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ÓWorldHealthOrganizationJuly2020Suggestedcitation:ThirteenthGeneralProgrammeofWork(GPW13):metadataforimpactmeasurementindicators.Geneva:WorldHealthOrganization;2020.

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TableofContentsIntroduction..................................................................................................................................................................6

Section1:46OutcomeIndicators.................................................................................................................................7Table1.Overviewof46outcomeindicators............................................................................................................8SDG1.5.1Numberofpersonsaffectedbydisasters(per100000population).....................................................12SDG1.a.2Domesticgeneralgovernmenthealthexpenditure(GGHE-D)(%ofgeneralgovernmentexpenditure(GGE)).....................................................................................................................................................................13SDG2.2.1Prevalenceofstuntinginchildrenunder5(%)......................................................................................14SDG2.2.2Prevalenceofwastinginchildrenunder5(%).......................................................................................15SDG2.2.2Prevalenceofoverweightinchildrenunder5(%).................................................................................16SDG3.1.1Maternalmortalityratio(per100000livebirths).................................................................................17SDG3.1.2Proportionofbirthsattendedbyskilledhealthpersonnel(%)..............................................................18SDG3.2.1Under-fivemortalityrate(per1000livebirths).....................................................................................19SDG3.2.2Neonatalmortalityrate(per1000livebirths).......................................................................................21SDG3.3.1NewHIVinfections(per1000uninfectedpopulation)...........................................................................23SDG3.3.2Tuberculosisincidence(per100000population)..................................................................................24SDG3.3.3Malariaincidence(per1000populationatrisk)....................................................................................25SDG3.3.4HepatitisBincidence(measuredbysurfaceantigen(HBsAg)prevalenceamongchildrenunder5years)......................................................................................................................................................................27SDG3.3.5NumberofpeoplerequiringinterventionsagainstNTDs......................................................................28SDG3.4.1ProbabilityofdyingfromanyofCVD,cancer,diabetes,CRD(ages30-70)(%).....................................30SDG3.4.2Suicidemortalityrate(per100000population)....................................................................................31SDG3.5.1Coverageoftreatmentinterventionsforsubstance-usedisorders(%).................................................32SDG3.5.2Totalalcoholpercapitaconsumptioninadultsaged15+(litresofpurealcohol).................................33SDG3.6.1Roadtrafficmortalityrate(per100000population).............................................................................35SDG3.7.1Proportionofwomen(aged15-49)havingneedforfamilyplanningsatisfiedwithmodernmethods(%)...........................................................................................................................................................................36SDG3.8.1UHCServiceCoverageIndex..................................................................................................................37SDG3.8.2Populationwithhouseholdexpendituresonhealth>10%oftotalhouseholdexpenditureorincome(%)...........................................................................................................................................................................39SDG3.9.1Mortalityrateattributedtoairpollution(per100000population)......................................................42SDG3.9.2MortalityrateattributedtoexposuretounsafeWASHservices(per100000population)..................43SDG3.9.3Mortalityratefromunintentionalpoisoning(per100000population)................................................44SDG7.1.2Proportionofpopulationwithprimaryrelianceoncleanfuels(%).......................................................45SDG11.6.2Annualmeanconcentrationsoffineparticulatematter(PM2.5)inurbanareas(μg/m3)..................46SDG3.a.1Prevalenceoftobaccouseinadultsaged15+(%).................................................................................47SDG3.b.1Proportionofpopulationcoveredbyallvaccinesincludedinnationalprogrammes(DTP3,MCV2,PCV3)(%)................................................................................................................................................................49SDG3.b.3Proportionofhealthfacilitieswithessentialmedicinesavailableandaffordableonasustainablebasis(%)...........................................................................................................................................................................50SDG3.c.1Densityofhealthworkers(doctors;nurseandmidwives;pharmacists;dentistsper10000population)................................................................................................................................................................................51SDG3.d.1InternationalHealthRegulations(IHR)capacityandhealthemergencypreparedness........................53

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SDG3.d.2Proportionofbloodstreaminfectionsduetoantimicrobialresistantorganisms(%)............................54SDG4.2.1Proportionofchildrenunder5developmentallyontrack(health,learningandpsychosocialwell-being)(%)................................................................................................................................................................55SDG5.2.1Proportionofwomen(15-49)subjectedtoviolencebycurrentorformerintimatepartner(%)..........56SDG5.6.1Proportionofwomen(15-49)whomaketheirowndecisionsregardingsexualrelations,contraceptiveuseandreproductivehealthcare(%).....................................................................................................................58SDG6.1.1Proportionofpopulationusingsafelymanageddrinking-waterservices(%)........................................59SDG6.2.1Proportionofpopulationusingsafelymanagedsanitationservicesandhand-washingfacility(%).....61SDG16.2.1Proportionofchildren(aged1-17)experiencingphysicalorpsychologicalaggression(%)................63HealthEmergenciesVaccinecoverageforepidemicpronediseases.....................................................................64HealthEmergenciesProportionofvulnerablepeopleinfragilesettingsprovidedwithessentialhealthservices(%)...........................................................................................................................................................................66WHA68.3Numberofcasesofpoliomyelitiscausedbywildpoliovirus(WPV)......................................................67WHA68.7Patternsofantibioticconsumptionatnationallevel............................................................................68WHA66.10Prevalenceofraisedbloodpressureinadultsaged18+.....................................................................70WHA66.10Effectivepolicy/regulationforindustriallyproducedtrans-fattyacids(TFA)(Y/N)............................71WHA66.10Prevalenceofobesity(%)....................................................................................................................72

Section2:UniversalHealthCoverage(UHC)Billion....................................................................................................73Table2.OverviewofUniversalHealthCoverage(UHC)BillionIndicators.............................................................74UHCBillion:FamilyPlanning...................................................................................................................................78UHCBillion:Pregnancyanddeliverycare...............................................................................................................79UHCBillion:Childtreatment(care-seekingforsymptomsofpneumonia).............................................................81UHCBillion:TuberculosisTreatment......................................................................................................................82UHCBillion:MalariaPrevention.............................................................................................................................84UHCBillion:WaterandSanitation..........................................................................................................................85UHCBillion:Preventionofcardiovasculardisease.................................................................................................86UHCBillion:Managementofdiabetes....................................................................................................................87UHCBillion:Tobacco...............................................................................................................................................88UHCBillion:Hospitalaccess....................................................................................................................................89UHCBillion:HealthExpenditure.............................................................................................................................92AverageServiceCoverage.......................................................................................................................................93

Section3:HealthEmergenciesBillion.........................................................................................................................95Table3.HealthEmergenciesBillionIndicators.......................................................................................................96HealthEmergenciesBillion:EmergencyPrepareIndicator(IHRCoreCapacity).....................................................97HealthEmergenciesBillion:EmergencyPreventIndicator.....................................................................................98HealthEmergenciesBillion:EmergencyDetectandRespondIndicator(Timeliness)............................................99

Section4:HealthierPopulationsBillion....................................................................................................................101Table4.HealthierPopulationsBillionIndicators..................................................................................................102

Section5:HealthyLifeExpectancy(HALE)................................................................................................................104Healthylifeexpectancy(HALE).............................................................................................................................105

Annex1:OutcomeIndicatorsandGPW132023Targets..........................................................................................107

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IntroductionThe13thGeneralProgrammeofWork(GPW13)setsoutWHO’sstrategicdirection,outlineshowtheOrganizationwillproceedwithitsimplementationandprovidesaframeworktomeasureprogressinthiseffort.IthastakenaccountofthestrategicplansofWHOregionalofficesandhasbeendevelopedincollaborationwiththeRegionalDirectors.GPW13willcovertheperiod2019−2023andwillserveasthebasisforresourcemobilizationandfortheprogrammebudgetsforthebienniums2020−2021and2022−2023.

AttheheartofGPW13arethetriplebilliongoalswhicharetoensurethatby2023:

• Abillionmorepeoplehaveuniversalhealthcoverage• Abillionmorepeopleareprotectedfromhealthemergencies• Abillionmorepeoplearelivingwithbetterhealthandwellbeing

TheGPW13impactmeasurementsystemmakesmeasurablethetriplebilliontargetsofGPW13.TheaimsoftheGPW13aretomakeameasurableimpactonpeople’shealthatcountrylevel;increasethelikelihoodthatthetriplebilliontargetswillbemet;accelerateprogresstowardstheSustainableDevelopmentGoals(SDGs);transformhowWHOworksbyanchoringcommitmentsinmeasurableresults;provideameansoftrackingthejointeffortsoftheSecretariat,MemberStatesandpartners;andstrengthencountrydataandinformationsystemsforhealth.

Theimpactmeasurementsystemhasthreelayers:

1. The46outcomeindicatorscoverarangeofhealthissuesandprovideasetofmeasurementindicatorsthatwillbeusedtomeasureoutcomesintheprogrammebudget.

2. Eachofthetriplebilliontargetswillbemeasuredusingcompositeindicesincluding:a. Universalhealthcoverageindex;b. Healthemergenciesprotectionindex;c. Healthierpopulationsindex.

3. HALE,healthylifeexpectancy,quantifiesexpectedyearsoflifeingoodhealthataparticularageandcanbeconsideredasummarymeasureoftheoverallhealthofpopulations.ItisproposedtouseHALEwithinGPW13asanoverarchingandcomparablemeasureoftheimpactofthetriplebilliontargets.

Thereare40GPW132023targets(SeeAnnex1)linkedtothe46outcomeindicators.EachtargetistrackedbyaoneormoreindicatorsandarealignedtoSDGs.Thirty-nineofthe46outcomeindicatorsareSDGindicatorsand7arefromWorldHealthAssemblyresolutions.TheoutcomeindicatorsweredevelopedbyWHOtechnicalprogrammesinconsultationwithMemberStates.

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Section1:46OutcomeIndicators

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Table1.Overviewof46outcomeindicators

SDG# OutcomeIndicators AssociatedReferenceName

SDG1.5.1 Numberofdeaths,missingpersonsanddirectlyaffectedpersonsattributedtodisastersper100000population

Numberofpersonsaffectedbydisasters(per100000population)

SDG1.a.2 Proportionoftotalgovernmentspendingonessentialservices(education,healthandsocialprotection)

Domesticgeneralgovernmenthealthexpenditure(GGHE-D)(%ofgeneralexpenditure(GGE))

SDG2.2.1 Prevalenceofstunting(heightforage<-2standarddeviationfromthemedianoftheWorldHealthOrganization(WHO)ChildGrowthStandards)amongchildrenunder5yearsofage

Prevalenceofstuntinginchildrenunder5(%)

SDG2.2.2 Prevalenceofmalnutrition(weightforheight>+2or<-2standarddeviationfromthemedianoftheWHOChildGrowthStandards)amongchildrenunder5yearsofage(wasting)

Prevalenceofwastinginchildrenunder5(%)

SDG2.2.2 Prevalenceofmalnutrition(weightforheight>+2or<-2standarddeviationfromthemedianoftheWHOChildGrowthStandards)amongchildrenunder5yearsofage(overweight)

Prevalenceofoverweightinchildrenunder5(%)

SDG3.1.1 Maternalmortalityratio Maternalmortalityratio(per100000livebirths)

SDG3.1.2 Proportionofbirthsattendedbyskilledhealthpersonnel Proportionofbirthsattendedbyskilledhealthpersonnel(%)

SDG3.2.1 Under-5mortalityrate Under-fivemortalityrate(per1000livebirths)

SDG3.2.2 Neonatalmortalityrate Neonatalmortalityrate(per1000livebirths)

SDG3.3.1 NumberofnewHIVinfectionsper1000uninfectedpopulation,bysex,ageandkeypopulations

NumberofnewHIVinfections(per1000uninfectedpopulation)

SDG3.3.2 Tuberculosisincidenceper100000population Tuberculosisincidence(per100000population)

SDG3.3.3 Malariaincidenceper1000population Malariaincidence(per1000populationatrisk)

SDG3.3.4 HepatitisBincidenceper100000population HepatitisBincidence(measuredby:surfaceantigen(HBsAg)prevalenceamongchildrenunder5years)per100000population

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SDG3.3.5 Numberofpeoplerequiringinterventionsagainstneglectedtropicaldiseases

Numberofpeoplerequiringinterventionsagainstneglectedtropicaldiseases(NTDs)

SDG3.4.1 Mortalityrateattributedtocardiovasculardisease,cancer,diabetesorchronicrespiratorydiseases

ProbabilityofdyingfromanyofCVD,cancer,diabetes,CRD(ages30–70)(%)

SDG3.4.2 Suicidemortalityrate Suicidemortalityrate(per100000population)

SDG3.5.1 Coverageoftreatmentinterventions(pharmacological,psychosocialandrehabilitationandaftercareservices)forsubstanceusedisorders

Coverageoftreatmentinterventionsforsubstanceusedisorders(%)

SDG3.5.2 Harmfuluseofalcohol,definedaccordingtothenationalcontextasalcoholpercapitaconsumption(aged15yearsandolder)withinacalendaryearinlitresofpurealcohol

Totalalcoholpercapitaconsumptioninadultsaged15+(litresofpurealcohol)

SDG3.6.1 Deathrateduetoroadtrafficinjuries Roadtrafficmortalityrate(per100000population)

SDG3.7.1 Proportionofwomenofreproductiveage(aged15–49years)whohavetheirneedforfamilyplanningsatisfiedwithmodernmethods

Proportionofwomen(aged15-49)havingneedforfamilyplanningsatisfiedwithmodernmethods(%)

SDG3.8.1 Coverageofessentialhealthservices(definedastheaveragecoverageofessentialservicesbasedontracerinterventionsthatincludereproductive,maternal,newbornandchildhealth,infectiousdiseases,noncommunicablediseasesandservicecapacityandaccess,amongthegeneralandthemostdisadvantagedpopulation)

UHCServiceCoverageIndex

SDG3.8.2 Proportionofpopulationwithlargehouseholdexpendituresonhealthasashareoftotalhouseholdexpendituresorincome

Proportionofpopulationwithlargehouseholdexpendituresonhealth>10%oftotalhouseholdexpenditureorincome(%)

SDG3.9.1 Mortalityrateattributedtohouseholdandambientairpollution

Mortalityrateattributedtoairpollution(per100000population)

SDG3.9.2 Mortalityrateattributedtounsafewater,unsafesanitationandlackofhygiene(exposuretounsafeWater,SanitationandHygieneforAll(WASH)services)

MortalityrateattributedtoexposuretounsafeWASHservices(per100000population)

SDG3.9.3 Mortalityrateattributedtounintentionalpoisoning Mortalityratefromunintentionalpoisoning(per100000population)

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SDG7.1.2 Proportionofpopulationwithprimaryrelianceoncleanfuelsandtechnology

Proportionofpopulationwithprimaryrelianceoncleanfuels(%)

SDG11.6.2 Annualmeanlevelsoffineparticulatematter(e.g.PM2.5andPM10)incities(populationweighted)

Annualmeanconcentrationsoffineparticulatematter(PM2.5)inurbanareas(µg/m3)

SDG3.a.1 Age-standardizedprevalenceofcurrenttobaccouseamongpersonsaged15yearsandolder

Prevalenceoftobaccouseinadults15+(%)

SDG3.b.1 Proportionofthetargetpopulationcoveredbyallvaccinesincludedintheirnationalprogramme

Proportionofthetargetpopulationcoveredbyallvaccinesincludedinnationalprogrammes(DTP3,MCV2,PCV3,)(%)

SDG3.b.3 Proportionofhealthfacilitiesthathaveacoresetofrelevantessentialmedicinesavailableandaffordableonasustainablebasis

Proportionofhealthfacilitieswithessentialmedicinesavailableandaffordableonasustainablebasis(%)

SDG3.c.1 Healthworkerdensityanddistribution Densityofhealthworkers(doctors;nurseandmidwife;pharmacists;dentistsper10000population)

SDG3.d.1 InternationalHealthRegulations(IHR)capacityandhealthemergencypreparedness

InternationalHealthRegulations(IHR)capacityandhealthemergencypreparedness

SDG3.d.2 Percentageofbloodstreaminfectionsduetoantimicrobialresistantorganisms.

Percentageofbloodstreaminfectionsduetoantimicrobialresistantorganisms(%)

SDG4.2.1 Proportionofchildrenunder5yearsofagewhoaredevelopmentallyontrackinhealth,learningandpsychosocialwell-being,bysex

Proportionofchildrenunder5developmentallyontrack(health,learningandpsychosocialwell-being)(%)

SDG5.2.1 Proportionofever-partneredwomenandgirlsaged15yearsandoldersubjectedtophysical,sexualorpsychologicalviolencebyacurrentorformerintimatepartnerintheprevious12months,byformofviolenceandbyage

Proportionofwomen(15-49)subjectedtoviolencebycurrentorformerintimatepartner(%)

SDG5.6.1 Proportionofwomenaged15–49yearswhomaketheirowninformeddecisionsregardingsexualrelations,contraceptiveuseandreproductivehealthcare

Proportionofwomen(15-49)whomaketheirowndecisionsregardingsexualrelations,contraceptiveuseandreproductivehealthcare(%)

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SDG6.1.1 Proportionofpopulationusingsafelymanageddrinkingwaterservices

Proportionofpopulationusingsafelymanageddrinkingwaterservices(%)

SDG6.2.1 Proportionofpopulationusing(a)safelymanagedsanitationservicesand(b)ahand-washingfacilitywithsoapandwater

Proportionofpopulationusingsafelymanagedsanitationservicesandhand-washingfacility(%)

SDG16.2.1 Proportionofchildrenaged1–17yearswhoexperiencedanyphysicalpunishmentand/orpsychologicalaggressionbycaregiversinthepastmonth

Proportionofchildren(aged1-17)experiencingphysicalorpsychologicalaggression(%)

HealthEmergencies

Vaccinecoverageofat-riskgroupsforepidemicorpandemicpronediseases

Vaccinecoverageforepidemicpronediseases

HealthEmergencies

Proportionofvulnerablepeopleinfragilesettingsprovidedwithessentialhealthservices

Proportionofvulnerablepeopleinfragilesettingsprovidedwithessentialhealthservices(%)

WHA68.3 Numberofcasesofpoliomyelitiscausedbywildpoliovirus(WPV)

Numberofcasesofpoliomyelitiscausedbywildpoliovirus(WPV)

WHA68.7 Patternsofantibioticconsumptionatnationallevel Patternsofantibioticconsumptionatnationallevel

WHA66.10 Age-standardizedprevalenceofraisedbloodpressureamongpersonsaged18+years(definedassystolicbloodpressureof>140mmHgand/ordiastolicbloodpressure>90mmHg)andmeansystolicbloodpressure

Prevalenceofraisedbloodpressureinadultsaged18+

WHA66.10 Protectionofthepopulationofacountrybyeffectivepolicy/regulationonindustryproducedtrans-fattyacids(TFA)

Effectivepolicy/regulationforindustriallyproducedtrans-fattyacids(TFA)(Y/N)

WHA66.10 Prevalenceofobesity Prevalenceofobesity

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SDG1.5.1Numberofpersonsaffectedbydisasters(per100000population)

Indicator

Numberofdeaths,missingpersonsanddirectlyaffectedpersonsattributedtodisastersper100000Population

Definition

Theestimatednumberofdeathsduetonaturaldisastersper100000populationaveragedovertheperiod.

Methodofestimation/calculation

!"#$%&()*%+,-.+,,&/$",%*,(*/.+.,%&.0123415256147829

∗100000

Numerator Numberofdeathsattributedtodisasters:Thenumberofpeoplewhodiedduringthedisaster,ordirectlyafter,asadirectresultofthehazardousevent.TheSendaiFrameworkandSDG1.5.1donotincludedeathsthatareconflict-related,orviolentdeaths.

Denominator GlobalpopulationPreferreddatasources

DataareavailablefromtheSendaiFrameworkmonitoringplatform,overseenbyUNISDR(https://sendaimonitor.unisdr.org/).DataprovideratnationallevelisappointedSendaiFrameworkFocalPoints.Inmostcountriesdisasterdataarecollectedbylineministriesandnationaldisasterlossdatabasesareestablishedandmanagedbyspecialpurposeagenciesincludingnationaldisastermanagementagencies,civilprotectionagencies,andmeteorologicalagencies.TheSendaiFrameworkFocalPointsineachcountryareresponsibleofdatareportingthroughtheSendaiFrameworkMonitoringSystem.

Otherpossibledatasources

DisasterlossdataforSustainableDevelopmentGoalsandSendaiFrameworkMonitoringSystem(DesInventarSendai;https://www.desinventar.net/);GlobalHealthObservatory;InternationalDisasterDatabase(EM-DAT;https://www.emdat.be/)

Disaggregation

Country(countrypopulationasdenominator);Hazardtype

Expectedfrequencyofdatacollection

Annual

Limitations

CurrentlydatafromUNIDSRandUNSDareavailableforonly73countriesin2017.Dataavailabilityareexpectedtoincreaseduringtheperiod.Datadisaggregatedbyhazardtype(e.g.,biological,climatological,hydrological)willbeavailableinfutureyearsallowingfornarrowingthescopetohazardspertinenttohealthemergencies.responses.

