Vital Statistics and Data Management for Evidence Health Situation

and Trend Assessment

Workshop on Civil Registration and Vital Statistics in UNESCWA Region, Cairo, Egypt, 3-6 December 2007

By

Dr Samuel Mikhail

EMRO/WHO

Content Introduction vital statistics The country's / EMRO system Appropriate use of health statistics Vital Statistics and discrepancies Barriers and constraints Barriers and constraints Discrepancies on Country’s / UN EstimatesDiscrepancies on Country’s / UN Estimates Unification of Database – Inter-country – inter-UN organizations

Introduction:- Policies and programmes to combat diseases and injuries should be based on current information about he nature and extent of health problems, their determinants, and how the impact of such diseases and injuries is changing, both with respect to magnitude and distribution in populations. - priorities for health research should, in part at least, be based on a thorough assessment of the relative importance of various diseases and injuries affecting the population's health

-- commonly used data for meeting these needs, and related needs for health policy, are statistics on the number of people who die, by age and sex, and on the causes of those deaths, classified according to a standard set of medical criteria. - Almost all countries have legislation that establishes vital registration systems to collect and collate statistics on who dies from what cause.. - Indeed, such systems are still inoperative for a large proportion of the world's population, especially in countries with high burdens of disease.- There's a lack of information on causes of death in many developing countries nevertheless Eastern Mediterranean Region countries, which draw the attention for the urgent need of the WHO and other international health agencies

to take a lead in redressing this situation.

- World health statistics has been collated from publications and database produced by WHO’s technical programmes and regional member states .

- The core set of indicators was selected on the basis of their relevance to global health, the availability and quality of the data, and the accuracy and comparability of estimates .

- The statistics for the indicators are derived from an interactive process of data collection, compilation, quality assessment and estimation occurring among WHO’s technical programmes and its Member States.

- The core of indicators do not aim to capture all relevant aspects of health but to provide a comprehensive summary of the current status of a population’s health and the health system at country level.

- These indicators include : mortality outcomes, morbidity outcomes ,risk factors, coverage of selected health interventions, health systems, inequalities in health, and demographic and socioeconomic statistics.

- World health statistics will be updated regularly ,and it includes the most recent estimates and time-series of relevant health statistics .

The vital statistics

Variables Definitions Concepts Ensuring comparability

The current level of existence and functioning of the country's / EMRO system

Data PoolingEMRO/EST

unit

Countries

Ministry of Health

Technical Units

(programs)

Regional 0ffice

Data Data

Refined data with priority for

Technical Unit data

Data request Data request

Revised

Resent for approval

Final data revised and approved by

countries

Approved

Regional Health

Database

Country profiles & different reports

Monitoring progress: appropriate use of health statistics- For monitoring, it is important to distinguish between corrected and predicted statistics. - Corrected statistics use adjustments made for known biases and, if needed, are based on a systemic reconciliation of data from multiple sources using established, transparent methods.- This mismatch was created partly by the demand for more timely statistics and partly by the lack of data and good measurement strategies for certain statistics.- It is crucial for the international community to invest in data collection and use indicators that are valid, reliable and comparable - the international community must also have well-defined measurement strategies for monitoring progress and evaluating health programmes.

The civil registration systems of many countries are not well functioning leading to difficulties and challenges when faced with the need of reliable source of statistics especially on vital events. For efficiently and effectively functioning health systems and for countries to be able to identify with their health needs, complete and reliable information on births and deaths by age, sex and cause are needed as are other recordings of vital events on a continuous and complete bases.

The result of such systems is an unstable impact upon decision making, policy formulation, and measurement of health programs.

Furthermore, differences in definitions and concepts of vital events and registration provide difficulty with comparability. Hence, the international standards & guidelines developed by the United Nations need to be applied so that universal comparison is possible.

Barriers and constraints:Barriers and constraints:-- In many countries and programs; definitions, classifications and method of calculation do not entirely conform to the WHO or international standards.- People (even in statistical offices) still mix between year of estimate and year of reporting. - Delay of reporting the updated and published data either from some countries or UN technical units.- - Many countries impose upon the indicators figures by using the same figures which were implied for many years ago for updating recent years.- Countries generally derive their estimates from reported services which are not always available and accurate.- Most countries do not cover the data on various types of government and private health services.

