health-related Millennium Development Goals (MDGs) by 2015. The gap exists for each of the MDGs and represents a fundamental and pragmatic knowledge translation challenge that must be addressed to strengthen health systems performance towards achieving the MDGs. The Report will expound the message that we must turn scientific knowledge into actions, which improves peoples health, and that health improvement through knowledge applications is a critical factor in human development and alleviation of ill-health and poverty worldwide. The Report will be highlighted at the World Ministerial Summit on Health Research in Mexico (November 16-20, 2004).

Health Care in Eastern Cape - Implications for planning

Published by: 
Health Systems Trust
The report is intended for health managers in the Eastern Cape Province managers at Provincial level but especially for Regional managers as the information is set out in a format which defines and compares the resources and services of the five regions. The information was obtained from ReHMIS (Regional Health Management Information System) by the Eastern Cape ReHMIS team and some additional sources were also used. Data was collected from all public (provincial and local authority) health facilities using national definitions. Maps and tables of population distribution are provided. These assist in defining the problems of reorientation from the previous administration (of South Africa and two so-called independent states Transkei and Ciskei) to a unified, integrated, decentralised, equitable health service based on Primary Health Care, and the health priorities of the Reconstruction and Development Programme.