Datatype

Rate

Relatedlinks

OfficialSDGMetadataURL:https://unstats.un.org/sdgs/metadata/files/Metadata-01-05-01.pdf<tobeupdatedwithnewdocs>InternationallyagreedmethodologyandguidelineURL:TechnicalguidanceformonitoringandreportingonprogressinachievingtheglobaltargetsoftheSendaiFrameworkforDisasterRiskReduction(UNISDR2017)https://www.preventionweb.net/files/54970_collectionoftechnicalguidancenoteso.pdfOtherreferences:Reportoftheopen-endedintergovernmentalexpertworkinggrouponindicatorsandterminologyrelatingtodisasterriskreduction(OEIWG).EndorsedbyUNGAon2ndFebruary2017.Availableat:https://www.preventionweb.net/publications/view/51748

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SDG1.a.2Domesticgeneralgovernmenthealthexpenditure(GGHE-D)(%ofgeneralgovernmentexpenditure(GGE))*

*onlycovershealthaspectofindicator

Indicator

Proportionoftotalgovernmentspendingonessentialservices(education,healthandsocialprotection)

Definition

Shareofgovernmenthealthexpendituresfromdomesticsourcesingeneralgovernmentexpenditures


Theshareofdomesticgeneralgovernmenthealthexpendituresingeneralgovernmentexpenditureindicatesthepriorityofhealthingovernmentbudgetallocation.Itexpressesthisprioritybycomparingthesizeofcurrentgovernmenthealthexpendituresrelativetothetotalsizeofgovernmentexpenditure.Theindicatoriscalculatedas(GGHED%GGE_t+5-GGHED%GGE_t)/GGHED%GGE_t

Numerator DomesticGeneralGovernmentHealthExpenditure

Denominator GeneralGovernmentExpenditure

Preferreddatasources

GlobalHealthExpenditureDatabase(GHED)


GlobalHealthObservatory(GHO)

Disaggregation

No


Annual

Limitations

AspermetadataforeachcountryinGHED

Datatype

Percentage

Relatedlinks http://www.who.int/health-accounts/

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SDG2.2.1Prevalenceofstuntinginchildrenunder5(%)

Indicator

Prevalenceofstunting(heightforage<-2standarddeviationfromthemedianoftheWorldHealthOrganization(WHO)ChildGrowthStandards)amongchildrenunder5yearsofage

Definition

Percentageofstunting(length-orheight-for-agelessthan-2standarddeviationsoftheWHOChildGrowthStandardsmedian)amongchildrenaged0-4years.Children’slengthandheightaremeasuredusingstandardtechnology,trainingandstandardizationproceduresforanthropometryisessentialforaccuratemeasurements.Determinationoftheexactchild’sageisthefirstandmostimportantstepinthisanthropometricassessment.Recumbentlengthshouldbemeasuredforchildrenlessthan24monthsofageandstandingheightshouldbemeasuredforchildren24monthsandabove.


Prevalenceofstuntedchildrenaged<5years=𝑁𝑢𝑚𝑏𝑒𝑟𝑜𝑓𝑐ℎ𝑖𝑙𝑑𝑟𝑒𝑛𝑎𝑔𝑒𝑑0 − 4𝑦𝑒𝑎𝑟𝑠𝑡ℎ𝑎𝑡𝑓𝑎𝑙𝑙𝑏𝑒𝑙𝑜𝑤𝑚𝑖𝑛𝑢𝑠𝑡𝑤𝑜𝑠𝑡𝑎𝑛𝑑𝑎𝑟𝑑𝑑𝑒𝑣𝑖𝑎𝑡𝑖𝑜𝑛𝑠𝑓𝑟𝑜𝑚𝑡ℎ𝑒𝑚𝑒𝑑𝑖𝑎𝑛

𝑙𝑒𝑛𝑔𝑡ℎ − 𝑜𝑟ℎ𝑒𝑖𝑔ℎ𝑡 − 𝑓𝑜𝑟 − 𝑎𝑔𝑒𝑜𝑓𝑡ℎ𝑒𝑊𝐻𝑂𝐶ℎ𝑖𝑙𝑑𝐺𝑟𝑜𝑤𝑡ℎ𝑆𝑡𝑎𝑛𝑑𝑎𝑟𝑑𝑠𝑇𝑜𝑡𝑎𝑙𝑛𝑢𝑚𝑏𝑒𝑟𝑜𝑓𝑐ℎ𝑖𝑙𝑑𝑟𝑒𝑛𝑎𝑔𝑒𝑑0 − 4𝑦𝑒𝑎𝑟𝑠𝑡ℎ𝑎𝑡𝑤𝑒𝑟𝑒𝑚𝑒𝑎𝑠𝑢𝑟𝑒𝑑

×100%

Numerator Numberofchildrenaged0-4yearsthatfallbelowminustwostandarddeviationsfromthemedianlength-orheight-for-ageoftheWHOChildGrowthStandards.

Denominator Totalnumberofchildrenaged0–4yearswhoweremeasured.


Nationalnutritionsurveys,anyothernationally-representativepopulation-basedsurveyswithnutritionmodules,andnationalsurveillancesystems.


Disaggregation

Byage,sex,location(urban/rural,majorregions/provinces),andsocio-economiccharacteristics(e.g.mother’seducation,wealthquintile).


Annualorevery3-5yearsbasedonsurveyavailabilityincountries

Limitations

Surveyestimatescomewithlevelsofuncertaintyduetobothsamplingandnon-samplingerror(e.g.measurementtechnicalerror,recordingerroretc.

Datatype

Prevalence

Relatedlinks WHO:http://apps.who.int/gho/data/node.wrapper.imr?x-id=72;http://www.who.int/childgrowth/en/;http://www.who.int/nutgrowthdb/en/;http://apps.who.int/bookorders/anglais/detart1.jsp?sesslan=1&codlan=1&codcol=15&codcch=660.

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SDG2.2.2Prevalenceofwastinginchildrenunder5(%)

Indicator

Prevalenceofmalnutrition(weightforheight>+2or<-2standarddeviationfromthemedianoftheWHOChildGrowthStandards)amongchildrenunder5yearsofage(wasting)

Definition

Percentageofwasting(weight-for-lengthorheightlessthan-2standarddeviationsoftheWHOChildGrowthStandardsmedian)amongchildrenaged0-4years.Children’sweightandheightaremeasuredusingstandardtechnology,e.g.childrenlessthan24monthsaremeasuredlyingdown,whilestandingheightismeasuredforchildren24monthsandolder.


Prevalenceofwastedchildrenaged<5years=𝑁𝑢𝑚𝑏𝑒𝑟𝑜𝑓𝑐ℎ𝑖𝑙𝑑𝑟𝑒𝑛𝑎𝑔𝑒𝑑0 − 4𝑦𝑒𝑎𝑟𝑠𝑡ℎ𝑎𝑡𝑓𝑎𝑙𝑙𝑏𝑒𝑙𝑜𝑤𝑚𝑖𝑛𝑢𝑠𝑡𝑤𝑜𝑠𝑡𝑎𝑛𝑑𝑎𝑟𝑑𝑑𝑒𝑣𝑖𝑎𝑡𝑖𝑜𝑛𝑠𝑓𝑟𝑜𝑚𝑡ℎ𝑒𝑚𝑒𝑑𝑖𝑎𝑛

𝑤𝑒𝑖𝑔ℎ𝑡 − 𝑓𝑜𝑟 − 𝑙𝑒𝑛𝑔𝑡ℎ𝑜𝑟ℎ𝑒𝑖𝑔ℎ𝑡𝑜𝑓𝑡ℎ𝑒𝑊𝐻𝑂𝐶ℎ𝑖𝑙𝑑𝐺𝑟𝑜𝑤𝑡ℎ𝑆𝑡𝑎𝑛𝑑𝑎𝑟𝑑𝑠𝑇𝑜𝑡𝑎𝑙𝑛𝑢𝑚𝑏𝑒𝑟𝑜𝑓𝑐ℎ𝑖𝑙𝑑𝑟𝑒𝑛𝑎𝑔𝑒𝑑0 − 4𝑦𝑒𝑎𝑟𝑠𝑡ℎ𝑎𝑡𝑤𝑒𝑟𝑒𝑚𝑒𝑎𝑠𝑢𝑟𝑒𝑑

×100%

Numerator Numberofchildrenaged0-4yearsthatfallbelowminustwostandarddeviationsfromthemedianweight-for-lengthorheightoftheWHOChildGrowthStandards

Denominator Totalnumberofchildrenaged0-4yearsthatweremeasured


Nationalnutritionsurveys,anyothernationally-representativepopulation-basedsurveyswithnutritionmodules,andnationalsurveillancesystems.


Disaggregation

Byage,sex,location(urban/rural,majorregions/provinces),andsocio-economiccharacteristics(e.g.mother’seducation,wealthquintile).


Annualorevery3-5yearsbasedonsurveyavailabilityincountries.

Limitations

Surveyestimatescomewithlevelsofuncertaintyduetobothsamplingandnon-samplingerror(e.g.measurementtechnicalerror,recordingerroretc.).

Datatype

Prevalence

Relatedlinks WHO:http://apps.who.int/gho/data/node.wrapper.imr?x-id=302;http://www.who.int/childgrowth/en/;http://www.who.int/nutgrowthdb/en/;http://apps.who.int/bookorders/anglais/detart1.jsp?sesslan=1&codlan=1&codcol=15&codcch=660.

16

SDG2.2.2Prevalenceofoverweightinchildrenunder5(%)

Indicator

Prevalenceofmalnutrition(weightforheight>+2or<-2standarddeviationfromthemedianoftheWHOChildGrowthStandards)amongchildrenunder5yearsofage(overweight)

Definition

For0-4years,overweightisdefinedasweight-for-lengthorheightabovetwostandarddeviationsoftheWHOChildGrowthStandardsmedian.


Prevalenceofoverweight=

]6^3_`2abc81d`_94e_dfghi_4`j7c47a411432k_7l2j749d4`dd_k847829j

a`2^7c_^_d849l_8ec7ga2`g1_9e7c2`c_8ec72a7c_mnopc81d0`2l7cq749d4`dj]6^3_`2abc81d`_94e_dfghi_4`j897c_j6`k_i7c47l_`_^_4j6`_d

×100%

Numerator Numberofchildrenaged0-4yearsthatfallabovetwostandarddeviationsfromthemedianweight-for-lengthorheightoftheWHOChildGrowthStandards.

Denominator Totalnumberofchildrenaged0-4yearsinthesurveythatweremeasured.


Nationallyrepresentativepopulation-basedhouseholdorschool-basedsurveyswithheightandweightmeasurementsof0-4-year-oldchildren.Othersourcesofdataincludenationalnutritionsurveillancesystems.


DatasetsofFAOandUNStatisticaloffice

Disaggregation

Byage,sex,location(urban/rural,majorregions/provinces),andsocio-economiccharacteristics(e.g.,mother’seducation,wealthquintile).


Annualoratleastevery3-5yearsbasedonsurveyavailabilityincountries.

Limitations

Surveyestimatescomewithlevelsofuncertaintyduetobothsamplingandnon-samplingerror(e.g.measurementtechnicalerror,recordingerroretc.).Anotherlimitation,especiallyfortheschool-agechildrenandadolescentagegroupistherepresentativenessofthesample.

Datatype

Prevalence

Relatedlinks WHO:http://who.int/chp/gshs/en/;http://www.who.int/dietphysicalactivity/childhood/en/

17

SDG3.1.1Maternalmortalityratio(per100000livebirths)

Indicator

Maternalmortalityratio

Definition

Thematernalmortalityratio(MMR)isthenumberofmaternaldeathsduringagiventimeperiodper100,000livebirthsduringthesametime-period.Maternaldeathreferstothedeathofawomanwhilepregnantorwithin42daysofterminationofpregnancy,irrespectiveofthedurationandsiteofthepregnancy,fromanycauserelatedtooraggravatedbythepregnancyoritsmanagement(fromdirectorindirectobstetricdeath),butnotfromaccidentalorincidentalcauses.Pregnancy-relateddeathreferstothedeathofawomanwhilepregnantorwithin42daysofterminationofpregnancy,irrespectiveofthecauseofdeath.Livebirthreferstothecompleteexpulsionorextractionfromitsmotherofaproductofconception,irrespectiveofthedurationofthepregnancy,which,aftersuchseparation,breathesorshowsanyotherevidenceoflife-e.g.beatingoftheheart,pulsationoftheumbilicalcordordefinitemovementofvoluntarymuscles-whetherornottheumbilicalcordhasbeencutortheplacentaisattached.Eachproductofsuchabirthisconsideredliveborn.


MMR=r274196^3_`2a^47_`941d_47cjr274196^3_`2a18k_38`7cj

×100,000

Numerator Totalnumberofmaternaldeaths

Denominator Totalnumberoflivebirths


Civilregistrationvitalstatistics(CRVS),healthservicerecords,householdsurveys,census.


Sampleregistrationsystems;verbalautopsy.

Disaggregation

Byage,parity,location(urban/rural,majorregions/provinces),andsocio-economiccharacteristics(e.g.,educationlevel,wealthquintile).


Annual(forCRVSandhealthservicerecords).

Limitations

Maternaldeathis,fromanepidemiologicalperspective,arelativelyrareeventandmortalityisdifficulttomeasureaccurately.Manylow-incomecountrieshaveno,incompleteorunusabledeathregistrydata.Modellingmaybeusedtoobtainanationalestimate.

Datatype

Ratio

Relatedlinks WHO:http://www.who.int/healthinfo/statistics/indmaternalmortality/en/WHO:https://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/.WHO:https://www.who.int/reproductivehealth/publications/monitoring/9789241548458/en/.UNSDG:https://unstats.un.org/sdgs/metadata/files/Metadata-03-01-01.pdf

18

SDG3.1.2Proportionofbirthsattendedbyskilledhealthpersonnel(%)

Indicator

Proportionofbirthsattendedbyskilledhealthpersonnel

Definition

Percentageoflivebirthsforwomenaged15-49yearsattendedbyskilledhealthpersonnel(doctor,nurseormidwife).Skilledhealthpersonnel,asreferencedbySDGindicator3.1.2,arecompetentmaternalandnewbornhealth(MNH)professionalseducated,trainedandregulatedtonationalandinternationalstandards.Theyarecompetentto:(i)provideandpromoteevidence-based,human-rights-based,quality,socioculturallysensitiveanddignifiedcaretowomenandnewborns;(ii)facilitatephysiologicalprocessesduringlabouranddeliverytoensureacleanandpositivechildbirthexperience;and(iii)identifyandmanageorreferwomenand/ornewbornswithcomplications.Inaddition,aspartofanintegratedteamofMNHprofessionals(includingmidwives,nurses,obstetricians,paediatriciansandanaesthetists,theyperformallsignalfunctionsofemergencymaternalandnewborncaretooptimizethehealthandwell-beingofwomenandnewborns.Withinanenablingenvironment,midwivestrainedtointernationalConfederationofMidwives(ICM),standardscanprovidenearlyalloftheessentialcareneededforwomenandnewborns.(Indifferentcountries,thesecompetenciesareheldbyprofessionalswithvaryingoccupationaltitles).


Thenumberofwomenaged15-49yearswithalivebirthattendedbyaskilledhealthpersonnel(doctor,nurseormidwife)duringchildbirthisexpressedasapercentageofwomenaged15-49yearswithalivebirthinthesameperiod.

Numerator Numberoflivebirthsattendedbyskilledhealthpersonnel(doctor,nurseormidwife)trainedinprovidinglife-savingobstetriccare,includinggivingthenecessarysupervision,careandadvicetowomenduringpregnancy,childbirthandthepostpartumperiod,toconductdeliveriesontheirown,andtocarefornewborns.

Denominator Thetotalnumberoflivebirthsofwomenaged15-49yearsinthesameperiod.


Nationalpopulation-basedsurveys.


Routinefacilityinformationsystems.

Disaggregation

Age,parity,placeofresidence,socioeconomicstatus.


3-5yearsfornationalpopulation-basedsurveys,annualforroutinefacilityinformationsystems.

Limitations

Discrepanciespossibleifnationalfiguresarefromhealthfacilitiesratherthanhouseholdleveldata.Institutionalbirthsmayunderestimatepercentageofbirthswithskilledattendant.

Datatype

Percentage

Relatedlinks https://unstats.un.org/sdgs/metadata/files/Metadata-03-01-02.pdfhttps://data.unicef.org/topic/maternal-health/delivery-care/#https://www.who.int/reproductivehealth/publications/statement-competent-mnh-professionals/en/

19

SDG3.2.1Under-fivemortalityrate(per1000livebirths)

Indicator Under-fivemortalityrateDefinition

Theunder-5yearsmortalityrate(U5MR)istheprobabilityofachildborninaspecificyearorperioddyingbeforereachingtheageoffive,ifsubjecttotheage-specificmortalityratesofthatperiod,expressedper1000livebirths.Itis,strictlyspeaking,notarate(i.e.thenumberofdeathsdividedbythenumberofpopulationatriskduringacertainperiodoftime)butaprobabilityofdeathderivedfromalifetableandexpressedasrateper1000livebirths.Livebirthreferstothecompleteexpulsionorextractionfromitsmotherofaproductofconception,irrespectiveofthedurationofthepregnancy,which,aftersuchseparation,breathesorshowsanyotherevidenceoflife-e.g.beatingoftheheart,pulsationoftheumbilicalcordordefinitemovementofvoluntarymuscles-whetherornottheumbilicalcordhasbeencutortheplacentaisattached.Eachproductofsuchabirthisconsideredliveborn.


TheUNInter-agencyGroupforChildMortalityEstimation(UNIGME)estimatesarederivedfromnationaldatafromcensuses,surveysorvitalregistrationsystems.TheUNIGMEdoesnotuseanycovariatestoderiveitsestimates.Itonlyappliesacurvefittingmethodtogood-qualityempiricaldatatoderivetrendestimatesafterdataqualityassessment.Inmostcases,theUNIGMEestimatesareclosetotheunderlyingdata.TheUNIGMEaimstominimizetheerrorsforeachestimate,harmonizetrendsovertimeandproduceup-to-dateandproperlyassessedestimates.TheUNIGMEappliestheBayesianB-splinesbias-reductionmodeltoempiricaldatatoderivetrendestimatesofunder-fivemortalityforallcountries.Seereferencesfordetails.Fortheunderlyingdatamentionedabove,themostfrequentlyusedmethodsareasfollows:Civilregistration:Theunder-fivemortalityratecanbederivedfromastandardperiodabridgedlifetableusingtheage-specificdeathsandmid-yearpopulationcountsfromcivilregistrationdatatocalculatedeathrates,whicharethenconvertedintoage-specificprobabilitiesofdying.Censusandsurveys:Anindirectmethodisusedbasedonasummarybirthhistory,aseriesofquestionsaskedofeachwomanofreproductiveageastohowmanychildrenshehasevergivenbirthtoandhowmanyarestillalive.TheBrassmethodandmodellifetablesarethenusedtoobtainanestimateofunder-fiveandinfantmortalityrates.Censusesoftenincludequestionsonhouseholddeathsinthelast12months,whichcanbeusedtocalculatemortalityestimates.Surveys:Adirectmethodisusedbasedonafullbirthhistory,aseriesofdetailedquestionsoneachchildawomanhasgivenbirthtoduringherlifetime.Neonatal,post-neonatal,infant,childandunder-fivemortalityestimatescanbederivedfromfullbirthhistorymodule.

Numerator Totalnumberofdeathsamongchildrenaged0-4years(thetotalnumberisactuallytheprobabilityofdeathderivedfromalifetable)

Denominator TotalnumberoflivebirthsPreferreddatasources

Civilregistrationandvitalstatistics,


censuses;andhouseholdsurveys.

Disaggregation

Bysex,placeofresidence,wealthquintileandmother’seducation


AnnualupdatesfromtheUN-IGMErevisions

20

Limitations

Thepreferredsourceofdataisacivilregistrationsystemthatrecordsbirthsanddeathsonacontinuousbasis.Ifregistrationiscompleteandthesystemfunctionsefficiently,theresultingestimateswillbeaccurateandtimely.However,manycountriesdonothavewell-functioningvitalregistrationsystems.Insuchcases,householdsurveys,suchastheUNICEF-supportedMultipleIndicatorClusterSurveys(MICS),theUSAID-supportedDemographicandHealthSurveys(DHS)andperiodicpopulationcensuseshavebecometheprimarysourcesofdataonunder-fivemortality.Thesesurveysaskwomenaboutthesurvivaloftheirchildren,anditisthesereportsthatprovidethebasisofchildmortalityestimatesforamajorityoflow-andmiddle-incomecountries.Thesedata,however,areoftensubjecttosamplingornon-samplingerrors(suchasmisreportingofageandsurvivorselectionbias;underreportingofchilddeathsisalsocommon)Theseunder-fivemortalityrateshavebeenestimatedbyapplyingmethodstotheavailabledatafromallMemberStatestoensurecomparabilityacrosscountriesandtime;hencetheyarenotnecessarilythesameastheofficialnationaldata.

Datatype

Mortalityestimate:probabilityofdeathderivedfromalifetableandexpressedasrateper1000livebirths.