- Some countries derive these data from survey, but since survey questions and definitions differ across countries, the estimate may not strictly comparable. - Most countries do not cover the data on various types of government and private health services.- Several figures related to the same indicator for the same year reported in different values and/or previous values.- Some figures reported from country to various regional office units with different values.- Consistency of the data in some indicators is questionable as it is published by several MOH units with different figures on the same dates.

- Some figures reported to UN technical units and never been routed to WHO/EMRO and/or routed with different figures.

- Some Countries not provide future estimations or projections except on population based country figures while some UN sources do that.

- Some Countries not covering, collecting and/or reporting all indicators required all users such as MDG indicators

- Some UN technical units might think that some of the national data reported by the countries is not accurate or reliable.

Discrepancies Discrepancies on on

Country’s / UN Country’s / UN EstimatesEstimates

Country Country’s estimates

UN estimates (World population reports )

Bahrain 743 (06) 739 (06)

Egypt 72 010 (06) 75 437 (06)

Iraq 27 963 (06) 29551 (06)

Jordan 5 600 (06) 5 837 (06)

Kuwait 3 051 (06) 2 765 (06)

Lebanon 4 141 (06) 3 614 (06)

Oman 2577 (06) 2612 (06)

Palestine 3952 (06) 4000 (07)

Qatar 838 (06) 839 (06)

Saudi Arabia 23 678 (06) 25 193 (06)

Syria 18 717 (06) 19 512 (06)

UAE 4106 (05) 4657 (06)

Yemen 20 892 (06) 21 639 (06)

Population (000S)

Country Country’s estimates

UN estimates (World population reports)

Bahrain 2.7(06) 1.6 (00-06)

Egypt 1.9 (06) 1.9 (00-06)

Iraq 2.7 (04) 2.8 (00-06)

Jordan 2.3 (06) 2.7 (00-06)

Kuwait 8.4 (05) 3.7 (00-06)

Lebanon 1.5 (06) 1.0 (00-06)

Oman 2.2 (06) 1.0 (00-06)

Palestine 3.3 (06) 2.9 (06)

Qatar 5.2 (05) 5.9 (00-06))

Saudi Arabia 2.3 (06) 2.7 (00-06)

Syria 2.5 (06) 2.5 (00-06)

UAE 4.9 (05) 6.5 (00-06)

Yemen 3.0 (04) 3.1 (00-06)

Population growth rate

Country Country’s estimates

UN estimates (World population reports)

Bahrain 2.5 (06) 2.5 (00-06)

Egypt 3.1 (05) 3.3 (00-06)

Iraq 6.0 (04) 4.8 (00-06)

Jordan 3.2 (05) 3.5 (00-06)

Kuwait 2.3 (02) 2.4 (00-06)

Lebanon 1.9 (04) 2.3 (00-06)

Oman 3.2 (06) 3.8 (00-06)

Palestine 4.6 (04) 4.6 (06)

Qatar 2.6 (05) 3.0(00-06)

Saudi Arabia 3.2 (06) 4.1 (00-06)

Syria 3.6 (06) 3.5 (00-06)

UAE 2.1 (05) 2.5 (00-06)

Yemen 6.2 (05) 6.2 (00-06)

Total Fertility Rate

Country Country’s estimates UN estimates (World population reports)

Bahrain 7.6 (06) 14 (00-06)

Egypt 20.5 (05) 37 (00-06)

Iraq 107.9 (03) 94 (00-06)

Jordan 22.0 (02) 23 (00-06)

Kuwait 8.2 (05) 10 (00-06)

Lebanon 18.6 (04) 22 (00-06)

Oman 10.3 (05) 16 (00-06)

Palestine 24.2 (05) 25 (06)

Qatar 8.1 (06) 12 (00-06)

Saudi Arabia 18.6 (06) 23 (00-06)

Syria 18.0 (06) 18 (00-06)

UAE 7.7 (05) 9 (00-06)

Yemen 75.0 (03) 69 (00-06)

Infant Mortality Rate/1000 Live births

Under 5 Mortality

Country Country’s estimates

UN estimates (World population reports)

Bahrain 10.1 (06) 14.0 (05-10)

Egypt 26.2 (05) 34.0 (05-10)

Iraq 130 (03) 105.0 (05-10)

