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South Africa

Engelbrecht B. A Barometer of District Hospital Management. Kwik Skwiz 27. Durban: Health Systems Trust; Aug 2000.
URL: http://hst.org.za/publications/395

Publication of the HST, based on work within the Initiative for sub-district support programme. Focus is limited to District Hospitals, and is more of a management tool.

Equity Gauge Project:
Focus includes other dimensions of equity. Limited data included on district-level comparisons, primarily through analysis of secondary data sources.

South African Health Review and online Health Indicators database: 
Data presented primarily at provincial level or by race groups. Analysis of data has not focussed on district-level comparison. Obtaining and analysing data at district level has been problematic, and layout/display of data has been a constraint.

Provincial Strategic Planning Framework and Early Warning System
Still in development and refinement. Issues have been identified with respect to capacity, data collection, quality and analysis, but it expected to provide a useful basis and reflects political commitment to the concept.
Limited to public health system.

District Competition
Scoring system rather arbitrary, not used for anything much apart from competition outcome.

Harrison D (editor). Progress Towards District Based Care. HST Update 17. Durban: Health Systems Trust; July 1996.
URL: http://hst.org.za/publications/102
This publication presented research and commentary on the status of district health systems development, measured at a provincial level. The focus then was on systems implementation, rather than health care or health systems performance indicators.

McCoy D, Gilson L. Improving and Monitoring the Equity of Health Care Provision: A discussion of the selection of indicators. In: A travelling seminar on the attainability and affordability of equity in Health Care Provision. Durban: Health Systems Trust; 1998.
http://www.gega.org.za/download/equity_sem.pdf

This paper includes important issues to consider in the construction of a district Barometer. It stresses the development of indicators that can drive change as much as monitor change, thus emphasising the advantage of disaggregating the population according to health districts as the basic management unit of the South African health system. Measuring disparities in the quality of health care between different districts will facilitate strategies for improving equity that can be implemented through the normal administrative and management structures of the health system. At the same time, it is important to recognise the limitations of using administrative boundaries to categorise population groups. Some health districts may consist of a mix of rural, urban and informal settlement areas, each with a different picture of health and a different set of health needs.

The document suggests that an accurate composite score of the overall quality of care provided by health districts would be difficult to measure because of the subjectivity involved in assessing some aspects of quality. In addition, it would be difficult to devise a scoring system that appropriately contrasts the adequacy of health care provision with the actual health needs and problems of specific districts. The paper goes on to discuss various criteria for selection of indicators that can measure equity of health care provision.

Strategic Priorities for the National Health System 2004-2009. National Department of Health.
http://www.doh.gov.za/docs/policy/stratpriorities.pdf
Provides a national level framework of health system priorities which should inform the development of the Barometer.

MESH Concept – A new way of looking at financing and resource allocation that may inform the construction of some of the Barometer indicators. An internal discussion paper is available.

Information on district level financing that contributes to this work includes:

Thomas S, Mbatsha S, Muirhead D, Okorafor O. Primary Health Care Financing and Need across Health Districts in South Africa. Health Systems Trust; 2004.
URL: http://hst.org.za/publications/604

Other countries / international

WHO framework for health system performance assessment, Summary Measures of Population Health, Sub-national performance assessment
http://w3.whosea.org/ehp/hspa/report.htm  (2001)
http://w3.whosea.org/ehp/hspa/pdf/framework/paper1.pdf

World Health Reports – in particular those which attempted to measure and rank health systems.

Enhancing Health Systems Performance Initiative (EHSPI)
http://www.who.int/health-systems-performance/ehspi.htm

Health Systems Performance Assessment: Debates, Methods and Empiricism
http://www.who.int/publications/2003/hspa/en/

This volume reports on a large body of work led by the World Health Organization that is intended to strengthen the foundations for evidence-based policies aimed at health systems development. This has included work to develop a common conceptual framework for health systems performance assessment, to encourage the development of tools to measure its components, and to collaborate with countries in applying these tools to measure and then to improve health systems performance. It began with the enunciation of a framework that specified a parsimonious set of key goals to which health systems contribute, and the first set of figures on goal attainment and health system efficiency in countries that were Members of the Organization was published in The World Health Report 2000. While most authors in this volume take a global perspective, the findings have important implications for the development of national performance frameworks and the creation of a culture of accountability.

Millennium Development Goals
http://www.undp.org/mdg/

Very high level, covering sectors other than health, although health is a substantial component. Unless used to strengthen the health system and health information systems, as well as considering sub-national equity issues, pursuit of these goals can add pressure to systems.

What should be measured in relation to health status: The EU aggregate experience
http://europa.eu.int/comm/health/ph_information/reporting/ev_20040524_rd01_en.pdf

Reviews some existing European health monitoring programmes and considers how this can be standardised across the countries in the region to provide comparable health status information.

Health Metrics Network
http://www.who.int/entity/mip/2003/other_documents/en/health_metrics-boerma.pdf
http://www.who.int/mip/2003/official/en/  - Health metrics

Initiative to set up a broad, international network of experts and key stakeholders in support of efforts to strengthen country health information systems. These systems will be able to provide sound information for monitoring progress towards international health goals together with essential information for improved public health programmes within countries. Not clear if there are further developments beyond this documentation.

PAHO
Core health data system http://www.paho.org/English/SHA/glossary.htm
http://www.paho.org/english/dbi/mds/HIA_2002.htm
http://www.campusvirtualsp.org/eng/pub/PublicHealthAmericas/english/E-08--CH8--89-96.pdf

The Regional Core Health Data Initiative is one of the main technical efforts of PAHO and its Member States to collect and disseminate health-related data that characterize the health situation of the region. The database includes a core set of 108 indicators, these are disaggregated (by sex, age groups, etc.) for a total of 216 indicators. Representing information from 48 countries and territories of the Western Hemisphere from 1997 to date, each indicator is defined and accessible through the Indicators Glossary. This glossary also contains technical notes, indicator type (absolute magnitude, proportion, rate, etc.) measurement units, and possible categories and subcategories.

The Table Generator System allows the creation of data tables by indicators, countries, and years.

Health in the Americas, 2002 Edition, is the Pan American Health Organization publication analysing the health situation and trends in the Region of the Americas. Volume I presents a Regional perspective on the current health situation. This volume includes analyses of the status and trends of several important health and health-related indicators and determinants, ranging from mortality and changes in life expectancy to the impact that income-level and income-distribution inequalities have on the population's health.

Volume II presents the most up-to-date health situation analysis for each of the 48 countries and territories of the Americas. This volume is a product of a Region wide analytical effort that is conducted using a common framework that includes an analysis of overall health status, specific health problems, and the response of health systems and services.

Association of Public Health Observatories
http://www.apho.org.uk/apho/viewResource.aspx?uri=http://www.phenet.org.uk/?id=930

Looks at indicators of public health in the English regions: population health status, priority public health interventions, effectiveness of partnerships, risk factors and determinants, public health capacity.

Includes a lot of statistical analysis with confidence intervals and adjusting for confounders such as deprivation.

The Wealth Gap in Health
http://www.prb.org/

Analyses data from the Demographic and Health Surveys by wealth quintiles to explore health inequalities by socio-economic status. While this is useful, it is just one analysis approach, and would be limited by the availability and level of DHS data.