Relatedlinks WHO:http://apps.who.int/gho/data/node.wrapper.imr?x-id=1;http://www.who.int/whosis/whostat2006InfantAndUnder5MortalityRate.pdf?ua=1;http://apps.who.int/gho/data/node.wrapper.imr?x-id=4717UNICEF:https://www.unicef.org/infobycountry/stats_popup1.html

21

SDG3.2.2Neonatalmortalityrate(per1000livebirths)Indicator NeonatalmortalityrateDefinition

Probabilitythatachildborninaspecificyearorperiodwilldieinthefirst28daysoflife(0-27days),ifsubjecttotheage-specificmortalityratesofthatperiod,expressedper1000livebirths.Neonataldeaths(deathsamonglivebirthsduringthefirst28daysoflife)


TheUNInter-AgencyGroupforChildMortalityEstimation(UNIGME)estimatesarederivedfromnationaldatafromcensuses,surveysorvitalregistrationsystems.TheUNIGMEdoesnotuseanycovariatestoderiveitsestimates.Itonlyappliesacurvefittingmethodtogood-qualityempiricaldatatoderivetrendestimatesafterdataqualityassessment.Inmostcases,theUNIGMEestimatesareclosetotheunderlyingdata.TheUNIGMEaimstominimizetheerrorsforeachestimate,harmonizetrendsovertimeandproduceup-to-dateandproperlyassessedestimates.TheUNIGMEproducesneonatalmortalityrateestimateswithaBayesiansplineregressionmodelwhichmodelstheratioofneonatalmortalityrate/(under-fivemortalityrate-neonatalmortalityrate).EstimatesofNMRareobtainedbyrecombiningtheestimatesoftheratiowithUNIGME-estimatedunder-fivemortalityrate.Seethereferencesfordetails.Fortheunderlyingdatamentionedabove,themostfrequentlyusedmethodsareasfollows:Civilregistration:Numberofchildrenwhodiedduringthefirst28daysoflifeandthenumberofbirthsusedtocalculateneonatalmortalityrates.Censusandsurveys:Censusoftenincludesquestionsonhouseholddeathsinthelast12months,whichcanbeusedtocalculatemortalityestimates.Surveys:Adirectmethodisusedbasedonafullbirthhistory,aseriesofdetailedquestionsoneachchildawomanhasgivenbirthtoduringherlifetime.Neonatal,post-neonatal,infant,childandunder-fivemortalityestimatescanbederivedfromfullbirthhistorymodule.

Numerator Numberofchildrenwhodiedinthefirst28days(0-27)oflife(thetotalnumberisactuallytheprobabilityofdeathderivedfromalifetable)

Denominator NumberoflivebirthsPreferreddatasources

Datafromcivilregistrationandvitalstatistics.


Censusesandhouseholdsurveys.

Disaggregation

Bysex,placeofresidence,wealthquintileandmother’seducation


AnnualupdatesfromtheUN-IGMErevisions

22

Limitations

Thepreferredsourceofdataisacivilregistrationsystemthatrecordsbirthsanddeathsonacontinuousbasis.Ifregistrationiscompleteandthesystemfunctionsefficiently,theresultingestimateswillbeaccurateandtimely.However,manycountriesdonothavewell-functioningvitalregistrationsystems.Insuchcases,householdsurveys,suchastheUNICEF-supportedMultipleIndicatorClusterSurveys(MICS),theUSAID-supportedDemographicandHealthSurveys(DHS)andperiodicpopulationcensuseshavebecometheprimarysourcesofdataonunder-fivemortality.Thesesurveysaskwomenaboutthesurvivaloftheirchildren,anditisthesereportsthatprovidethebasisofchildmortalityestimatesforamajorityoflow-andmiddle-incomecountries.Thesedata,however,areoftensubjecttosamplingornon-samplingerrors(suchasmisreportingofageandsurvivorselectionbias;underreportingofchilddeathsisalsocommon)Theseunder-fivemortalityrateshavebeenestimatedbyapplyingmethodstotheavailabledatafromallMemberStatestoensurecomparabilityacrosscountriesandtime;hencetheyarenotnecessarilythesameastheofficialnationaldata.

Datatype

Mortalityestimate:probabilityofdeathderivedfromalifetableandexpressedasrateper1000livebirths.

Relatedlinks WHO:http://apps.who.int/gho/data/node.wrapper.imr?x-id=1;http://www.who.int/whosis/whostat2006InfantAndUnder5MortalityRate.pdf?ua=1;http://apps.who.int/gho/data/node.wrapper.imr?x-id=4717UNICEF:https://www.unicef.org/infobycountry/stats_popup1.html

23

SDG3.3.1NewHIVinfections(per1000uninfectedpopulation)

Indicator

NumberofnewHIVinfectionsper1000uninfectedpopulation,bysex,ageandkeypopulations

Definition

ThenumberofnewHIVinfectionsper1000uninfectedpopulation,bysex,ageandkeypopulationsasdefinedasthenumberofnewHIVinfectionsper1000person-yearsamongtheuninfectedpopulation.


Longitudinaldataonindividualsarethebestsourceofdatabutarerarelyavailableforlargepopulations.SpecialdiagnostictestsinsurveysorfromhealthfacilitiescanbeusedtoobtaindataonHIVincidence.HIVincidenceisthusmodelledusingtheSpectrumsoftware.

Numerator NumberofnewHIVinfectionsbysex,ageandkeypopulations

Denominator Totaluninfectedpopulationbysex,ageandkeypopulations


Spectrummodelling,householdorkeypopulationsurveyswithHIVincidence-testing


Otherpossibledatasources:Regularsurveillancesystemamongkeypopulations.

DisaggregationGeneralpopulation,keypopulations(menwhohavesexwithmen,sexworkers,peoplewhoinjectdrugs,transgenderpeople,prisoners),agegroups(0-14,15-24,15-49,50+years),forkeypopulations(<25,25+years),modeoftransmission(includingmother-to-childtransmission),placeofresidence,sex


Datasourcesarecompiledallyearlong.ThespectrummodelsarecreatedinthefirstthreemonthsofeveryyearandfinalizedbyJune.

Limitations

Datatype

Rate

Relatedlinks https://www.unaids.org/en/dataanalysis/datatools/spectrum-eppUNAIDSGlobalAIDSMonitoring:Indicatorsformonitoringthe2016UnitedNationsPoliticalDeclarationonEndingAIDSPoliticalDeclarationonHIVandAIDS:OntheFastTracktoAcceleratingtheFightagainstHIVandtoEndingtheAIDSEpidemicby2030http://www.unaids.org/sites/default/files/media_asset/2017-Global-AIDS-Monitoring_en.pdf.UNAIDSwebsiteforrelevantdataandnationalSpectrumfileshttp://aidsinfo.unaids.org/ConsolidatedStrategicInformationGuidelinesforHIVintheHealthSector.Geneva:WorldHealthOrganization;https://www.who.int/hiv/pub/guidelines/en/Adescriptionofthemethodologyisavailableat:http://www.unaids.org/sites/default/files/media_asset/Estimates_methods_2018.pdf

24

SDG3.3.2Tuberculosisincidence(per100000population)

Indicator

Tuberculosisincidenceper100000population

Definition

TuberculosisincidenceisdefinedastheestimatednumberofnewandrelapseTBcases(allformsofTB,includingcasesinpeoplelivingwithHIV)arisinginagivenyear,expressedasarateper100000population.


Estimatesofincidenceforeachcountryarederivedusingoneormoreofthefollowingapproaches,dependingonavailabledata:(i)incidence=casenotifications/estimatedproportionofcasesdetected;(ii)capture-recapturemodelling;(iii)incidence=prevalence/durationofcondition.

Numerator EstimatednumberofnewandrelapseTBcases(allformsofTB,includingcasesinpeoplelivingwithHIV)arisinginagivenyear

Denominator Totalpopulation


High-qualitysurveillancesystemsinwhichunderreportingisnegligible,andstronghealthsystemssothatunder-diagnosisisalsonegligible


Annualcasenotifications,assessmentsofthequalityandcoverageofTBnotificationdata,nationalsurveysoftheprevalenceofTBdiseaseandinformationfromdeath(vital)registrationsystems

Disaggregation

Bycountry,sex,age(childrenvsadults).


Annual

Limitations

Uncertaintyinindicatorvalues

Datatype Rate

Relatedlinks https://unstats.un.org/sdgs/metadata/files/Metadata-03-03-02.pdf

25

SDG3.3.3Malariaincidence(per1000populationatrisk)

Indicator

Malariaincidenceper1000population

Definition

Thenumberofnewcasesofmalariaper1,000peopleatriskeachyear.


Thenumberofmalariacaseswasestimatedbyoneofthefollowingtwomethods:Method1:Method1wasusedforcountriesandareasoutsideAfricaandforlow-transmissioncountriesandareasinAfrica:Afghanistan,Bangladesh,Bolivia(PlurinationalStateof),Botswana,Brazil,Cambodia,Colombia,DominicanRepublic,Eritrea,Ethiopia,FrenchGuiana,Gambia,Guatemala,Guyana,Haiti,Honduras,India,Indonesia,LaoPeople’sDemocraticRepublic,Madagascar,Mauritania,Myanmar,Namibia,Nepal,Nicaragua,Pakistan,Panama,PapuaNewGuinea,Peru,Philippines,Rwanda,Senegal,SolomonIslands,Timor-Leste,Vanuatu,Venezuela(BolivarianRepublicof),VietNam,YemenandZimbabwe.Estimatesweremadebyadjustingthenumberofreportedmalariacasesforcompletenessofreporting,thelikelihoodthatcaseswereparasitepositive,andtheextentofhealthserviceuse.Theprocedure,whichisdescribedintheWorldmalariareport2008(5),combinesdatareportedbyNMPs(reportedcases,reportingcompletenessandlikelihoodthatcasesareparasitepositive)withdataobtainedfromnationallyrepresentativehouseholdsurveysonhealthserviceuse.Briefly:T=(a+(cxe))/dx(1+f/g+(1−g−f)/2/g)where:aismalariacasesconfirmedinpublicsectorbissuspectedcasestestedcispresumedcases(nottestedbuttreatedasmalaria)disreportingcompletenesseistestpositivityrate(malariapositivefraction)=a/bfisfractionseekingtreatmentinprivatesectorgisfractionseekingtreatmentinpublicsectorNotreatmentseekingfactor:(1-g-f)Casesinpublicsector:(a+(cxe))/dCasesinprivatesector:(a+(cxe))/dxf/gMethod2wasusedforhigh-transmissioncountriesinAfricaandforsomecountriesintheWHOEasternMediterraneanRegioninwhichthequalityofsurveillancedatadidnotpermitarobustestimatefromthenumberofreportedcases:Angola,Benin,BurkinaFaso,Burundi,Cameroon,CentralAfricanRepublic,Chad,Congo,Côted’Ivoire,DemocraticRepublicoftheCongo,EquatorialGuinea,Gabon,Ghana,Guinea,Guinea-Bissau,Kenya,Liberia,Malawi,Mali,Mozambique,Niger,Nigeria,SierraLeone,Somalia,SouthSudan,Sudan,Togo,Uganda,UnitedRepublicofTanzaniaandZambia.Inthismethod,estimatesofthenumberofmalariacaseswerederivedfrominformationonparasiteprevalenceobtainedfromhouseholdsurveys.First,dataonparasiteprevalencefromnearly60000surveyrecordswereassembledwithinaspatiotemporalBayesiangeostatisticalmodel,alongwithenvironmentalandsociodemographiccovariates,anddatadistributiononinterventionssuchasinsecticide-treatedmosquitonet(ITNs),antimalarialdrugsandindoorresidualspraying(IRS).ThegeospatialmodelenabledpredictionsofPlasmodiumfalciparumprevalenceinchildrenaged2–10years,ataresolutionof5×5km2,throughoutallmalariaendemicAfricancountriesforeachyearfrom2000to2018.1Second,anensemblemodelwasdevelopedtopredictmalariaincidenceasafunctionofparasiteprevalence.Themodelwasthenappliedtotheestimatedparasiteprevalenceinordertoobtainestimatesofthemalariacaseincidenceat5×5km2resolutionforeachyearfrom2000to2018.1Dataforeach5×5km2areawerethenaggregatedwithincountryandregional1FormethodsonthedevelopmentofmapsbytheMalariaAtlasProject,seehttps://www.map.ox.ac.uk/making-maps/.boundaries,toobtainbothnationalandregionalestimatesofmalariacasesFormoredetailsseeWorldMalariaReport2019asreferencedinlinksbelow.

Numerator Totalestimatednumberofnewcasesofmalaria



Countrysurveillancesystems(numberofsuspectedcases,numberoftestedcases,numberofpositivecasesbymethodofdetectionandbyspeciesaswellasnumberofhealthfacilitiesthatreportthosecases)

26


Representativehouseholdsurveys

Disaggregation

Country


Annual

Limitations

TheestimatedincidencecandifferfromtheincidencereportedbyaMinistryofHealthwhichcanbeaffectedby(1)completenessofreporting(2)extentofmalariadiagnostictesting,(3)useofprivatehealthfacilitiesnotincludedinreportingsystems,and(4)estimationonlywheremalariatransmissionoccurs.

DatatypeRate

Relatedlinks https://www.who.int/publications-detail/world-malaria-report-2019https://unstats.un.org/sdgs/metadata/files/Metadata-03-03-03.pdf

27

SDG3.3.4HepatitisBincidence(measuredbysurfaceantigen(HBsAg)prevalenceamongchildrenunder5years)

Indicator

HepatitisBincidenceper100000population

Definition

ThenumberofnewhepatitisBinfectionsper100,000populationinagivenyearisestimatedfromtheprevalenceoftotalantibodiesagainsthepatitisBcoreantigen(Totalanti-HBc)andhepatitisBsurfaceantigen(HBsAg)positiveamongchildren5yearsofage,adjustedforsamplingdesign.


NumberofsurveyparticipantswithTotalanti − HBcandHBsAgpositivetestNumberinsurveywithTotalanti − Hc/HBsAgresult

Numerator NumberofsurveyparticipantswithTotalanti-HBcandHBsAgpositivetest

Denominator NumberinsurveywithTotalanti-Hc/HBsAgresult


Serosurvey


RoutinelycollectedhepatitisBvaccineadministrativecoveragedataincludingtheproportionnewborninfantsgiventhefirstdosewithin24hoursofbirth(HepB0%)andthepercentageofinfantshavingreceivedthreedosesofhepatitisBvaccine(HepB3%)

Disaggregation

Bysex,location(urban/rural,majorregions/provinces),andsocio-economiccharacteristics(e.g.,education,wealthquintile).


Intermittent,dependentonpopulationseroprevalenceofHBsAgbeforehepatitisBimmunizationandinfanthepatitisBvaccinationcoverage.

Limitations

Datatype

Rate

Relatedlinks HepatitisBControlThroughImmunization:aReferenceGuidehttp://iris.wpro.who.int/bitstream/10665.1/10820/3/9789290616696_eng.pdfDocumentingtheImpactofHepatitisBImmunization:bestpracticesforconductingaserosurveyhttp://whqlibdoc.who.int/hq/2011/WHO_IVB_11.08_eng.pdfSampledesignandproceduresforHepatitisBimmunizationsurveys:AcompaniontotheWHOclustersurveyreferencemanualhttp://whqlibdoc.who.int/hq/2011/WHO_IVB_11.12_eng.pdf

28

SDG3.3.5NumberofpeoplerequiringinterventionsagainstNTDs

Indicator

Numberofpeoplerequiringinterventionsagainstneglectedtropicaldiseases

Definition

Numberofpeoplerequiringtreatmentandcareforanyoneoftheneglectedtropicaldiseases(NTDs)targetedbytheWHONTDRoadmap,WorldHealthAssemblyresolutionsandreportedtoWHO


Someestimationisrequiredtoaggregatedataacrossinterventionsanddiseases.Thereisanestablishedmethodologythathasbeentestedandanagreedinternationalstandard.[http://www.who.int/wer/2012/wer8702.pdf?ua=1]1)Averageannualnumberofpeoplerequiringmasstreatmentknownaspreventivecare(PC)foratleastonePC-NTD:PeoplemayrequirePCformorethanonePC-NTD.ThenumberofpeoplerequiringPCiscomparedacrossthePC-NTDs,byagegroupandimplementationunit(e.g.district).ThelargestnumberofpeoplerequiringPCisretainedforeachagegroupineachimplementationunit.ThetotalisconsideredtobeaconservativeestimateofthenumberofpeoplerequiringPCforatleastonePC-NTD.PrevalencesurveysdeterminewhenanNTDhasbeeneliminatedorcontrolledandPCcanbestoppedorreducedinfrequency,suchthattheaverageannualnumberofpeoplerequiringPCisreduced.2)NumberofnewcasesrequiringindividualtreatmentandcareforotherNTDs:Thenumberofnewcasesisbasedoncountryreports,wheneveravailable,ofnewandknowncasesofBuruliulcer,Chagasdisease,cysticercosis,dengue,guinea-wormdisease,echinococcosis,humanAfricantrypanosomiasis(HAT),leprosy,theleishmaniases,rabiesandyaws.WherethenumberofpeoplerequiringandrequestingsurgeryforPC-NTDs(e.g.trichiasisorhydrocelesurgery)isreported,itcanbeaddedhere.Similarly,newcasesrequiringandrequestingrehabilitation(e.g.leprosyorlymphoedema)canbeaddedwheneveravailable.Populationsreferredtounder1)and2)mayoverlap;thesumwouldoverestimatethetotalnumberofpeoplerequiringtreatmentandcare.Themaximumof1)or2)isthereforeretainedatthelowestcommonimplementationunitandsummedtogetconservativecountry,regionalandglobalaggregates.By2030,improvedco-endemicitydataandmodelswillvalidatethetrendsobtainedusingthissimplifiedapproach.Areductionof400millioniscalculatedbysubtractingcurrentyearnumeratorbybaselineyearnumerator(2017)

Numerator Numberofpeoplerequiringinterventionsagainstneglectedtropicaldiseases

Denominator NA


ThenumberofpeoplerequiringtreatmentandcareforNTDsismeasuredbyexistingcountrysystems,andreportedthroughjointrequestandreportingformsfordonatedmedicines,theintegratedNTDdatabase,andotherreportstoWHO.


DevelopastandardprotocolforsystematicdatacollectionforNTDsthroughWorldHealthSurveyPlus(WHS+).

29

Disaggregation

DisaggregationbyageisrequiredforPC:pre-school-agedchildren(1-4years),school-aged(5-14years)andadults(=15years).


Annual

Limitations

Countryreportsmaynotbeperfectlycomparableovertime.Improvedsurveillanceandcase-findingmayleadtoanapparentincreaseinthenumberofpeopleknowntorequiretreatmentandcare.Somefurtherestimationmayberequiredtoadjustforchangesinsurveillanceandcase-finding.Missingcountryreportsmayneedtobeimputedforsomediseasesinsomeyears.

Datatype

Absolutenumber

Relatedlinks https://unstats.un.org/sdgs/metadata/?Text=&Goal=3&Target=3.3http://www.who.int/neglected_diseases/mediacentre/resolutions/en/http://www.who.int/neglected_diseases/resources/NTD_Generic_Framework_2015.pdf

30

SDG3.4.1ProbabilityofdyingfromanyofCVD,cancer,diabetes,CRD(ages30-70)(%)

Indicator

Mortalityrateattributedtocardiovasculardisease,cancer,diabetesorchronicrespiratorydiseases

DefinitionProbabilityofdyingbetweentheexactages30and70yearsfromcardiovasculardiseases,cancer,diabetes,orchronicrespiratorydiseases.DeathsfromthesefourcauseswillbebasedonthefollowingICD-10codes:I00-I99,C00-C97,E10-E14,andJ30-J98.


Age-specificdeathratesforthecombinedfourcausecategories(typicallyintermsof5-yearagegroups30-34,65-69).Alifetablemethodallowscalculationoftheriskofdeathbetweenexactages30and70fromanyofthesecauses,intheabsenceofothercausesofdeath.TheICDcodestobeincludedinthecalculationare:cardiovasculardisease:I00-I99,Cancer:C00-C97,Diabetes:E10-E14,orChronicrespiratorydiseases:J30-J98.Tocalculateage-specificmortalityrateforeach5-yearagegroupandcountry,foreach5-yearagerangebetween30and70:

𝑀� =𝑇𝑜𝑡𝑎𝑙𝑑𝑒𝑎𝑡ℎ𝑠𝑓𝑟𝑜𝑚𝑓𝑜𝑢𝑟𝑚𝑎𝑗𝑜𝑟𝑁𝐶𝐷𝑐𝑎𝑢𝑠𝑒𝑠𝑏𝑒𝑡𝑤𝑒𝑒𝑛𝑒𝑥𝑎𝑐𝑡𝑎𝑔𝑒𝑥𝑎𝑛𝑑𝑒𝑥𝑎𝑐𝑡𝑎𝑔𝑒𝑥 + 5

𝑇𝑜𝑡𝑎𝑙𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛𝑏𝑒𝑡𝑤𝑒𝑒𝑛𝑒𝑥𝑎𝑐𝑡𝑎𝑔𝑒𝑥𝑎𝑛𝑑𝑒𝑥𝑎𝑐𝑡𝑎𝑔𝑒𝑥 + 5�∗

Thentranslatethe5-yeardeathratetotheprobabilityofdeathineach5-yearagerange:

𝑞� =𝑀� ∗ 5�∗

1 + 𝑀� ∗ 2.5�∗�

∗

Theprobabilityofdeathfromage30to70years,independentofothercausesofdeathcanbecalculatedas:

𝑞�f = 1 − (1 − 𝑞��∗

��

��fhf∗ )

Numerator Seeabove

Denominator Seeabove


Vitalregistrationsystemswhichrecorddeathswithsufficientcompletenesstoallowestimationofall-causedeathrates.