Jordan 27.0 (02) 22.0 (05-10)

Kuwait 10.0 (05) 10 (05-10)

Lebanon 19.1 (04) 26.0 (05-10)

Oman 11.0 (05) 14.0 (05-10)

Palestine 28.5 (05) 20.0 (05-10)

Qatar 10.7 (06) 10.0 (05-10)

Saudi Arabia 21.7 (06) 22.0 (05-10)

Syria 22.0 (06) 18.0 (05-10)

UAE 9.9 (05) 9.0 (05-10)

Yemen 102.0 (03) 79.0 (05-10)

Maternal Mortality

Country Country’s estimates

UN estimates (World population reports)

Bahrain 1.0 (06) 28.0 (00)

Egypt 63.0 (05) 84.0 (00)

Iraq 294.0 (03) 250.0 + (00)

Jordan 41.0 (06) 41.0 (00)

Kuwait 4.0 (05) 5.0 (00)

Lebanon 86 (04) 150.0+ (00)

Oman 15.0 (05) 87.0+ (00)

Palestine 8.0 (05) 100.0 (00)

Qatar 7.0 (06) 7.0 (00)

Saudi Arabia 16.0 (04) 23.0 (00)

Syria 58.0 (06) 160.0 (00)

UAE 1.0 (05) 54.0+ (00)

Yemen 366.0 (03) 570.0 (00)

Unification of Database Database is one of the most powerful and important assets an operator

possesses. Unfortunately, it is extremely difficult to gather accurate representations in multinomial, converged network environments where data is often locked away in proprietary systems and fragmented across many database. That’s why all operators urgently need a solution that can harness data, wherever it resides, so they can reduce network complexity and cut the time. And that solution needs to be open and flexible enough to help operators migrate along their strategic path to converged programs. The solutions provide the ability to greatly accelerate the launch and support of revenue-generating programs.

The aims of the unification of database: Provide a conceptual framework of information domains. establish a common language to improve communication; permit comparisons

of data focus on multi-dimensional aspects of programs Meet the needs of its different and varied users; and provide a platform for

users and developers. Covering all the basic elements: hence the need for the clearness of

terminologies and vocabularies. Provide a common reference point for reporting and statistical use. Provide a configuration of data/and or information between the units of the

division moreover,

Definitions need to be standardized,

- and vital statistic variables need to be chosen. Without these norms there will remain an inconsistency and incomparability between the national registration systems.

- Without comparability, national systems will loose out on shared experiences to built and improve upon. The system will just be a system of the nation without possible global interaction.

Demographic Indicators Area sq. km Population Total Urban % Crude birth rate Crude death rate Population growth rate Population <15 years 65+ years Dependency Ratio Total fertility rate

Socioeconomic Indicators Adult literacy rate 15+ years T % M % F % Gross primary school enrollment ratio T % M % F % Gross secondary school enrollment ratio T % M % F % Per capita GNP US$ Population with access to safe drinking water % Population with adequate excreta disposal facilities %

Unemployed % Regular smokers 15+ years T % M % F %

Health Expenditure Indicators GDP per capita,US$ Exchange rate Total Health Expenditure per capita,US$ Exchange rate

General Government Expenditure on Health Per Capita, US$ Exchange rate

Total Health Expenditure as % of GDP General Government Expenditure on Health as % of Total Health

Expenditure Out Of Pocket as % of Total Health Expenditure MOH's budget as a % of government budget Human and Physical Resources Indicators, Rate per 10,000 pop

Physicians Dentists Pharmacists Nursing and midwifery personnel Hospital beds PHC units and centers

Indicators of Coverage with Primary Health Care services

Population with access to local health services Total % Urban % Rural % Married women (15-49) using contraceptives % Pregnant women attended by trained personnel %

Deliveries attended by trained personnel % Infants attended by trained personnel % Infants fully immunized with BCG % DPT % OPV % Measles Vaccine % Hepatitis B Vaccine % Pregnant women given TT2+ %

Health Status Indicators Life expectancy at birth ( years) T M F Newborns with birth weight at least 2500 kg %

Children with acceptable weight for age %

Infant mortality rate per 1000 live births Probability of dying before reaching 5th birthday per

1000 live births Maternal mortality ratio per 10 000 live births

Thank you