Disaggregation

Bysex,location(urban/rural,majorregions/provinces),andsocio-economiccharacteristics(e.g.,education,wealthquintile).


Annual

Limitations

-incompleteorunusabledeathregistrationdata

Datatype

Probability

Relatedlinks WHO:http://www.who.int/gho/ncd/mortality_morbidity/ncd_premature_text/en/;http://www.who.int/healthinfo/statistics/LT_method.pdf.

31

SDG3.4.2Suicidemortalityrate(per100000population)

Indicator

Suicidemortalityrate

Definition

Numberofsuicidedeathsdividedbythepopulationandmultipliedby100,000inacountryinagivenperiodoftime.SuicidedeathswillbebasedonthefollowingICD-10codes:X60-X84,Y87.0.


Suicidemortalityrate=]6^3_`2ad_47cja`2^j68b8d_

r27415256147829

×100,000

Numerator Numberofsuicidedeathsinagivenperiodoftime

Denominator Totalpopulationinagivenperiodoftime


Vitalregistrationsystemswhichrecorddeathswithsufficientcompletenesstoallowestimationofcause-specificdeathrates.



Disaggregation

Bysex,age.


Annual

Limitations

-incompleteorunusabledeathregistrationdata

Datatype

Rate

Relatedlinks WHO:http://www.who.int/gho/mental_health/mental_health_indicatorbook.pdf?ua=1.

32

SDG3.5.1Coverageoftreatmentinterventionsforsubstance-usedisorders(%)

Indicator

Coverageoftreatmentinterventions(pharmacological,psychosocialandrehabilitationandaftercareservices)forsubstanceusedisorders

Definition

Substanceusedisordersincludesubstancedependenceandharmfulpatternofsubstanceuse.Severesubstanceusedisordersincludesubstancedependenceonly.


Therearetwoapproachescurrentlyunderdevelopmentandtestingtowardstheindicatorreport:1)Estimationbasedonactualserviceutilization:Treatmentcoverage= Treatmentdemands(Numberofpeopleincontactwithtreatmentservices)

Treatmentneeds(Numberofpeoplewithsubstanceusedisorders)×100%

2)Estimationbasedoncompositeindicatorofservicedevelopment:proxy-datareflectingmajorcomponentsoftreatmentsystemsforsubstanceusedisorders.

Numerator Numberofpeoplewithsubstanceusedisorders/substancedependenceincontactwithtreatmentservicesinagivenyear

Denominator Totalnumberofpeoplewithsubstanceusedisorders/substancedependenceinthepopulationinagivenyear


WHOATLASonSubstanceUse(ATLAS-SU)andassociateddatacollectionactivities;WHOGlobalInformationSystemonAlcoholandHealth(GISAH)andassociateddatacollectionactivities;UNODCdatageneratedthroughAnnualReportQuestionnaire(ARQ)surveys;WHO-UNODCFacilitysurveys;datacollectedthroughNationalstatisticalsystemsandhealthsystemdata;population-basedhouseholdsurveys;GBDdataforsubstanceusedosoravailabilityandutilization.


Othersourcesofinformationavailablefromdifferentinternationalorganizationsandmemberstates,suchasadministrative,projectdata,expertopinions,country-leveltargetedactivitiestogenerateandimputedata.Theunitisintheprocessofexploringfeasibilityandvalidityofthetwoapproachesforpickinguptrendsinthedevelopmentofpreventionandtreatmentsystemsforsubstanceusedisorders.Fundingwassecuredforadvancingtheworkonbothdirectionswithfieldtestingofthesecondapproachinatleast5countriesduring2019.

Disaggregation

Bytypeofsubstances,substanceusedisordersandtreatmentmodalities


Thefrequencyofdatacollectionwillremainthesame:-annualdatacollectionforillicitdrugscomponent;-annualoratleastbiennialforalcoholandothersubstanceusecomponent;-every3-5yearsforWHOATLASonSubstanceUsecollectsdata.

Limitations

Effectivecoverageestimationmaynotfeasibleorlimitedtofewpredominantlyhigh-incomecountries;Incaseofpoororunavailabledata,countryestimationsmaybelimitedtothelevelofavailabilitycoverage.

DatatypePercentage

Relatedlinks ATLAS-SU:http://www.who.int/gho/substance_abuse/en/GISAH:http://www.who.int/gho/alcohol/en/UNODCWorldDrugReport:https://www.unodc.org/wdr2018/http://www.who.int/mental_health/publications/action_plan/en/http://www.who.int/mental_health/evidence/atlas/mental_health_atlas_2017/en/

33

SDG3.5.2Totalalcoholpercapitaconsumptioninadultsaged15+(litresofpurealcohol)

Indicator

Harmfuluseofalcohol,definedaccordingtothenationalcontextasalcoholpercapitaconsumption(aged15yearsandolder)withinacalendaryearinlitersofpurealcohol

Definition

Consumptionofpurealcohol(ethanol)inlitresperpersonaged15+yearsduringonecalendaryear.


Recordedalcoholpercapita(15+)consumptionofpurealcoholiscalculatedasthesumofbeverage-specificalcoholconsumptionofpurealcohol(beer,wine,spirits,other)basedondatacollectionbyWHOfromdifferentsources.Thefirstpriorityinthedecisiontreeisgiventogovernmentstatistics;secondarecountry-specificdatainthepublicdomainfromdataproviderssupportedbythealcoholindustrybasedonresultsofthefieldworkatcountrylevelordatafromtheInternationalOrganisationofVineandWine(OIV);thirdistheFoodandAgricultureOrganizationoftheUnitedNations'statisticaldatabase(FAOSTAT);andfourthisdatafromindustry-supporteddatainthepublicdomainbasedondeskreviews.Tomaketheconversionintolitresofpurealcohol,thealcoholcontent(%alcoholbyvolume)isasfollows:Beer(barleybeer5%),Wine(grapewine12%;mustofgrape9%,vermouth16%),Spirits(distilledspirits40%;spirit-like30%),andOther(sorghum,millet,maizebeers5%;cider5%;fortifiedwine17%and18%;fermentedwheatandfermentedrice9%;otherfermentedbeverages9%).Unrecordedalcoholconsumptionreferstoalcoholwhichisnottaxedandisoutsidetheusualsystemofgovernmentalcontrol,suchashomeorinformallyproducedalcohol(legalorillegal),smuggledalcohol,surrogatealcohol(whichisalcoholnotintendedforhumanconsumption),oralcoholobtainedthroughcross-bordershopping(whichisrecordedinadifferentjurisdiction).Unrecordedalcoholconsumptionwasestimatedasapercentageoftotalalcoholconsumption.Country-levelproportionsofunrecordedalcoholconsumptionwereestimatedusingaregressionanalysiswithinputdatacollectedbyWHOfromdifferentsources.DatasourcesincludedexpertjudgementsfromaWHOsurvey,nominalexpertgroupDelphisurveys,andWHOSTEPSsurveys.Touristconsumptiontakesintoconsiderationalcoholpurchasedandconsumedbytouriststoacountryandalcoholpurchasedandconsumedwhenpeoplearevisitingcountriesotherthantheirhomecountry.Fortotalalcoholpercapitaconsumptionbysex,theproportionofalcoholconsumedbymenversuswomen(fromsurveys)andthedemographics(fromUNpopulationdata)wereused.PopulationdatacamefromtheUNWorldPopulationProspects.Totalalcoholpercapitaconsumption=

q6^2a`_b2`d_d49d69`_b2`d_d41b2c21b29j6^_d8945256147829d6`89e4b41_9d_4`i_4`¡8di_4``_j8d_9752561478294e_d¢�£i_4`j897c_j4^_b41_9d4`i_4`

Numerator Sumofrecordedandunrecordedalcoholconsumedinapopulationduringacalendaryear,adjustedfortouristconsumption,inlitres.

Denominator Midyearresidentpopulationaged15+forthesamecalendaryear.Preferreddatasources

AdministrativereportingsystemsforrecordedAPCandsurveydataforunrecordedAPC.Thepriorityofdatasourcesforrecordedalcoholpercapitaconsumptionshouldbegiventogovernmentstatisticsonsales/taxationofalcoholicbeveragesduringacalendaryearordataonproduction,exportandimportofalcoholindifferentbeveragecategories.Forcountries,wherethegovernmentalsalesorproductiondataisnotavailable,thepreferreddatasourcewouldbecountryspecificandpubliclyavailabledatafromtheprivatesector,includingalcoholproducersorcountryspecificdatafromtheFoodandAgricultureOrganizationoftheUnitedNationsstatisticaldatabase(FAOSTAT),whichmayalsoincludetheestimatesofunrecordedalcoholconsumption.Datasourcesforunrecordedalcoholconsumptionincludesurveydata,customsorpolicedata,andexpertopinions.



34

Disaggregation

Byage,sex.


Annual

Limitations

-gapsinadministrativerecordsofsalesorproduction,import,exportofalcoholicbeverages-surveysmaybesubjecttounder-reportingofalcoholconsumption,-mis-interpretationofquestionsand/orsizeofastandarddrink,orassociatedwithvalidityofthesurveyinstruments

Datatype

Volume(litrespercapita)

Relatedlinks WHO:http://apps.who.int/gho/data/node.gisah.GISAH?showonly=GISAH

35

SDG3.6.1Roadtrafficmortalityrate(per100000population)

Indicator Deathrateduetoroadtrafficinjuries

Definition

Deathrateduetoroadtrafficinjuriesasdefinedasthenumberofroadtrafficfatalinjurydeathsper100,000population.


Ourmodelisbasedonthequalityofdatawereceived.Asahealthorganization,werelyprimarilyonthesubmissionofvitalregistrationdatafromcountries’MinistriesofHealthtoWHO(throughtheofficialchannels).Thesedata,onallcausesofdeath,arethenanalysedbyourcolleaguesintheHealthInformationSystemsdepartmenttodecideonhowgoodthedataare,thatis,determiningifthereisgoodcompletenessandcoverageofdeathsforallcauses.Weclassifiedthecountrieson4categoriesorgroupsnamely,Group1:Countrieswithdeathregistrationdata(goodvital/deathregistrationdata)Group2:CountrieswithothersourcesofinformationoncausesofdeathGroup3:Countrieswithpopulationlessthan150000Group4:Countrieswithouteligibledeathregistrationdata.

Numerator Numberofdeathsduetoroadtrafficcrashes



Fortheroadtrafficdeaths,wehavetwosourcesofdata.DatafromGlobalStatusReportonRoadSafetysurveyandVitalregistrationorcertificatedeathsdatathatWHOreceiveeveryyearfrommemberstates(ministriesofhealth).


Disaggregation

Typesofroadusers,age,sex,incomegroupsandWHOregions


Biennial

Limitations

Therearenovitalregistrationdataforallcountriestomakecomparisonagainstthedatareceivedonthesurvey.Wepublishedonlyconfidenceintervalsforcountriesthathavepoorcompletenessofvitalregistrationdata.Also,wecannotcollectroadtrafficdataeveryyearusingthismethodologyoutlinedintheGlobalstatusreport.

Datatype

Rate

Relatedlinks http://www.who.int/violence_injury_preventionhttp://www.who.int/violence_injury_prevention/road_safety_status/2015/en/

36

SDG3.7.1Proportionofwomen(aged15-49)havingneedforfamilyplanningsatisfiedwithmodernmethods(%)

Indicator

Proportionofwomenofreproductiveage(aged15–49years)whohavetheirneedforfamilyplanningsatisfiedwithmodernmethods

Definition

Thepercentageofwomenofreproductiveage(15-49years)whodesireeithertohaveno(additional)childrenortopostponethenextchildandwhoarecurrentlyusingamoderncontraceptivemethod.


Thenumeratoristhepercentageofwomenofreproductiveage(15-49yearsold)whoarecurrentlyusing,orwhosesexualpartneriscurrentlyusing,atleastonemoderncontraceptivemethod.Thedenominatoristhetotaldemandforfamilyplanning(thesumofcontraceptiveprevalence(anymethod)andtheunmetneedforfamilyplanning).

Numerator Percentageofwomenofreproductiveage(15-49yearsold)whoarecurrentlyusing,orwhosesexualpartneriscurrentlyusing,atleastonemoderncontraceptivemethod.

Denominator Totaldemandforfamilyplanning(thesumofcontraceptiveprevalence(anymethod)andtheunmetneedforfamilyplanning).


Thisindicatoriscalculatedfromnationally-representativehouseholdsurveydata.Multi-countrysurveyprogrammesthatincluderelevantdataforthisindicatorare:ContraceptivePrevalenceSurveys(CPS),DemographicandHealthSurveys(DHS),FertilityandFamilySurveys(FFS),ReproductiveHealthSurveys(RHS),MultipleIndicatorClusterSurveys(MICS),PerformanceMonitoringandAccountability2020surveys(PMA),WorldFertilitySurveys(WFS),otherinternationalsurveyprogrammesandnationalsurveys.


Disaggregation

Age,geographiclocation,maritalstatus,socioeconomicstatusandothercategories,dependingonthedatasourceandnumberofobservations.


Annual

Limitations

Differencesinthesurveydesignandimplementation,aswellasdifferencesinthewaysurveyquestionnairesareformulatedandadministeredcanaffectthecomparabilityofthedata.Themostcommondifferencesrelatetotherangeofcontraceptivemethodsincludedandthecharacteristics(age,sex,maritalorunionstatus)ofthepersonsforwhomcontraceptiveprevalenceisestimated(basepopulation).Thetimeframeusedtoassesscontraceptiveprevalencecanalsovary.Inmostsurveys,thereisnodefinitionofwhatismeantby“currentlyusing”amethodofcontraception.Insomesurveys,thelackofprobingquestions,askedtoensurethattherespondentunderstandsthemeaningofthedifferentcontraceptivemethods,canresultinanunderestimationofcontraceptiveprevalence,fortraditionalmethods.Samplingvariabilitycanalsobeanissue,especiallywhencontraceptiveprevalenceismeasuredforaspecificsubgroup(accordingtomethod,age-group,levelofeducationalattainment,placeofresidence,etc.)orwhenanalyzingtrendsovertime.

Datatype

Percentage

Relatedlinks https://www.un.org/en/development/desa/population/publications/pdf/family/ContraceptiveUseByMethodDataBooklet2019.pdfhttps://www.un.org/en/development/desa/population/publications/pdf/popfacts/PopFacts_2019-3.pdf

37

SDG3.8.1UHCServiceCoverageIndex

Indicator

Coverageofessentialhealthservices(definedastheaveragecoverageofessentialservicesbasedontracerinterventionsthatincludereproductive,maternal,newbornandchildhealth,infectiousdiseases,non-communicablediseasesandservicecapacityandaccess,amongthegeneralandthemostdisadvantagedpopulation)

DefinitionCoverageofessentialhealthservices(definedastheaveragecoverageofessentialservicesbasedontracerinterventionsthatincludereproductive,maternal,newbornandchildhealth,infectiousdiseases,non-communicablediseasesandservicecapacityandaccess,amongthegeneralandthemostdisadvantagedpopulation).Theindicatorisanindexreportedonaunitlessscaleof0to100,whichiscomputedasthegeometricmeanof14tracerindicatorsofhealthservicecoverage.


Theindexiscomputedwithgeometricmeans,basedonthemethodsusedfortheHumanDevelopmentIndex.Thecalculationofthe3.8.1indicatorrequiresfirstpreparingthe14tracerindicatorssothattheycanbecombinedintotheindex,andthencomputingtheindexfromthosevalues.The14tracerindicatorsarefirstallplacedonthesamescale,with0beingthelowestvalueand100beingtheoptimalvalue.Formostindicators,thisscaleisthenaturalscaleofmeasurement,e.g.,thepercentageofinfantswhohavebeenimmunizedrangesfrom0to100percent.However,forafewindicatorsadditionalrescalingisrequiredtoobtainappropriatevaluesfrom0to100,asfollows:•Rescalingbasedonanon-zerominimumtoobtainfinerresolution(this“stretches”thedistributionacrosscountries):prevalenceofnon-raisedbloodpressureandprevalenceofnonuseoftobaccoarebothrescaledusingaminimumvalueof50%.

rescaledvalue=(X-50)/(100-50)*100•Rescalingforacontinuousmeasure:meanfastingplasmaglucose,whichisacontinuousmeasure(unitsofmmol/L),isconvertedtoascaleof0to100usingtheminimumtheoreticalbiologicalrisk(5.1mmol/L)andobservedmaximumacrosscountries(7.1mmol/L).

rescaledvalue=(7.1-originalvalue)/(7.1-5.1)*100Notethatincountrieswith,thetracerindicatorforuseofinsecticide-treatednetsisdroppedfromthecalculation.•Maximumthresholdsforrateindicators:hospitalbeddensityandhealthworkforcedensityarebothcappedatmaximumthresholds,andvaluesabovethisthresholdareheldconstantat100.ThesethresholdsarebasedonminimumvaluesobservedacrossOECDcountries.rescaledhospitalbedsper10,000=minimum(100,originalvalue/18*100)rescaledphysiciansper1,000=minimum(100,originalvalue/0.9*100)rescaledpsychiatristsper100,000=minimum(100,originalvalue/1*100)rescaledsurgeonsper100,000=minimum(100,originalvalue/14*100)Oncealltracerindicatorvaluesareonascaleof0to100,geometricmeansarecomputedwithineachofthefourhealthserviceareas,andthenageometricmeanistakenofthosefourvalues.Ifthevalueofatracerindicatorhappenstobezero,itissetto1(outof100)beforecomputingthegeometricmean.

Numerator Thisindicatorisbasedonaggregateestimates.

Denominator Thisindicatorisbasedonaggregateestimates.


Manyofthetracerindicatorsofhealthservicecoveragearemeasuredbyhouseholdsurveys.However,administrativedata,facilitydata,facilitysurveys,andsentinelsurveillancesystemsareutilizedforcertainindicators.

38


Disaggregation

Geographiclocation,householdwealth.EquityiscentraltothedefinitionofUHC,andthereforetheUHCservicecoverageindexshouldbeusedtocommunicateinformationaboutinequalitiesinservicecoveragewithincountries.Thiscanbedonebypresentingtheindexseparatelyforthenationalpopulationvsdisadvantagedpopulationstohighlightdifferencesbetweenthem.


Datacollectionvariesfromevery1to5yearsacrosstracerindicators.Forexample,countrydataonimmunizationsandHIVtreatmentarereportedannually,whereashouseholdsurveystocollectinformationonchildtreatmentmayoccurevery3-5years,dependingonthecountry.

Limitations

Thetracerindicatorsaremeanttobeindicativeofservicecoverage,notacompleteorexhaustivelistofhealthservicesandinterventionsthatarerequiredforuniversalhealthcoverage.The14tracerindicatorswereselectedbecausetheyarewell-established,withavailabledatawidelyreportedbycountries(orexpectedtobecomewidelyavailablesoon).Therefore,theindexcanbecomputedwithexistingdatasourcesanddoesnotrequireinitiatingnewdatacollectioneffortssolelytoinformtheindex.

DatatypeIndex

Relatedlinks https://unstats.un.org/sdgs/metadata/files/Metadata-03-08-01.pdf.Individualtracerindicatorsareavailablehere:http://www.who.int/healthinfo/universal_health_coverage/UHC_Tracer_Indicators_Metadata.pdf

39

SDG3.8.2Populationwithhouseholdexpendituresonhealth>10%oftotalhouseholdexpenditureorincome(%)

Indicator

Proportionofpopulationwithlargehouseholdexpendituresonhealthasashareoftotalhouseholdexpendituresorincome

Definition

Proportionofthepopulationwithlargehouseholdexpenditureonhealthasashareoftotalhouseholdexpenditureorincome.Twothresholdsareusedtodefine“largehouseholdexpenditureonhealth”:greaterthan10%andgreaterthan25%oftotalhouseholdexpenditureorincome.


Populationweightedaveragenumberofpeoplewithlargehouseholdexpenditureonhealthasashareoftotalhouseholdexpenditureorincome

𝑚8𝜔81ℎ𝑒𝑎𝑙𝑡ℎ𝑒𝑥𝑝𝑒𝑛𝑑𝑖𝑡𝑢𝑟𝑒𝑜𝑓𝑡ℎ𝑒ℎ𝑜𝑢𝑠𝑒ℎ𝑜𝑙𝑑𝑖𝑡𝑜𝑡𝑎𝑙𝑒𝑥𝑝𝑒𝑛𝑑𝑖𝑡𝑢𝑟𝑒𝑜𝑓𝑡ℎ𝑒ℎ𝑜𝑢𝑠𝑒ℎ𝑜𝑙𝑑𝑖 > 𝜏8

𝑚88 𝜔8

whereidenotesahousehold,1()istheindicatorfunctionthattakesonthevalue1ifthebracketedexpressionistrue,and0otherwise,micorrespondstothehouseholdsize(numberofhouseholdmembersofi),ω/correspondstothesamplingweightofhouseholdi.Household’ssampleweightω/multipliedbythehouseholdsizemiisusedtoobtainrepresentativenumbersperperson.Ifthesampleisself-weightingtonlythehouseholdsizeisusedastheweight.τisathresholdidentifyinglargehouseholdexpenditureonhealthasashareoftotalhouseholdconsumptionorincome(i.e.10%and25%).

Numerator Totalnumberofpeoplewithlargehouseholdexpenditureonhealthasashareoftotalhouseholdexpenditureorincome(i.e.greaterthan10%and25%).Householdexpenditureonhealthisdefinedasanyexpenditureincurredatthetimeofserviceusetogetanytypeofcare(promotive,preventive,curative,rehabilitative,palliativeorlong-termcare)includingallmedicines,vaccinesandotherpharmaceuticalpreparationsaswellasallhealthproducts,fromanytypeofproviderandforallmembersofthehousehold.Thesehealthexpendituresarecharacterizedbyadirectpaymentthatarefinancedbyahousehold’sincome(includingremittances),savingsorloansbutdonotincludeanythird-partypayerreimbursement.TheyarelabelledOut-Of-Pocket(OOP)paymentsintheclassificationofhealthcarefinancingschemes(HF)oftheinternationalClassificationforHealthAccounts(ICHA).Thecomponentsofahouseholdexpenditureonhealthsodefinedshouldbeconsistentwithdivision06oftheUNClassificationofIndividualConsumptionAccordingtoPurpose(COICOP-2018)andincludeexpendituresonmedicinesandmedicalproducts(06.1),outpatientcareservices(06.2)and,inpatientcareservices(06.3)andotherhealthservices(06.4).Expenditureonhouseholdconsumptionandhouseholdincomearebothmonetarywelfaremeasures.Theformerisgenerallydefinedasthesumofthemonetaryvaluesofallitems(goodsandservices)consumedbythehouseholdduringareferenceperiod.Itincludestheimputedvaluesofgoodsandservicesthatarenotpurchasedbutprocuredotherwiseforconsumption.Themostrelevantmeasureofhouseholdincomeisdisposableincomeasitisclosetothemaximumavailabletothehouseholdforconsumptionexpenditureduringtheaccountingperiod.Disposableincomeisdefinedastotalincomelessdirecttaxes(netofrefunds),compulsoryfeesandfines.Totalincomeisgenerallycomposedofincomefromemployment,propertyincome,incomefromhouseholdproductionofservicesforownconsumption,transfersreceivedincashandgoods,transfersreceivedasservices.Expenditureonhouseholdconsumptionistherecommendedmonetarywelfaremeasure.

Denominator Totalnumberofpeople

40


Keyrequirementsfortheselectionofadatasourceistheavailabilityofinformationonbothhouseholdexpendituresonhealthandhouseholdtotalexpenditureorincome,fromapopulationbasedsurveynationallyrepresentative;thethreemostcommondatasourcesarehouseholdbudgetsurveys(HBS),householdincomeandexpendituresurveys(HIES),socio-economicorlivingstandardssurveys.Thesesurveysaretypicallyimplementedbyorinclosecollaborationwithnationalstatisticalbureaus.


Healthsurveyswithamodulecollectingexpendituredataonbothhouseholdtotalexpenditure(includingonfood,housingandutilities)andhouseholdexpenditureonhealth

Disaggregation

Subnationalvariablesavailableinsurveydata.Informationonhouseholdlocation(urbanvsrural);thegender,ageandeducationoftheheadofthehousehold;householdcharacteristics;andothersocio-economicvariablesareusefulforequityanalysis.


Every1–5yearsdependingonimplementationofpopulation-basedhouseholdexpendituresurveysledbynationalstatisticsoffices

Limitations

Thisindicatorattemptstoidentifyfinancialhardshipthatindividualsfacewhenusingtheirincome,savingsortakingloanstopayforhealthcare.However,mosthouseholdsurveysfailtoidentifythesourceoffundingusedbyahouseholdwhoisreportinghealthexpenditure.Incountrieswherethereisnoretrospectivereimbursementofhouseholdspendingonhealththisisnotaproblem.Butinthosecountrieswherethereisretrospectivereimbursement–forexample,viaacontributoryhealthinsurancescheme-theamountreportedbyahouseholdonhealthexpendituresmightbetotallyorpartiallyreimbursedatsomelaterpoint,perhapsoutsidetherecallperiodofthehouseholdsurvey.Thisindicatorreliesonasinglecut-offpointtoidentifywhatconstitutes‘largehealthexpenditureasashareoftotalhouseholdexpenditureorincome’.Peoplejustbeloworabovesuchthresholdsarenottakenintoaccount,whichisalwaystheproblemwithmeasuresbasedoncut-offs.Byplottingthecumulativedistributionfunctionofthehealthexpenditureratio,itispossibletoidentifytheproportionofthepopulationthatisdevotinganyshareofitshousehold’sbudgettohealthforanythreshold.Lowvaluesoftheseindicatorscanbedrivenbypeople’sinabilitytospendanythingatallonhealth.Forthisreasonfinancialhardshipneedstobemonitoredjointlywithindicatorsofservicecoverage.Thereareotherindicatorsusedtomonitorfinancialhardship.WithintheGPWmonitoringframeworkthedefinitionadoptedisconsistentwiththeSDGdefinitionofcatastrophichealthexpendituresbasedonabudgetsharemetric(indicator3.8.2).Catastrophichealthexpenditurescanbemeasuredindifferentwaystoenrichtheanalysisandprovidepolicyadvicetailoredtoindividualcountries.Foranoverviewofdifferentapproachestomonitorcatastrophichealthexpendituresusingdifferentversionsofcapacity-to-payapproaches(deductingformeetingbasicneeds)basedonrelevantglobalandregionalresolutionsseebox2.2inchapter2ofthe2017WHO/WBGlobalUHCMonitoringReportaswellasCylusetal2018andXuetal2003.FinancialhardshipcanalsobemonitoredbyestimatingtheproportionofthepopulationwithimpoverishinghealthexpendituretolinkSDGgoal3.8onUniversalhealthcoveragedirectlytothefirstSDGgoalonpovertyeradication.Differentpovertylinescanbeusedformonitoringatglobal,regionalandcountrylevel.Formoreinformationseechapter2ofthe2017WHO/WBGlobalUHC

Datatype

Percentage

41

Relatedlinks MetadataSDGindictor3.8.2metadataGlobalreferencelistof100coreindicatorlist-page136DataportalonfinancialprotectionUHCfinancialprotectiondataportalWHOwebpagesWHOfinancialprotectionWHO-EUROfinancialprotectionReports2018WHO-EUROcountryreviewsonfinancialprotection2017UHCglobalmonitoringreport2017regionalreportsonfinancialprotection2015PAHO/WBreportonUHCCOICOP-2018divisiononhealthUNStatisticsDivision.Division06oftheUNClassificationofIndividualConsumptionAccordingtoPurpose(COICOP-2018).NewYork.Internetsite:https://unstats.un.org/unsd/class/revisions/coicop_revision.asp

Scientificpapers(byyearofpublication)JonathanCylus,SarahThomson,TamásEvetovits,CatastrophichealthspendinginEurope:equityandpolicyimplicationsofdifferentcalculationmethods.WHObulletin2018.http://dx.doi.org/10.2471/BLT.18.209031HuiWang,LluisVinyalsTorres,PhyllidaTravis.FinancialprotectionanalysisineightcountriesintheWHOSouth-EastAsiaRegion.WHObulletin2018.http://dx.doi.org/10.2471/BLT.18.209858HsuJ,FloresG,EvansDetal.Measuringfinancialprotectionagainstcatastrophichealthexpenditures:methodologicalchallengesforglobalmonitoring.2017.InternationalJournalforEquityinHealth2018,17:69.https://doi.org/10.1186/s12939-018-0749-5WagstaffA,FloresG,HsuJetal.Progressoncatastrophichealthspending:resultsfor133countries.Aretrospectiveobservationalstudy.LancetGlobalHealth.2017.http://dx.doi.org/10.1016/S2214-109X(17)30429-1WagstaffA,FloresG,SmitzM-Fetal.Progressonimpoverishinghealthspending:resultsfor122countries.Aretrospectiveobservationalstudy.2017.http://dx.doi.org/10.1016/S2214-109X(17)30486-2SaksenaP,HsuJ,EvansDB.Financialriskprotectionanduniversalhealthcoverage:evidenceandmeasurementchallenges.PLoSMed.2014;11(9):e1001701.https://doi.org/10.1371/journal.pmed.1001701XuK,EvansDB,CarrinG,Aguilar-RiveraAM,MusgroveP,EvansT.Protectinghouseholdsfromcatastrophichealthspending.HealthAff(Millwood).2007;26(4):972-83.https://doi.org/10.1377/hlthaff.26.4.972XuK,EvansDB,KawabataKetal.Householdcatastrophichealthexpenditure:amulticountryanalysis.Lancet.2003;362(9378):111-7.https://doi.org/10.1016/S0140-6736(03)13861-5WagstaffA,vanDoorslaerE.Catastropheandimpoverishmentinpayingforhealthcare:withapplicationstoVietnam1993-1998.HealthEconomics.2003;12(11):921-34.https://doi.org/10.1002/hec.776

42

SDG3.9.1Mortalityrateattributedtoairpollution(per100000population)

Indicator

Mortalityrateattributedtohouseholdandambientairpollution

Definition

Evidencefromepidemiologicalstudieshaveshownthatexposuretoambientairpollutionislinked,amongothers,totheimportantdiseasestakenintoaccountinthisestimate:acuterespiratoryinfectionsinyoungchildren(estimatedunder5yearsofage);cerebrovasculardiseasesinadults(estimatedabove25years);ischemicheartdiseasesinadults(estimatedabove25years);chronicobstructivepulmonarydiseaseinadults(estimatedabove25years);andlungcancerinadults(estimatedabove25years).


Burdenofdiseaseattributedtoairpollutioniscalculatedbyfirstcombininginformationontheincreased(orrelative)riskofadiseaseresultingfromexposure,withinformationonhowwidespreadtheexposureisinthepopulation(inthiscase,theannualmeanconcentrationofparticulatemattertowhichthepopulationisexposed).Thisallowscalculationofthe'populationattributablefraction'(PAF),whichisthefractionofdiseaseseeninagivenpopulationthatcanbeattributedtotheexposure,inthiscasetheannualmeanconcentrationofparticulatematter.Applyingthisfractiontothetotalburdenofdisease(e.g.cardiopulmonarydiseaseexpressedasdeathsorDALYs),givesthetotalnumberofdeathsorDALYsthatresultsfromambientairpollution.

PopulationAttributedFraction(PAF)=©ª×««ªg ©ª

¬×««ªª®¯

ª®¯

©ªª®¯ ×««ª

𝑃8=proportionofpopulationatexposureleveli,currentexposure𝑃8±=proportionofpopulationatexposureleveli,counterfactualorideallevelofexposureRR=therelativeriskatexposurelevelin=thelevelofexposurelevelsMortalityrateattributedtohouseholdandambientairpollution=

𝑇𝑜𝑡𝑎𝑙𝑛𝑢𝑚𝑏𝑒𝑟𝑜𝑓𝑑𝑒𝑎𝑡ℎ𝑠𝑎𝑡𝑡𝑟𝑖𝑏𝑢𝑡𝑒𝑑𝑡𝑜ℎ𝑜𝑢𝑠𝑒ℎ𝑜𝑙𝑑𝑎𝑛𝑑𝑎𝑚𝑏𝑖𝑒𝑛𝑡𝑎𝑖𝑟𝑝𝑜𝑙𝑙𝑢𝑡𝑖𝑜𝑛𝑇𝑜𝑡𝑎𝑙𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛

×100,000

Numerator Totalnumberofdeathsattributedtohouseholdandambientairpollution



Civilregistrationwithcompletecoverageandmedicalcertificationofcauseofdeath;Specialstudies


SampleRegistrationSystemsandVerbalAutopsy

Disaggregation

Byage,sex,location(urban/rural,majorregions/provinces),andsocio-economiccharacteristics(e.g.,education,wealthquintile).


Annualorevery5years

Limitations

-incompleteorunusabledeathregistrationdata-measurementerrors

Datatype

Rate

Relatedlinks WHO:http://apps.who.int/gho/data/node.wrapper.imr?x-id=2259;http://www.who.int/healthinfo/global_burden_disease/metrics_paf/en/.

43

SDG3.9.2MortalityrateattributedtoexposuretounsafeWASHservices(per100000population)

Indicator

Mortalityrateattributedtounsafewater,unsafesanitationandlackofhygiene(exposuretounsafeWater,SanitationandHygieneforAll(WASH)services)

Definition

Deathsattributabletounsafewater,sanitationandhygienefocusingoninadequateWASHservices,expressedper100,000population.Deathratesarecalculatedbydividingthenumberofdeathsbythetotalpopulation.Evidencefromepidemiologicalstudieshaveshownthatexposuretounsafewater,sanitationandhygienehabitsis,amongothers,directlylinkedtodiarrhoealdiseasesandintestinalnematodeinfectionsandotherdiseases.Repeateddiarrhoeaepisodesarelinkedtoprotein-energymalnutrition.Inthisestimate,onlytheimpactofdiarrhoealdiseases,intestinalnematodeinfections,andprotein-energymalnutritionaretakenintoaccount.TheincludeddiseasesaretheWASHattributableportionsofdiarrhoea(ICD-10codeA00,A01,A03,A04,A06-A09),intestinalnematodeinfections(ICD-10codeB76-B77,B79)andprotein-energymalnutrition(ICD-10codeE40-E46).


Attributablediarrhoeadeathsarecalculatedbyfirstcombininginformationontheincreased(orrelative)riskofadiseaseresultingfromexposure,withinformationonhowwidespreadtheexposureisinthepopulation(inthiscase,thepercentageofthepopulationwithexposuretounsafewater,sanitationandlackofhygiene).Thisallowscalculationofthe'populationattributablefraction'(PAF),whichisthefractionofdiseaseseeninagivenpopulationthatcanbeattributedtotheexposure,inthiscaselackofaccesstoimprovedwater,sanitationandhygiene.Applyingthisfractiontothetotaldeathsfromdiarrhoearesultsinthenumberofdiarrhoeadeathsthatresultsfrominadequatewater,sanitationandhygiene.Deathsfromprotein-energymalnutritionattributabletoinadequatewater,sanitationandhygieneareestimatedbyevaluatingtheimpactsofrepeatedinfectiousdiarrhoeaepisodesonnutritionalstatus(inparticularstunting).Alldeathsfromintestinalnematodeinfectionsareattributedtoinadequatewater,sanitationandhygieneduetotheirtransmissionpathway.

Numerator Totalnumberofdeathsattributedtounsafewater,unsafesanitationandlackofhygiene

Denominator TotalpopulationPreferreddatasources

Civilregistrationwithcompletecoverageandmedicalcertificationofcauseofdeath


Householdsurveys,specialstudies,sampleorsentinelregistrationsystems,populationcensus,surveillancesystems

Disaggregation



Limitations


Datatype

Rate

Relatedlinks http://www.who.int/water_sanitation_health/diseases-risks/gbd_poor_water/enhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4255749/

44

SDG3.9.3Mortalityratefromunintentionalpoisoning(per100000population)

Indicator

Mortalityrateattributedtounintentionalpoisoning.

Definition

Themortalityrateattributedtounintentionalpoisoningisdefinedasthenumberofdeathsofunintentionalpoisoningsinayear,dividedbythepopulation,andmultipliedby100000.


Mortalityrateinthecountryattributedtounintentionalpoisoningperyearisestimated.TheICD-10codescorrespondingtotheindicatorincludesX40,X43-X44,X46-X49.TheestimatesfornumberofdeathsattributedtounintentionalpoisoningarederivedfromtheWHOGlobalHealthEstimates(GHE),andthecorrespondingpopulationestimatesarederivedfromtheUNWorldPopulationProspects.Mortalityrateattributedtounintentionalpoisoning=

𝑇𝑜𝑡𝑎𝑙𝑛𝑢𝑚𝑏𝑒𝑟𝑜𝑓𝑑𝑒𝑎𝑡ℎ𝑠𝑎𝑡𝑡𝑟𝑖𝑏𝑢𝑡𝑒𝑑𝑡𝑜unintentionalpoisoning𝑇𝑜𝑡𝑎𝑙𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛

×100,000

Numerator Totalnumberofdeathsattributedtounintentionalpoisoning


Civilregistrationwithcompletecoverageandmedicalcertificationofcauseofdeath;Specialstudies


Householdsurveys,specialstudies,sampleorsentinelregistrationsystems,populationcensus,surveillancesystems

Disaggregation



Every2-3years

Limitations


Datatype

Rate

Relatedlinks WHO:http://apps.who.int/gho/data/node.wrapper.imr?x-id=2259;http://www.who.int/healthinfo/global_burden_disease/metrics_paf/en/.

45

SDG7.1.2Proportionofpopulationwithprimaryrelianceoncleanfuels(%)

Indicator

Proportionofpopulationwithprimaryrelianceoncleanfuelsandtechnology

Definition

Thepercentageofthepopulationthatreliesoncleanfuelsandtechnologiesastheprimarysourceofdomesticenergyforcooking.“Clean”isdefinedbytheemissionratetargetsandspecificfuelrecommendations(i.e.againstunprocessedcoalandkerosene)includedinthenormativeguidanceWHOguidelinesforindoorairquality:householdfuelcombustion.


Theindicatoriscalculatedasthenumberofpeopleusingcleanfuelsandtechnologiesdividedbytotalpopulation,expressedaspercentage.Householdenergyusedataareroutinelycollectedatthenationalandsubnationallevelsinmostcountriesusingcensusesandsurveys.Householdsurveysusedinclude:UnitedStatesAgencyforInternationalDevelopment(USAID)-supportedDemographicandHealthSurveys(DHS);UnitedNationsChildren’sFund(UNICEF)-supportedMultipleIndicatorClusterSurveys(MICS);WHO-supportedWorldHealthSurveys(WHS);nationalpopulationandhousingcensusesandotherreliableandnationallyrepresentativecountrysurveys.

Numerator Thenumberofpeopleusingcleanfuelsandtechnologiesforcooking,heatingandlighting


Nationalsurvey,populationcensus,householdsurveys


Disaggregation

Location(urban/rural)


Annual

Limitations

Theindicatorusescleanfuelsandtechnologiesuseasaproxyforindoorairpollution,asitisnotcurrentlypossibletoobtainnationallyrepresentativesamplesofindoorconcentrationsofcriteriapollutants,suchassmallparticlesandcarbonmonoxide.Theindicatorisbasedonthemaintypeoffuelusedforcookingascookingoccupiesthelargestshareofoverallhouseholdenergyneeds.However,manyhouseholdsusemorethanonetypeoffuelforcookingand,dependingonclimaticandgeographicalconditions,heatingwithsolidfuelscanalsobeacontributortoindoorairpollutionlevels.

Datatype

Percentage

Relatedlinks https://www.who.int/airpollution/data/HAP_exposure_results_final.pdf?ua=1https://www.who.int/indoorair/publications/burning-opportunities/en/

46

SDG11.6.2Annualmeanconcentrationsoffineparticulatematter(PM2.5)inurbanareas(μg/m3)

Indicator

Annualmeanlevelsoffineparticulatematter(e.g.PM2.5andPM10)incities(populationweighted)

Definition

Themeanannualconcentrationoffinesuspendedparticlesoflessthan2.5micronsindiameters(PM2.5)isacommonmeasureofairpollution.Themeanisapopulation-weightedaverageforurbanpopulationinacountry,andisexpressedinmicrogramspercubicmeter[μg/m3].


AlthoughPMismeasuredatmanythousandsoflocationsthroughouttheworld,theamountofmonitorsindifferentgeographicalareasvary,withsomeareashavinglittleornomonitoring.Inordertoproduceglobalestimatesathighresolution(0.1°grid-cells),additionaldataisrequired.AnnualurbanmeanconcentrationofPM2.5isestimatedwithimprovedmodellingusingdataintegrationfromsatelliteremotesensing,populationestimates,topographyandgroundmeasurements.

Numerator Sumoftheproductsofthegriddedpopulationandtheleveloffineparticulatematter,foragivenareaDenominator Sumofthepopulationforallgridsforagivenarea


Specialstudies


Disaggregation


Every2-3years

Limitations

Urban/ruraldata:whilethedataqualityavailableforurban/ruralpopulationisgenerallygoodforhigh-incomecountries,itcanberelativelypoorforsomelow-andmiddleincomeareas.Furthermore,thedefinitionofurban/ruralmaygreatlyvarybycountry.Grid-size:Thegridsizeusedforthemodelis0.1°x0.1°(10x10kmclosetotheequator,butsmallertowardsthepoles).Thisresolutionmaycauselimitationswhenconsideringlocalsituations.Howeverfinerresolutionsareplannedforfuturestudies.ConversionfromPM10:WheremeasurementsofPM2.5arenotavailable,PM10measurementsareusedafterconversiontoPM2.5usingcountryorregionalconversionfactors.Conversionfactorsrangebetween0.3-0.8dependingonlocation.Localizedconversionfactorsarelikelytobemoreaccuratebuttheabilitytocalculatethemreliesonlocalizeddatabeingavailable.ThepotentialforinaccuraciesinconversionfactorsmeansthatmodeloutputsforareasusinglargenumbersofconvertedvaluesmaybelessaccuratethanthosebaseddirectlyonmeasurementsofPM2.5andextracareshouldbetakenintheirinterpretation.Modelcalibrationindata-poorareas:Themodelproducesacalibrationequationforeachcountryusingcountryleveldataasapriority,withregionaldatabeingusedtosupplementlocalinformationforcountrieswithoutgroundmonitoringdata.Itisacknowledgedthattheestimatesfordata-poorcountriesmayberelativelyimpreciseandthisimprecisioncanresultinapparentlyabruptchangesinairpollutionlevelsatborderswithdata-poorcountries.Forenhancedaccuracyofmodelleddataitisimportantthatcountriescontinueand/orimprovetheirgroundmeasurements.

Datatype

Mean

Relatedlinks www.who.int/gho/phe

47

SDG3.a.1Prevalenceoftobaccouseinadultsaged15+(%)

Indicator

Age-standardizedprevalenceofcurrenttobaccouseamongpersonsaged15yearsandolder

Definition

Theindicatorisdefinedasthepercentageofthepopulationaged15yearsandoverwhocurrentlyuseanytobaccoproduct(smokedand/orsmokelesstobacco)onadailyornon-dailybasis.Tobaccousemeansuseofsmokedand/orsmokelesstobaccoproducts.“Currentuse”meansusewithintheprevious30daysatthetimeofthesurvey,whetherdailyornon-dailyuse.Tobaccoproductsmeansproductsentirelyorpartlymadeoftheleaftobaccoasrawmaterialintendedforhumanconsumptionthroughsmoking,sucking,chewingorsniffing.“Smokedtobaccoproducts”includecigarettes,cigarillos,cigars,cheroots,bidis,pipes,shisha(waterpipes),roll-your-owntobacco,kretekandanyotherformoftobaccothatisconsumedbysmoking."Smokelesstobaccoproduct"includesmoistsnuff,creamysnuff,drysnuff,plug,dissolvables,gul,looseleaf,redtoothpowder,snus,chimo,gutkha,khaini,gudakhu,zarda,quiwam,dohra,tuibur,nasway,naas,naswar,shammah,toombak,paan(betelquidwithtobacco),iq’mik,mishri,tapkeer,tombolandanyothertobaccoproductthatconsumedbysniffing,holdinginthemouthorchewing.


Prevalenceofcurrenttobaccouse=𝑁𝑢𝑚𝑏𝑒𝑟𝑜𝑓𝑟𝑒𝑠𝑝𝑜𝑛𝑑𝑒𝑛𝑡𝑠𝑎𝑔𝑒𝑑15 + 𝑦𝑒𝑎𝑟𝑠𝑐𝑢𝑟𝑟𝑒𝑛𝑡𝑙𝑦𝑢𝑠𝑖𝑛𝑔𝑎𝑛𝑦𝑡𝑜𝑏𝑎𝑐𝑐𝑜𝑝𝑟𝑜𝑑𝑢𝑐𝑡(𝑠𝑚𝑜𝑘𝑒𝑑𝑜𝑟𝑠𝑚𝑜𝑘𝑒𝑙𝑒𝑠𝑠)

𝑁𝑢𝑚𝑏𝑒𝑟𝑜𝑓𝑠𝑢𝑟𝑣𝑒𝑦𝑟𝑒𝑠𝑝𝑜𝑛𝑑𝑒𝑛𝑡𝑠𝑎𝑔𝑒𝑑15 + 𝑦𝑒𝑎𝑟𝑠 ×100%

Numerator Numberofcurrenttobaccousersaged15+years.“Currentusers”includesbothdailyandnon-dailyusersandsmokedorsmokelesstobacco.

Denominator Allrespondentsofthesurveyaged15+years.


Population-based(preferablynationallyrepresentative)survey.


Disaggregation



Annualoratleastevery5years

48

Limitations

-Biasthroughself-report,includingunder-reportingoftobaccouse-Misunderstanding/-interpretationofquestions-Limitedvalidityofsurveyinstruments-RepresentativenessofthesampleRawdatacollectedthroughnationallyrepresentativepopulation-basedsurveysinthecountriesareusedtocalculatecomparableestimatesforthisindicator.Informationfromsubnationalsurveysarenotused.Insomecountries,alltobaccouseandtobaccosmokingmaybeequivalent,butformanycountrieswhereotherformsoftobaccoarealsobeingconsumed,smokingrateswillbelowerthantobaccouseratestosomedegree.

Datatype

Prevalence

Relatedlinks WHO:http://www.who.int/tobacco/surveillance/survey/gats/en/;http://www.who.int/chp/steps/en/index.html.

49

SDG3.b.1Proportionofpopulationcoveredbyallvaccinesincludedinnationalprogrammes(DTP3,MCV2,PCV3)(%)

Indicator

Proportionofthetargetpopulationcoveredbyallvaccinesincludedintheirnationalprogramme

Definition

Thisindicatoraimstomeasureaccesstovaccines,includingthenewlyavailableorunderutilizedvaccines,atthenationallevelCoverageofDTPcontainingvaccine(3rddose):Percentageofsurvivinginfantswhoreceivedthe3dosesofdiphtheriaandtetanustoxoidwithpertussiscontainingvaccineinagivenyear.CoverageofMeaslescontainingvaccine(2nddose):Percentageofchildrenwhoreceivedtwodoseofmeaslescontainingvaccineaccordingtonationallyrecommendedschedulethroughroutineimmunizationservicesinagivenyear.CoverageofPneumococcalconjugatevaccine(lastdoseintheschedule):Percentageofsurvivinginfantswhoreceivedthenationallyrecommendeddosesofpneumococcalconjugatevaccineinagivenyear.CoverageofHPVvaccine(lastdoseintheschedule):Percentageof15yearsoldgirlsreceivedtherecommendeddosesofHPVvaccine.


WHOandUNICEFjointlydevelopedamethodologytoestimatenationalimmunizationcoveragefromselectedvaccinesin2000.Themethodologyhasbeenrefinedandreviewedbyexpertcommitteesovertime.Themethodologywaspublishedandreferenceisavailableunderwebsite.EstimatestimeseriesforWHOrecommendedvaccinesproducedandpublishedannuallysince2001.Themethodologyusesdatareportedbynationalauthoritiesfromcountriesadministrativesystemsaswellasdatafromimmunizationormultiindicatorhouseholdsurveys.

Numerator Numberofchildrenvaccinatedinthetargetgroup.(12-23monthsorotheragegroupdependingonrecommendednationalimmunizationschedule).

Denominator Numberof2yearsoldchildrenglobally


NationalHealthInformationSystemsorNationalImmunizationsystemsNationalimmunizationregistries


Highqualityhouseholdsurveyswithimmunizationmodule(e.g.DHS,MICS,nationalin-countrysurveys)

Disaggregation

Geographicallocation,i.e.regionalandnationalandpotentiallysubnationalestimates


AnnualdatacollectionAnnualdatacollectionMarch-Mayeachyear.CountryconsultationJuneeachyearDatarelease:15Julyeachyearfortimeseries1980–releaseyear-1.(inJuly2018estimatesfrom1980-2017)15Julyeachyearfortimeseries1980–releaseyear-1.(inJuly2017estimatesfrom1980-2016)

Limitations

Timeseriesofcoveragearesubjecttochangewhennewdatabecomesavailable.

Datatype

Percentage

Relatedlinks WHO:http://www.who.int/immunization/monitoring_surveillance/routine/coverage/en/index4.html

50

SDG3.b.3Proportionofhealthfacilitieswithessentialmedicinesavailableandaffordableonasustainablebasis(%)

Indicator

Proportionofhealthfacilitiesthathaveacoresetofrelevantessentialmedicinesavailableandaffordableonasustainablebasis

Definition

Percentageofpublicandprivateprimaryhealthcarefacilitieswhoatleasthaveallthefollowingavailableessentialmedicines-aspirin,astatin,anangiotensinconvertingenzymeinhibitor,thiazidediuretic,alongactingcalciumchannelblocker,metformin,insulin,abronchodilatorandasteroidinhalant.


%availability=]6^3_`2aa4b81878_j7c47c4k_411_jj_97841^_d8b89_ja`2^7c_^898^6^18j74k481431_]6^3_`2aj_`k_i_da4b81878_j

×100%

Numerator Numberoffacilitiesthathaveavailableduringassessmenttheminimumlistofessentialmedicines.Theminimumlistis:Medicines-atleastaspirin,astatin,anangiotensinconvertingenzymeinhibitor,thiazidediuretic,alongactingcalciumchannelblocker,metformin,insulin,abronchodilatorandasteroidinhalant.

Denominator Numberofsurveyedfacilities.


Nationally-representativehealthfacilityassessment


Disaggregation

Public,private


Annualorevery5years

Limitations

Datatype

Percentage

Relatedlinks WHO:http://www.who.int/healthinfo/systems/sara_introduction/en/

51

SDG3.c.1Densityofhealthworkers(doctors;nurseandmidwives;pharmacists;dentistsper10000population)

Indicator

Healthworkerdensityanddistribution

Definition

Densityofmedicaldoctors:Thedensityofmedicaldoctorsisdefinedasthenumberofmedicaldoctors,includinggeneralistsandspecialistmedicalpractitionersper10,000populationinthegivennationaland/orsubnationalarea.TheInternationalStandardClassificationofOccupations(ISCO)unitgroupcodesincludedinthiscategoryare221,2211and2212ofISCO-08.Densityofnursingandmidwiferypersonnel:Thedensityofnursingandmidwiferypersonnelisdefinedasthenumberofnursingandmidwiferypersonnelper10,000populationinthegivennationaland/orsubnationalarea.TheISCO-08codesincludedinthiscategoryare2221,2222,3221and3222.Densityofdentists:Thedensityofdentistsisdefinedasthenumberofdentistsper10,000populationinthegivennationaland/orsubnationalarea.TheISCO-08codesincludedinthiscategoryare2261.Densityofpharmacists:Thedensityofpharmacistsisdefinedasthenumberofpharmacistsper10,000populationinthegivennationaland/orsubnationalarea.TheISCO-08codesincludedinthiscategoryare2262.


Thefiguresfornumberofmedicaldoctors(includinggeneralistandspecialistmedicalpractitioners)dependingonthenatureoftheoriginaldatasourcemayincludepractisingmedicaldoctorsonlyorallregisteredmedicaldoctors.Thefiguresfornumberofnursingandmidwiferyincludenursingpersonnelandmidwiferypersonnel,wheneveravailable.Inmanycountries,nursestrainedwithmidwiferyskillsarecountedandreportedasnurses.Thismakesthedistinctionbetweennursingpersonnelandmidwiferypersonneldifficulttodraw.Thefiguresfornumberofdentistsincludedentistsinthegivennationaland/orsubnationalarea.Dependingonthenatureoftheoriginaldatasourcemayincludepractising(active)onlyorallregisteredinthehealthoccupation.TheISCO-08codesincludedhereare2261.Thefiguresfornumberofpharmacistsincludeinthegivennationaland/orsubnationalarea.Dependingonthenatureoftheoriginaldatasourcemayincludepractising(active)onlyorallregisteredinthehealthoccupation.TheISCO-08codesthatrelatetothisoccupationis2262.Numerator Numeratorisdefinedasthenumberofhealthworkers,definedinheadcounts.

Denominator Denominatordataforworkforcedensity(i.e.nationalpopulationestimates)areobtainedfromtheUnitedNationsPopulationDivision'sWorldPopulationProspectsdatabase.


ThisindicatorwillbereportedbyWHOusingtheNationalHealthWorkforceAccounts(NHWA).InresponsetoWHA69.19,anonlineNationalHealthWorkforceAccounts(NHWA)dataplatformwasdevelopedtofacilitatenationalreporting.Inadditiontothereporting,theplatformalsoservesasananalyticaltoolatthenational/regionalandgloballevels.SinceItslaunchinNovember2017,MemberStatesarecalledtousetheNHWAdataplatformtoreporthealthworkforcedata.ComplementingthenationalreportingthroughtheNHWAdataplatform,additionalsourcessuchastheNationalCensus,LabourForceSurveysandkeyadministrativenationalandregionalsourcesarealsoemployed.Mostofthedatafromadministrativesourcesarederivedfrompublishednationalhealthsectorreviewsand/orofficialcountryreportstoWHOoffices.


Disaggregation

Nationalleveldata,subnationalleveldata

52


Annual

Limitations

Dataonhealthworkerstendtobemorecompleteforthepublichealthsectorandmayunderestimatetheactiveworkforceintheprivate,military,nongovernmentalorganizationandfaith-basedhealthsectors.Inmanycases,informationmaintainedatthenationalregulatorybodiesandprofessionalcouncilsarenotupdated.Asdataisnotalwayspublishedannuallyforeachcountry,thelatestavailabledatahasbeenused.Duetothedifferencesindatasources,considerablevariabilityremainsacrosscountriesinthecoverage,periodicity,qualityandcompletenessoftheoriginaldata.DensitiesarecalculatedusingnationalpopulationestimatesfromtheUnitedNationsPopulationDivision'sWorldPopulationProspectsdatabaseandmayvaryfromdensitiesproducedbythecountry.

DatatypeRate

Relatedlinks https://www.who.int/hrh/statistics/en/

53

SDG3.d.1InternationalHealthRegulations(IHR)capacityandhealthemergencypreparedness

Indicator InternationalHealthRegulations(IHR)capacityandhealthemergencypreparedness

Definition

Percentageofattributesof13corecapacitiesthathavebeenattainedataspecificpointintime.The13corecapacitiesare:(1)Nationallegislation,policyandfinancing;(2)CoordinationandNationalFocalPointcommunications;(3)Surveillance;(4)Response;(5)Preparedness;(6)Riskcommunication;(7)Humanresources;(8)Laboratory;(9)Pointsofentry;(10)Zoonoticevents;(11)Foodsafety;(12)Chemicalevents;(13)Radionuclearemergencies.


IHR(2005)CapacityLevel(Annual)=q6^2aq_1ag«_52`7_d³n«p454b87i´k_`4e_j

¢�

Numerator StatePartyself-reportedaverageof13IHR(2005)capacities,asmeasuredbytheSPAR.

Denominator Totalnumberofreportedcapacities(i.e.,13).


SPARreports(availableontheGlobalHealthObservatory);StrategicPartnershipforInternationalHealthRegulations(2005)andHealthSecurity(https://extranet.who.int/sph/)


Jointexternalevaluation(JEE;availableathttps://extranet.who.int/sph/);CurrentHealthExpenditure(CHE;availableonGlobalHealthObservatory);previousyears’IHR(2005)self-assessmentannualreportingdata(availableonGlobalHealthObservatory).

Disaggregation

Country;capacity.


Annual

Limitations

Dataareself-reportedfromMemberStates;analysisofself-reportofcapacitiesusingtheSPAR(2018)identifiedthattherewasastrongcorrelationbetweenself-reportedcapacitiesandexternallyevaluatedcapacities.Althoughself-assessmentannualreportingismandatedunderIHR(2005),itispossiblethatnotallMemberStateswillsubmitareportintimeforcalculatingthebaseline.Inthisevent,whichisanticipatedtoberare,previousyears’annualreportingdata,validatedagainstotherexistingIHR(2005)monitoringandevaluationframeworkcomponents,willbeusedtoestimateabaselinevalue.

Datatype

Self-reportedassessmentdata,usingastandardizedtool.Averagevalue(0‒100)ofindicatorcapacitylevels,eachexpressedasanintegervaluefrom0‒5.

Relatedlinks GlobalHealthObservatory:http://www.who.int/gho/ihr/en/;SPH:https://extranet.who.int/sph/

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SDG3.d.2Proportionofbloodstreaminfectionsduetoantimicrobialresistantorganisms(%)

Indicator

Percentageofbloodstreaminfectionsduetoantimicrobialresistantorganisms

Definition

Frequencyofbloodstreaminfectionamonghospitalpatients’duetomethicillin-resistantStaphylococcusaureus(MRSA)andEscherichiacoliresistantto3rd-generationcephalosporin(e.g.,ESBL-E.coli).RationalforselectingthesetwotypesofAMR:(i)E.coliandS.aureusareamongthemostcommonhumanfast-growingbacteriacausingacutehumaninfections;(ii)E.coliishighlyfrequentinbothhumans,animalsandenvironment,beinganexcellentindicatorformonitoringAMRacrossthesectorsinlinewiththeOneHealthapproach;(iii)bothMRSAandESBL-E.coliarelargelydisseminatedandfrequentlyinhighfrequencyinhospitalsettingsallovertheworld.InfectionswiththesetypesofAMRleadtoincreaseinuseofthelastresortdrugs(e.g.,vancomycinforMRSAinfections,andcarbapenemsforESBL-E.coli)againstwhichnewtypesofAMRareemerging.WHOhasdefinedglobalinfectionpreventionandcontrolstandardsandstrategies.EffectivecontrolofthesetwotypesofAMRwillultimatelypreservethecapacitytotreatinfectionswithavailableantimicrobialswhilenewpreventionandtreatmentsolutionscanbedeveloped.


TheWHOGlobalAMRSurveillanceSystem(GLASS)supportscountriestoimplementanAMRstandardizedsurveillancesystem.Atnationallevelcasesarefoundamongpatientsfromwhomroutineclinicalsampleshavebeencollectedforbloodcultureatsurveillancesitesaccordingtolocalclinicalpractices,andantimicrobialsusceptibilitytests(AST)areperformedfortheisolatedbloodpathogens.Themicrobiologicalresults(bacteriaidentificationandAST)arecombinedwiththepatientdataandrelatedtopopulationdatafromthesurveillancesites.GLASSdoescollectinformationontheoriginoftheinfectioneithercommunityorigin(lessthan2calendardaysinhospital)orhospitalorigin(patientshospitalizedformorethan2calendardays).DataarecollatedandvalidatedatnationallevelandreportedtoGLASSwhereepidemiologicalstatisticsandmetricsaregenerated.

Numerator NumberofpatientspresentingwithbloodstreaminfectionduetoMRSAandESBL-E.coliamongpatientsseekinghospitalcare

Denominator NumberofpatientsseekinghospitalcareandfromwhomthebloodspecimenwastakenduetosuspectedbloodstreaminfectionandfromwhombloodspecimenshavebeensubmittedforbloodcultureandAST.


NationalAMRdatacollectedthroughthenationalAMRsurveillancesystemandreportedtoGLASS.


Publishedandnon-publisheddatafromnationalcentersandresearch/academicinstitutionsandfromothersregionalsurveillancenetworks.

Disaggregation

Datawillbeaggregatedatthecountrylevel.Datawillbeanalyzedandreportedaccordingtowhetherspecimeniswithin2calendardaysofadmission(communityorigin)orafter2calendardaysofadmission(hospitalorigin).


Annual

Limitations

ConstraintsassociatedwithinnationalAMRsurveillancesystems(numberanddistributionofsurveillancesitesandrepresentativenessofsurveillancedata,samplingbias,poordiagnosticcapacity,measurementserrors,issueswithdatamanagement).

Datatype

Percentage

Relatedlinks http://www.who.int/glass/en/

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SDG4.2.1Proportionofchildrenunder5developmentallyontrack(health,learningandpsychosocialwell-being)(%)

Indicator

Proportionofchildrenunder5whoaredevelopmentallyontrackinhealth,learningandpsychosocialwell-being,bysex

Definition

Theproportionofchildrenunder5yearsofagewhoaredevelopmentallyontrackinhealth,learningandpsychosocialwell-beingiscurrentlybeingmeasuredbythepercentageofchildrenaged36-59monthswhoaredevelopmentallyon-trackinatleastthreeofthefollowingfourdomains:literacy-numeracy,physical,socio-emotionalandlearning.


Thenumberofchildrenundertheageoffivewhoaredevelopmentallyontrackinhealth,learningandpsychosocialwell-beingdividedbythetotalnumberofchildrenundertheageoffiveinthepopulationmultipliedby100.

Numerator Thenumberofchildrenundertheageoffivewhoaredevelopmentallyontrackinhealth,learningandpsychosocialwell-beingmultipliedby100

Denominator Totalnumberofchildrenundertheageoffiveinthepopulation


TheUNICEF-supportedMICSsurveyshavebeencollectingdataonthisindicatorandconvertingitintotheEarlyChildhoodDevelopmentIndexorECDIinselectedlow-andmiddle-incomecountriessince2010.ManyoftheindividualitemsincludedintheECDIarecollectedthroughothermechanismsinhigh-income(OECD)countriesaswell.


Disaggregation

Age,sex,placeofresidence,wealth,geographiclocation,caregivereducationandotherbackgroundcharacteristics.


Annual

Limitations

Comparabledataareavailablefor58low-andmiddle-incomecountriessince2010

Datatype

Percentage

Relatedlinks UNICEF:https://data.unicef.org/topic/early-childhood-development/development-status/

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SDG5.2.1Proportionofwomen(15-49)subjectedtoviolencebycurrentorformerintimatepartner(%)

Indicator

Proportionofever-partneredwomenandgirlsaged15yearsandoldersubjectedtophysical,sexualorpsychologicalviolencebyacurrentorformerintimatepartnerintheprevious12months,byformofviolenceandbyage

Definition

Thisindicatormeasuresthepercentageofever-partneredwomenandgirlsaged15-49yearswhohaveexperiencedphysical,sexualorpsychologicalviolencebyacurrentorformerintimatepartner,intheprevious12months.Intimatepartnerviolenceisthemostcommonformofviolenceagainstwomenandgirlsglobally.Givenprevailingsocialnormsthatsanctionmaledominanceoverwomen,violencebetweenintimatepartnersisoftenperceivedasordinary,particularlyinthecontextofmarriage,cohabitationoranyformalorinformalunion.Violenceagainstwomenandgirlsisanextremeformofgenderinequality.


Thisindicatorcallsforbreakdownbyformofviolenceandbyagegroup.Countriesareencouragedtocomputeprevalencedataforeachformofviolence,disaggregatedbyageasdetailedbelowtoassistcomparabilityatregionalandgloballevels:1.Physicalviolence:Numberofever-partneredwomenandgirls(aged15-49yearswhoexperiencephysicalviolencebyacurrentorformerintimatepartnerintheprevious12monthsdividedbythenumberofever-partneredwomenandgirls(aged15yearsandabove)inthepopulationmultipliedby100.2.Sexualviolence:Numberofever-partneredwomenandgirls(aged15-49years)whoexperiencesexualviolencebyacurrentorformerintimatepartnerintheprevious12monthsdividedbythenumberofever-partneredwomenandgirls(aged15yearsandabove)inthepopulationmultipliedby100.3.Anyformofphysicaland/orsexualviolence:Numberofever-partneredwomenandgirls(aged15-49years)whoexperiencephysicaland/orsexualviolencebyacurrentorformerintimatepartnerintheprevious12monthsdividedbythenumberofever-partneredwomenandgirls(aged15-49years)multipliedby100.

Numerator Seemethodofestimation/calculation

Denominator Seemethodofestimation/calculation


ThemainsourcesofintimatepartnerviolenceprevalencedataforSDGIndicator5.2.1comprisesdatafrominternationallycomparablepopulation-basedsurveysthatare(1)specializednationalsurveysdedicatedtomeasuringviolenceagainstwomenand(2)internationalhouseholdsurveysthatincludeamoduleonexperiencesofviolencebywomen,suchastheDHS.Whereavailable,otherdedicatedsurveysareincludedifthedataaredeemedcomparable.Since2015,around135countrieshadconductedviolenceagainstwomennationalprevalencesurveysorhaveincludedamoduleonviolenceagainstwomeninaDHSorothernationalhouseholdsurvey.


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Disaggregation

Inadditiontoformofviolenceandage,income/wealth,education,ethnicity(includingindigenousstatus),disabilitystatus,marital/partnershipstatus,relationshipwiththeperpetrator(i.e.current/formerpartner),geographiclocationandfrequencyofviolencearesuggestedasdesiredvariablesfordisaggregationforthisindicator.


Limitations

Comparability:Theavailabilityofcomparabledataremainsachallengeinthisareaasmanydatacollectioneffortshavereliedondifferentsurveymethodologies,useddifferentdefinitionsofpartnerorspousalviolenceandofthedifferentformsofviolenceanddifferentsurveyquestionformulations.Furthermore,diverseagegroupsareoftenutilized.Willingnesstodiscussexperiencesofviolenceandunderstandingofrelevantconceptsmayalsodifferaccordingtotheculturalcontextandthiscanaffectreportedprevalencelevels.Regularityofdataproduction:Since1995,onlysome40countrieshaveconductedmorethanonesurveyonviolenceagainstwomen.Obtainingdataonviolenceagainstwomenisacostlyandtime-consumingexercise,whethertheyareobtainedthroughstand-alonededicatedsurveysorthroughmodulesinothersurveys.Feasibility:Psychologicalpartnerviolence—whichmaybeconceptualiseddifferentlyacrossculturesandindifferentcontexts—isstillaTearIIIsub-indicator.Sinceitisnotyetfeasibletoreportonpsychologicalpartnerviolence,thisindicatorcurrentlyreportsonphysicaland/orsexualintimatepartnerviolenceonly.Effortsareunderway,ledbyWHO,todevelopaglobalstandardformeasuringandreportingonpsychologicalintimatepartnerviolence.Similarly,thisindicatorcallsforglobalreportingofviolenceexperiencedbyever-partneredwomenaged15yearsandabove.However,mostdatacomefromDHS,whichtypicallysampleonlywomenaged15-49,andthereisalackofconsistencyintheagerangeofsamplepopulationsacrossothercountrysurveys.Forthosesurveysthatinterviewasampleofwomenfromadifferentagegroup,theprevalenceforthe15-49agegroupisoftenpublishedorcanbecalculatedfromavailabledata.Theglobalindicatorthereforecurrentlyreportsviolenceexperiencedbyever-partneredwomenandgirls15-49yearsofage.Effortsareunderwaytoaddressthisissueandtobetterunderstandandmeasurepartnerviolenceagainstwomenaged50andabove.

Datatype

Percentage

Relatedlinks http://evaw-global-database.unwomen.org/endata.unicef.orghttp://unstats.un.org/unsd/gender/default.html

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SDG5.6.1Proportionofwomen(15-49)whomaketheirowndecisionsregardingsexualrelations,contraceptiveuseandreproductivehealthcare(%)

Indicator

Proportionofwomenaged15-49yearswhomaketheirowninformeddecisionsregardingsexualrelations,contraceptiveuseandreproductivehealthcare

Definition

Proportionofwomenaged15-49years(marriedorinunion)whomaketheirowndecisiononallthreeselectedareasi.e.cansaynotosexualintercoursewiththeirhusbandorpartneriftheydonotwant;decideonuseofcontraception;anddecideontheirownhealthcare.Onlywomenwhoprovidea“yes”answertoallthreecomponentsareconsideredaswomenwhomakeherowndecisionsregardingsexualandreproductivehealth.Aunioninvolvesamanandawomanregularlycohabitinginamarriage-likerelationship


Proportion=NumeratorX100/Denominator[seenumeratoranddenominator]

Numerator Numberofmarriedorinunionwomenaged15-49yearsold:–whocansay“no”tosex;and–forwhomthedecisiononcontraceptionisnotmainlymadebythehusband/partner;and–forwhomdecisiononhealthcareforthemselvesisnotusuallymadebythehusband/partnerorsomeoneelseOnlywomenwhosatisfyallthreeempowermentcriteriaareincludedinthenumerator.

Denominator Totalnumberwomenaged15-49yearsold,whoaremarriedorinunion.


Currentdataontheindicatorarederivedfromnationallyrepresentativedemographicandsurveys(DHS).PlansareunderwaytobroadenthedatasourcestoincludeMICsandothercountryspecificsurveys.


Disaggregation

BasedonavailableDHSdata,disaggregationispossiblebyage,geographiclocation,placeofresidence,education,andwealthquintile.


CurrentlydatacomesfromtheDHSwhichhavethreetofive-yearcycles.

Limitations

Untilrecently,theindicatorcapturedresultsformarriedandin-unionwomenandadolescentgirlsofreproductiveage(15–49yearsold)whoareusinganytypeofcontraception.InthephaseofthenationalDemographicandHealthSurvey(DHS–7)andlaterrounds,thequestionnaireareextendedtorespondentswhethertheyareusingcontraceptionornot.Onelimitationofthedataisthatunmarriedwomenandgirlsarenotincluded.Asofearly2020,atotalof57countries,themajorityinsub-SaharanAfrica,haveatleastonesurveywithdataonallthreequestionsnecessaryforcalculatingIndicator5.6.1.Broaderdatasourcesareneededandeffortstoincreasedatacoverageareunderway.CurrentdataontheindicatoraremainlyderivedfromtheDHSandeffortsarebeingmadetoincludetheMultipleIndicatorClusterSurveys(MICS),theGenerationandGenderSurvey(GGS)andothercountry-specificsurveys.Inmanynationalcontexts,householdsurveys,whicharethemaindatasourceforthisindicator,excludethehomelessandarelikelytounder-enumeratelinguisticorreligiousminoritygroups. indicator,excludethehomelessandarelikelytounder-enumeratelinguisticorreligiousminoritygroups.

Datatype

Percentage

Relatedlinks

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SDG6.1.1Proportionofpopulationusingsafelymanageddrinking-waterservices(%)

Indicator

Proportionofpopulationusingsafelymanageddrinkingwaterservices

Definition

Proportionofpopulationusingsafelymanageddrinkingwaterservicesiscurrentlybeingmeasuredbytheproportionofpopulationusinganimprovedbasicdrinkingwatersourcewhichislocatedonpremises,availablewhenneededandfreeoffaecal(andprioritychemical)contamination.‘Improved’drinkingwatersourcesinclude:pipedwaterintodwelling,yardorplot;publictapsorstandpipes;boreholesortubewells;protecteddugwells;protectedsprings;packagedwater;deliveredwaterandrainwater.


Householdsurveysandcensusescurrentlyprovideinformationontypesofbasicdrinkingwatersourceslistedabove,andalsoindicateifsourcesareonpremises.Thesedatasourcesoftenhaveinformationontheavailabilityofwaterandincreasinglyonthequalityofwateratthehouseholdlevel,throughdirecttestingofdrinkingwaterforfaecalorchemicalcontamination.Thesedatawillbecombinedwithdataonavailabilityandcompliancewithdrinkingwaterqualitystandards(faecalandchemical)fromadministrativereportingorregulatorybodies.TheWHO/UNICEFJointMonitoringProgrammeforWaterSupply,SanitationandHygiene(JMP)estimatesaccesstobasicservicesforeachcountry,separatelyinurbanandruralareas,byfittingaregressionlinetoaseriesofdatapointsfromhouseholdsurveysandcensuses.Thisapproachwasusedtoreportonuseof‘improvedwater’sourcesforMDGmonitoring.TheJMPisevaluatingtheuseofalternativestatisticalestimationmethodsasmoredatabecomeavailable.

Numerator Totalestimatednumberofpeopleusingsafelymanageddrinkingwaterservice



Nationallyrepresentativehouseholdsurveys,censuses,andadministrativedata.CurrentlytheJMPdatabaseholdsover1,700censusesandsurveys.Inhigh-incomecountrieswherehouseholdsurveysorcensusesdonotalwayscollectinformationonbasicaccess,dataaredrawnfromadministrativerecords.


Disaggregation

Disaggregationbyplaceofresidence(urban/rural)andsocioeconomicstatus(wealth,affordability)ispossibleforallcountries.Disaggregationbyotherstratifiersofinequality(subnational,gender,disadvantagedgroups,etc.)willbemadewheredatapermit.Drinkingwaterserviceswillbedisaggregatedbyservicelevel(includingnoservices,basic,andsafelymanagedservices)followingtheJMPdrinkingwaterladder


Biennial

Limitations

Datatype

Percentage

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Relatedlinks JMPwebsite:www.washdata.org.JMP2017updateandSDGbaselineshttps://washdata.org/report/jmp-2017-report-finalSafelymanageddrinkingwaterthematicreporthttps://washdata.org/report/jmp-2017-tr-smdwWHOGuidelinesforDrinkingWaterQuality:http://www.who.int/water_sanitation_health/dwq/guidelines/en/

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SDG6.2.1Proportionofpopulationusingsafelymanagedsanitationservicesandhand-washingfacility(%)

Indicator

Proportionofpopulationusingsafelymanagedsanitationservices,includingahand-washingfacilitywithsoapandwater

Definition

Theproportionofpopulationusingsafelymanagedsanitationservices,includingahand-washingfacilitywithsoapandwateriscurrentlybeingmeasuredbytheproportionofthepopulationusingabasicsanitationfacilitywhichisnotsharedwithotherhouseholdsandwhereexcretaissafelydisposedinsituortreatedoff-site.‘Improved’sanitationfacilitiesinclude:flushorpourflushtoiletstosewersystems,septictanksorpitlatrines,ventilatedimprovedpitlatrines,pitlatrineswithaslab,andcompostingtoilets.Populationwithabasichandwashingfacility:adevicetocontain,transportorregulatetheflowofwatertofacilitatehandwashingwithsoapandwaterinthehousehold.Concepts:Improvedsanitationfacilitiesincludethefollowing:flushorpourflushtoiletstosewersystems,septictanksorpitlatrines,ventilatedimprovedpitlatrines,pitlatrineswithaslab,andcompostingtoilets.Ahandwashingfacilitywithsoapandwater:ahandwashingfacilityisadevicetocontain,transportorregulatetheflowofwatertofacilitatehandwashing.Thisindicatorisaproxyofactualhandwashingpractice,whichhasbeenfoundtobemoreaccuratethanotherproxiessuchasself-reportsofhandwashingpractices.


Householdsurveysandcensusesprovidedataonuseoftypesofbasicsanitationfacilitieslistedabove,aswellasthepresenceofhandwashingmaterialsinthehome.Thepercentageofthepopulationusingsafelymanagedsanitationservicesiscalculatedbycombiningdataontheproportionofthepopulationusingdifferenttypesofbasicsanitationfacilitieswithestimatesoftheproportionoffaecalwastewhichissafelydisposedinsituortreatedoff-site.

Numerator Totalestimatednumberofpeopleusingsafelymanagedsanitationservices



Nationallyrepresentativehouseholdsurveys,censuses,andadministrativedata.CurrentlytheJMPdatabaseholdsover1,700surveysandcensuses.Inhigh-incomecountrieswherehouseholdsurveysorcensusesdonotalwayscollectinformationonbasicaccess,dataaredrawnfromadministrativerecords.Estimatesofexcretamanagementwillbecollectedfromcountriesandusedtoadjustthedataonuseofbasicsanitationfacilitiesasneeded.Administrative,populationandenvironmentaldatacanalsobecombinedtoestimatesafedisposalortransportofexcreta,whennocountrydataareavailable.Dataondisposalortreatmentofexcretaarelimitedbutestimatesforsafemanagementoffaecalwastescanbecalculatedbasedonfaecalwasteflowsassociatedwiththeuseofdifferenttypesofbasicsanitationfacility.Sincethehandwashingwithsoapsurveyquestionswerestandardizedin2009,over70DHSandMICSsurveyshaveincludedthemodule.JMPpublishedhandwashingestimatesfor12countriesinits2014update,for54countriesinits2015update,andfor70countriesinits2017update.ThepopulationdatausedbyJMP,includingtheproportionofthepopulationlivinginurbanandruralareas,arethoseestablishedbytheUNPopulationDivision.


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Disaggregation

Disaggregationbyplaceofresidence(urban/rural)andsocioeconomicstatus(wealth,affordability)ispossibleforallcountries.Disaggregationbyotherstratifiesofinequality(subnational,gender,disadvantagedgroups,etc.)willbemadewheredatapermit.Sanitationserviceswillbedisaggregatedbyservicelevel(includingnoservices,basic,andsafelymanagedservices)followingtheJMPsanitationladder.


Biennial

Limitations

Aframeworkformeasuringfaecalwasteflowsandsafetyfactorshasbeendevelopedandpilotedin12countries(WorldBankWaterandSanitationProgram,2014),andisbeingadoptedandscaledupwithinthesanitationsectors.Thisframeworkhasservedasthebasisforindicators6.2.1and6.3.1.Dataonsafedisposalandtreatmentarenotavailableforallcountries.However,sufficientdatawereavailabletomakeglobalandregionalestimatesofsafelymanagedsanitationservicesin2017.Presenceofahandwashingstationwithsoapandwaterdoesnotguaranteethathouseholdmembersconsistentlywashhandsatkeytimes,buthasbeenacceptedasthemostsuitableproxy.Datawereavailablefor70countriesin2017.

Datatype

Percentage

Relatedlinks www.washdata.orgJMPwebsite:www.washdata.org.JMP2017updateandSDGbaselineshttps://washdata.org/report/jmp-2017-report-finalRam,P.,PracticalGuidanceforMeasuringHandwashingBehaviour:2013update,WorldBankWaterSupplyandSanitationProgramme,2013.http://www.wsp.org/sites/wsp.org/files/publications/WSP-Practical-Guidance-Measuring-HandwashingBehavior-2013-Update.pdf"

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SDG16.2.1Proportionofchildren(aged1-17)experiencingphysicalorpsychologicalaggression(%)

Indicator

Proportionofchildrenaged1–17yearswhoexperiencedanyphysicalpunishmentand/orpsychologicalaggressionbycaregiversinthepastmonth

Definition

Proportionofchildrenaged1-17yearswhoexperiencedanyphysicalpunishmentand/orpsychologicalaggressionbycaregiversinthepastmonthiscurrentlybeingmeasuredbytheProportionofchildrenaged1-14yearswhoexperiencedanyphysicalpunishmentand/orpsychologicalaggressionbycaregiversinthepastmonth.


Numberofchildrenaged1-17yearswhoarereportedtohaveexperiencedanyphysicalpunishmentand/orpsychologicalaggressionbycaregiversinthepastmonthdividedbythetotalnumberofchildrenaged1-17inthepopulationmultipliedby100

Numerator Numberofchildrenaged1-17yearswhoarereportedtohaveexperiencedanyphysicalpunishmentand/orpsychologicalaggressionbycaregiversinthepastmonthmultipliedby100

Denominator Thetotalnumberofchildrenaged1-17inthepopulation


HouseholdsurveyssuchasUNICEF-supportedMICSandDHSthathavebeencollectingdataonthisindicatorinlow-andmiddle-incomecountriessincearound2005.Insomecountries,suchdataarealsocollectedthroughothernationalhouseholdsurveys.


Disaggregation

Sex,age,income,placeofresidence,geographiclocation


Limitations

Thereisanexisting,standardizedandvalidatedmeasurementtool(theParent-ChildversionoftheConflictTacticsScale,orCTSPC)thatiswidelyacceptedandhasbeenimplementedinalargenumberofcountries,includinghigh-incomecountries.DefinitionsofbothphysicalpunishmentandpsychologicalaggressionwillneedtobeveryclearlydefinedforcountriesbutthisshouldnotbeaproblemasthereisawealthofavailableliteratureandresearchontheviolentpunishmentofchildrenandGeneralCommentNo.13ontheConventionoftheRightsoftheChild(CRC)alsoprovidesadefinitionfor“corporal”or“physical”punishmentaswellas"mentalviolence".

Datatype

Percentage

Relatedlinks https://data.unicef.org/topic/child-protection/violence/violent-discipline/

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HealthEmergenciesVaccinecoverageforepidemicpronediseases

Indicator

Vaccinecoverageofat-riskgroupsforepidemicorpandemicpronediseasesDefinition

TheInfectiousHazardsManagement(IHM)departmentintheHealthEmergenciesProgrammehasidentifiedcertaincountriesasat-riskforyellowfever,cholera,andmeningococcalmeningitispreventionandcontrol.Sixty-sixcountriesareconsideredat-riskforatleastoneofthesepathogens.Animmunizationcoverageestimateforroutine(yellowfever;meningococcalmeningitis)andcampaigncoverage(yellowfever;meningococcalmeningitis;cholera)willbegeneratedforeachcategoryofcountrypresented,weightedbytherelativesizesofthetargetpopulationsforroutineimmunizationandvaccinationcampaigns.BecausenotallMemberStatesarenotat-riskforthesediseases,routineimmunizationestimatesforfirstdosemeasles-containingvaccine(MCV1)willbeusedinordertodevelopestimatesforallMemberStates,andtohighlighttheimportanceofafunctioningimmunizationsprogramfordiseaseprevention.Coverageforallantigenswillbeweightedequally.Animmunizationcoverageestimateforroutine(yellowfever;meningococcalmeningitis)andcampaigncoverage(yellowfever;meningococcalmeningitis;cholera)willbegeneratedforeachcategoryofcountrypresented,weightedbytherelativesizesofthetargetpopulationsforroutineimmunizationandvaccinationcampaigns.BecausenotallMemberStatesarenotat-riskforthesediseases,routineimmunizationestimatesforfirstdosemeasles-containingvaccine(MCV1)willbeusedinordertodevelopestimatesforallMemberStates,andtohighlighttheimportanceofafunctioningimmunizationsprogramfordiseaseprevention.Coverageforallantigenswillbeweightedequally.Theindicatorisaweightedaverageofroutineandcampaignvaccinationsfordiseaseslinkedwithepidemicsandpandemics.Theindicatorwillincludeonlythepriorityinfectionhazardsrelevanttoeachcountry.Theindicatorcanbeadaptedtoincludeothermass-vaccinationcampaignsthatareneeded(e.g.pandemicinfluenza,Ebolavirusdisease).

Currentvaccinationsusedinthepreventindicatorare:

o priorityinfectioushazards:yellowfever,meningococcalmeningitisAandcholera–whenrelevant

o measles,polio–toemphasizetheimportanceofroutinecoverage.


Theindicatoriscalculatedasthepopulation-weightedaverageofroutineandcampaignvaccinecoveragesfortheapplicablediseases:i.e.measlesandpolioforallMemberStates,andyellowfeverand/orcholeraand/ormeningitiswherethereisarisk.

Emergencypreventindicator =Coverage·×relevantpopulation··

relevantpopulation··

wherevrepresentstherelevantvaccinesforthecountryandyearofestimation.Thecoverageestimatesareeachweightedbytherelevantpopulation.Forroutinevaccination,thisisthetotalpopulationofsurvivinginfants.Forcampaigns,thisisthetargetpopulation.Therolling/cumulativevaccinatedpopulationisusedduringemergenciesoranysupplementarycampaigns.Thereare66MemberStatescurrentlyconsideredatriskbytheWHOHealthEmergenciesProgrammeforatleastoneofyellowfever,cholera,andmeningitisA.BecausenotallMemberStatesthatareathighriskfor,oraffectedby,yellowfever,cholera,andmeningitismadeorhadrequestsapprovedbytheICGorconductedothervaccinationcampaigns,themeancampaigncoverageestimateiscalculatedusingtheantigendataavailable(i.e.,non-missing).Theestimateforcholeraistheaverageofcampaigncoverage(whenavailable),weightedbytherelativesizesofthetargetpopulationforthe

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specificcampaign(s).Thereisnocholeravaccinationcurrentlyrecommendedaspartoftheroutinevaccinationschedule.Wheretargetpopulationdataarenotavailableforaspecificcampaign,thenumberofdosesshippedbytheICGorGTFCCwillbeusedasaproxyfortargetpopulationsize.

Numerator Vaccinationcoverage(routineand/orcampaign)

Denominator TargetpopulationPreferreddatasources

Coverageestimatesforroutinevaccination(yellowfever,measles,polio)fromWHO/UNICEFestimateofimmunizationcoverage(WUENIC)forMCV1andYFroutineimmunizationestimates;WHO/UNICEFJointReportingForm(JRF)foradministrativecoverageestimatesofmeningococcalmeningitisroutineimmunizationcoverage;emergencyimmunizationcoverageforcholera,meningococcalmeningitisandyellowfeverusingtheInternationalCoordinatingGroup(ICG)onVaccineProvision;masspreventiveoralcholeravaccinationcampaigncoveragedatafromtheGlobalTaskForceonCholeraControl(GTFCC);polioimmunizationcampaigndatafromWHO/GlobalPolioEradication;additionalmeningitis,polioandyellowfeverimmunizationcampaigncoverageestimatesfromtheWHO/UNICEFJRF.


GlobalHealthObservatory;pandemicinfluenzavaccinationcampaigndataintargetedcountries,whereapplicable

Disaggregation

Country;antigen


Annual(routineimmunizations);periodic(vaccinationcampaigns),updatedannually

Limitations

RoutineimmunizationdataformeningococcalmeningitisarenotavailablefromWUENICandareonlyavailable(self-reportedadministrativecoverage)fromtheJRF.Emergencyvaccinationcampaigncoverageestimatesmightrequiretheuseofadministrativeestimates,whichcouldbias(overestimate)campaigncoverageasmeasuredusingapopulation-basedsurvey.Becausecholeraisnotpartofroutineimmunizationprograms,relativelysmallcholeracampaignscanhaveadisproportionateinfluenceonthemeancoverageestimate.Theindicatorisanabsoluteestimate,meaningthatcountriescandemonstrateprogressbyincrementalimprovementindependentlyofothercountries’performance.Ultimately,allcountriesshouldhavecoverageestimatesof>90%.Theweightingschemeplacesahighweightonroutinevaccination,emphasizingthevalueofroutinecoverageformanydiseases.Apotentiallimitationofthisapproachisthatsmalltargetedcampaignswillhaveonlyasmallimpactontheindicator.Otherweightingschemeswerealsoconsidered(e.g.equalweightingforallantigens–inwhichsmallcampaigns(e.g.forcholera)hadanoversizedeffectonthemean).

Datatype

Percentage

Relatedlinks

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HealthEmergenciesProportionofvulnerablepeopleinfragilesettingsprovidedwithessentialhealthservices(%)

Indicator


Definition

Theindicatorwillprovidetheoverallnumberoffunctioninghealthfacilitiesatprimaryandsecondaryandtertiarycarelevelsthatprovidetheminimumservicespackagesagainstthepopulationsize.Theminimumservicespackageisdefinedbythecountry/eventcontext.Fragile,conflict,andvulnerable(FCV)countriesareidentifiedbyWHObasedoncriteriaincludingtheexistingprotractedgrade,existingacutegradebutlikelytoconverttoprotractedgrade,havingahumanitarianresponseplan(HRP)orotherrelevantresponseplans,anINFORMindexofatleast4.4,orcountrieswith“riskofveryhighconcern”or“highconcern”intheIASCEWEAR.ThislistisupdatedperiodicallybyWHO,inconsultationwiththeRegionalEmergencyDirectors.AsofJanuary2019,therewere29FCVcountries.


TheHealthResourcesandServicesAvailabilityMonitoringSystem(HeRAMS)aimstoguidethestandardized,systematicandcontinuouscollection,collation,analysisanddisseminationofdataontheavailabilityofessentialhealthresourcesandservicesinhighlyconstrained,low-resourcedandfastchangingenvironments.HeRAMSisadatacollectionsystemwithstandardandcountry-definedindicators,whichisupdatedonanear-realtimebasisbyserviceproviders.Dataonthefunctioningofhealthfacilitiesandtheavailabilityofcontext-specificminimumservicepackagesarecollectedandsharedusinganonlineplatform.Theindicatorcanbemeasuredusingthenumeratoranddenominatordescribedbelow.

Numerator Numberoffragile,conflict,orvulnerablesettingswithanaverageattainmentoftheSphereindicatorsforavailabilityofdeliveryofaminimumservicespackageatprimaryandsecondary/tertiarylevels(i.e.,per50,000forprimarycarehealthfacilities;per250,000forsecondaryandtertiarycarehealthfacilities).

Denominator Totalnumberoffragile,conflict,orvulnerablesettings.


HeRAMS


Population-basedsurveydata,whereavailable,canbeusedtoassessaccesstoservicesamongaffectedpopulations.

Disaggregation

Byhealthfacilitytype;bycountry/setting


Dataarecollectedonanear-realtimebasis.Estimateswillbeupdatedannually,theaveragemonthlymid-point.

Limitations

HeRAMShasnotyetbeenrolled-outinallFCVsettings.Dataqualityisdifficulttoverifygiventhechallengingnatureoftheseenvironments.Availabilityofessentialhealthresourcesandservicesisaproxyforaccesstoessentialhealthresourcesandservices,whichismeasurableonlybypopulation-basedsurveys.

Datatype

Percentage

Relatedlinks http://www.who.int/hac/herams/en/

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WHA68.3Numberofcasesofpoliomyelitiscausedbywildpoliovirus(WPV)

Indicator

Numberofcasesofpoliomyelitiscausedbywildpoliovirus(WPV)

Definition

Reportedcasesoflaboratory-confirmedpoliocases.ApoliocaseisconfirmedifwildpoliovirusisisolatedfromstoolspecimenscollectedfromanAcuteflaccidparalysis(AFP)case.


Sumofreportedcases.

Numerator

Denominator


Surveillancesystems


Disaggregation


Weekly

Limitations

Datatype

Count,absolutenumberofcases

Relatedlinks WHO:http://www.who.int/immunization/monitoring_surveillance/en/;

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WHA68.7Patternsofantibioticconsumptionatnationallevel

Indicator

PatternsofantibioticconsumptionatnationallevelDefinition

ProportionofAccessgroupantibioticsaspercentageofoverallantibioticsales.Fromdataontotalconsumptionofantibiotics,theproportionofthetotal,byDDDthatarewithintheACCESSgroup(EML2017).Thetermconsumptionreferstoestimatesofaggregateddata,mainlyderivedfromimport,salesorreimbursementdatabases.IntherecentrevisionoftheWHOModelListofEssentialMedicines,antibioticsinthelisthavebeengroupedintothreeAWaRecategories:Access,WatchandReserve.TheAccesscategoryincludesfirstandsecondchoiceantibioticsfortheempiricaltreatmentofcommoninfectioussyndromesandtheyshouldbewidelyavailableinhealthcaresettings.AntibioticsintheWatchcategoryhaveahigherpotentialforresistancetodevelopandtheiruseasfirstandsecondchoicetreatmentshouldbelimited.Finally,theReservecategoryincludes“lastresort”antibioticswhoseuseshouldbereservedforspecializedsettingsandspecificcaseswherealternativetreatmentshavefailed.Rationale:Narrow-spectrumbeta-lactamsoftheAccessgroupsuchasamoxicillinarethepreferredtreatmentoptionformostRTIandarethoughttohavealowerecologicimpactregardingtheselectionandspreadofantibioticresistancethanbroader-spectrumagentssuchascephalosporins,macrolidesorfluoroquinolones.Accessgroupantibioticsshouldthereforeconstitutethemajorityofantibioticuseintheoutpatientsettingandoverall(asoutpatientuserepresentsthevastmajorityofABsales).Broader-spectrumagentsclassifiedintheWatchgroupshouldbemostlylimitedtotheirspecificrecommendedEMLuses.


DataonoverallconsumptionbyAWaRecategories:ACCESS,WATCH,RESERVE,OTHER,arecollectedandvalidatedatthenationallevelandreportedtoWHOwhereepidemiologicalstatisticsandmetricsaregenerated.Antibioticconsumptionispresentedusingthefollowingkeyindicators:

• QuantityofantibioticsasDDDper1000inhabitantsperdayfortotalconsumptionandbypharmacologicalsubgroup(ATC3)

• Quantityofantibioticsasweightintonnesfortotalconsumption• Relativeconsumptionofantibioticsasapercentageoftotalconsumptionbyrouteof

administration(oral,parenteral,rectalandinhaled)andAWaRecategories(Access,Watch,andReserve).

Tomeasuretheconsumptionofantimicrobials,themethodologyusesthenumberofdefineddailydoses(DDDs).TheDDDistheassumedaveragemaintenancedoseperdayofanantimicrobialsubstance(s)usedforitsmainindicationinadults,andisassignedtoactiveingredientswithanexistingATCcode.Asarule,theDDDsforantimicrobialsarebasedontreatmentforinfectionsofmoderateseverity.Toadjustforpopulationsize,theconsumptionisusuallypresentedasnumberofDDDsper1000inhabitantsperday.Thismetriccanberoughlyinterpretedasthenumberofindividualsper1000inhabitantsonantibiotictreatmentperday.Thevolumeofantibioticsconsumedcanbepresentedusingtwometrics:DDDandtheweightoftheantibioticsubstancesinmetrictonnes(t).Thesecondmetriccanbeusedforcomparisonwithantimicrobialconsumptionintheanimalsector.

Numerator AntibioticconsumptionofATCclassJ01antibioticsplusoralmetronidazole(P01AB01),oralvancomycin(A07AA09)andoralfidaxomicin(A07AA12)indefineddailydosesbelongingtotheACCCESgroup.ThenumberofDDDsconsumedforeachantibioticsubstancecanbecalculatedbydividingtheamountconsumedingramsofthesubstancebytheDDDvalueassignedtothatsubstance:NumberofDDDs=gramsofactivesubstance/substance-specificDDD.Thetotalamountingramsisobtainedbymultiplyingthestrengthofeachtabletorvialbythenumberofunitsperpackageandthenumberofpackagesconsumed.TheDDDvalueismostlyspecifiedingrams,butcanalsobedefinedasMU(millionunits)forcertainsubstances.Forcombinationsofantibiotics,theDDDvalueisspecifiedasUD(unitdose).OnetabletorvialofacombinationproductwithaspecificstrengthisdefinedasoneUD.

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ToobtaintheDDDconsumedofaspecificcombinationproduct,thetotalnumberofUDsisdividedbytheassignedDDDvalue.ForcountriesthathavedataatthesubstancelevelandbyDDD,areversecalculationcanbedoneusingDDDvaluestoobtainthetotalnumberoftonnes.

Denominator Overallantibioticconsumption/salesofATCclasses:J01antibioticsplusoralmetronidazole

(P01AB01),oralvancomycin(A07AA09)andoralfidaxomicin(A07AA12)indefineddailydosesThepopulationsizeforeachcountrycanbeobtainedfromtheWorldBankpopulationdatabaseforallcountries,butforMemberStatesoftheESAC-Net,specificpopulationsindicatedbythedataprovider(EuropeanCentreforDiseasePreventionandControl)isused.


National(orsamplingof)antibioticconsumptiondataavailableatnationallevelthroughdifferentsources(sales,prescribing,dispensing)ConsumptiondatawillbecollatedaccordingtotheWHOmethodologyforaglobalprogrammeonsurveillanceofantimicrobialconsumption.ConsumptiondatacollectedthroughastandardizedprotocolcomparablewiththeWHOmethodologywillalsobeutilized,includingdatacollectedthroughtheEuropeanSurveillanceofAntimicrobialConsumptionNetwork(ESAC-Net),theAntimicrobialMedicinesConsumptionNetworkmanagedbytheWHORegionalOfficeforEurope,andthesurveillanceprogrammesonantimicrobialconsumptioninCanada,Japan,NewZealandandtheRepublicofKorea.AccordingtotheWHOprotocol,dataarecollectedattheproductlevel(proprietaryandgeneric-products)andcompriseinformationontheactivesubstance(s)oftheproduct,routeofadministration,strengthperunit,numberofunitsperpackageandtotalnumberofpackagesconsumed.


Salesshouldbethemainsourceofdata.Othersourcescouldinclude:

• Importrecords:forexamplefromcustomrecordsanddeclarationforms;• Productionrecordsfromdomesticmanufacturers;• Wholesalerrecords:bothprocurementdatabythewholesalerorsalesdatafromwholesaler

tohealthcarefacilitiesandpharmacies;• Publicsectorprocurement:fromcentralizedordecentralizedpurchasingofmedicinesforthe

publicsector,e.g.recordsfromcentralmedicalstores;

Disaggregation

Datawillbeaggregatedatthecountrylevel–allowdisaggregationatregional/districtlevel,byantibioticcategory(Access,WatchandReserve)


Yearly

Limitations

• Completeness/representativenessofsalesdata.Currently,dataarecollectedfromofficialchannelsandnodataexplicitlycapturingantimicrobialscirculatingontheinformalmarkethavebeenobtained.Consequently,forcountriesinwhichtheinformalmarketissignificant,onlyanincompletepictureofantibioticconsumptioncanbepresented.

• Datamaybeavailableonlyincertainmetrics(e.g.StandardUnitsinsteadofDDD)anditisunclearhowthiswillaffecttheindex.

• Measurementerrors• Antibiotic“Blackmarket”• DDDsarenotadequateforchildrenbutthiswillhavenoimpactinthisindicatorexpressedas

relativeproportionofDDDDatatype

Percentage

Relatedlinks http://www.who.int/antimicrobial-resistance/global-action-plan/optimise-use/surveillance/en/https://www.who.int/medicines/areas/rational_use/WHO_AMCsurveillance_1.0.pdf

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WHA66.10Prevalenceofraisedbloodpressureinadultsaged18+

Indicator

Age-standardizedprevalenceofraisedbloodpressureamongpersonsaged18+years(definedassystolicbloodpressureof>140mmHgand/ordiastolicbloodpressure>90mmHg)andmeansystolicbloodpressure

Definition

Systolicbloodpressure≥140and/ordiastolicbloodpressure≥90amongpersonsaged18+years.


Prevalenceofraisedbloodpressure=

𝑁𝑢𝑚𝑏𝑒𝑟𝑜𝑓𝑟𝑒𝑠𝑝𝑜𝑛𝑑𝑒𝑛𝑡𝑠𝑎𝑔𝑒𝑑18 + 𝑦𝑒𝑎𝑟𝑠𝑤𝑖𝑡ℎ𝑠𝑦𝑠𝑡𝑜𝑙𝑖𝑐𝑏𝑙𝑜𝑜𝑑𝑝𝑟𝑒𝑠𝑠𝑢𝑟𝑒 ≥ 140𝑚𝑚𝐻𝑔𝑜𝑟𝑑𝑖𝑎𝑠𝑡𝑜𝑙𝑖𝑐𝑏𝑙𝑜𝑜𝑑𝑝𝑟𝑒𝑠𝑠𝑢𝑟𝑒 ≥ 90𝑚𝑚𝐻𝑔𝑁𝑢𝑚𝑏𝑒𝑟𝑜𝑓𝑠𝑢𝑟𝑣𝑒𝑦𝑟𝑒𝑠𝑝𝑜𝑛𝑑𝑒𝑛𝑡𝑠𝑎𝑔𝑒𝑑18 + 𝑦𝑒𝑎𝑟𝑠 ×100%

Numerator Numberofrespondentswithsystolicbloodpressure≥140mmHgordiastolicbloodpressure≥90mmHg.Ideallythreebloodpressuremeasurementsshouldbetakenandtheaveragesystolicanddiastolicreadingsofthesecondandthirdmeasuresshouldbeusedinthiscalculation.

Denominator Allrespondentsofthesurveyaged18+years.Preferreddatasources

Population-based(preferablynationallyrepresentative)surveyinwhichbloodpressurewasmeasured,notself-reported.


Disaggregation



Annualorevery5years

Limitations

-measurementerror-representativenessofthesample

Datatype

Prevalence

Relatedlinks WHO:http://www.who.int/chp/steps/en/;http://apps.who.int/gho/data/node.wrapper.imr?x-id=2386.

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WHA66.10Effectivepolicy/regulationforindustriallyproducedtrans-fattyacids(TFA)(Y/N)

Indicator

Protectionofthepopulationofacountrybyeffectivepolicy/regulationonindustryproducedtrans-fattyacids(TFA)

Definition

PresenceofaWHObest-practiceTFApolicy/regulationwhichhascomeintoeffectinacountrytoeliminateindustriallyproducedtrans-fattyacids(TFA)inthefoodsupply.Thetwoalternativebest-practiceTFApoliciesare:1)mandatorynationallimitof2gramsofindustriallyproducedTFAper100gramsoftotaloilsandfatsinallfoods;and2)mandatorynationalbanontheproductionoruseofpartiallyhydrogenatedoils(PHO)asaningredientinallfoods.


Countrycanrespond"yes"tothequestion“Hasabest-practiceTFApolicy/regulationcomeintoeffectinyourcountrytoeliminateindustriallyproducedTFAinthefoodsupply?”TheindicatorwillstoretheY/Nforeachyear.

Numerator Yes/No.Yes:ifbest-practicepolicy/regulationisfullyimplemented;Missing:ifnodata

Denominator NotapplicablePreferreddatasources

WHOGlobaldatabaseontheImplementationofNutritionAction(GINA)(http://www.who.int/nutrition/gina/en/)

InformationfromWHORegionalOffices,CountryOffices,MinistriesofHealthandpartners


Nationalnutritionandhealthsurvey,GlobalNutritionPolicyReview

Disaggregation

Notapplicable


Yearly

Limitations

Requirescarefulconfirmationtoascertaininformationonthepolicycontents,thestatusofpolicyadoption,andwhenpoliciescomeintoeffectincountries.

Datatype

Yearly

Relatedlinks WHO:https://www.who.int/nutrition/topics/replace-transfat/http://www.who.int/nutrition/gina/en/https://www.who.int/ncds/surveillance/ncd-capacity/en/http://www.who.int/nmh/publications/best_buys_summary.pdf.

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WHA66.10Prevalenceofobesity(%)

Indicator

Prevalenceofobesity

Definition

For5-19years,obesityisdefinedasbodymassindex(BMI)-for-ageabovetwostandarddeviationsoftheWHOGrowthReferenceforSchool-agedChildrenandAdolescentsmedian.Forages20yearsandolder,obesityisdefinedasBMIof30kg/m2orhigher.BMIiscalculatedbydividingthesubject’sweightinkilogramsbytheirownheightinmeterssquared.


Prevalenceofobesity=

]6^3_`2a5_`j29jlc24`_23_j_r274196^3_`2a5_`j29j897c_j6`k_i7c47l_`_^_4j6`_d

×100%

Numerator Numberofpersonswhoareobese

Denominator Totalnumberofpersonsinthesurveythatweremeasured


Nationallyrepresentativepopulation-basedhouseholdorschool-basedsurveyswithheightandweightmeasurementsofadultsaged20yearsandolderandschool-agechildrenandadolescentsaged5–19years.Othersourcesofdataincludenationalnutritionsurveillancesystems.



Disaggregation

Byage,sex,location(urban/rural,majorregions/provinces),andsocio-economiccharacteristics(e.g.,mother’seducation,wealthquintile).


Annualoratleastevery3-5yearsbasedonsurveyavailabilityincountries.

Limitations

Surveyestimatescomewithlevelsofuncertaintyduetobothsamplingandnon-samplingerror(e.g.measurementtechnicalerror,recordingerroretc.).Anotherlimitation,especiallyfortheschool-agechildrenandadolescentagegroupistherepresentativenessofthesample.

Datatype

Prevalence

Relatedlinks WHO:http://who.int/chp/gshs/en/;http://www.who.int/dietphysicalactivity/childhood/en/

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Section2:UniversalHealthCoverage(UHC)Billion

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Table2.OverviewofUniversalHealthCoverage(UHC)BillionIndicatorsNote:14tracerindicatorsareusedtocalculateaverageservicecoverage.ThesearebasedontheSDG3.8.1tracerindicatorswiththefollowingadjustments.Assuch,metadataforUHCBillionisembeddedwithinSection1(OutcomeIndicators);seecross-referencedoutcomeindicator.

Tracer IndicatorDefinition Cross-referenced

OutcomeIndicatorAdjustmentmadefromSDG3.8.1(ifapplicable)

RescalingNotes(ifapplicable)

Reproductive,maternal,newbornandchildhealth

FamilyPlanning Proportionofmarriedwomenorin-union(aged15–49)havingneedforfamilyplanningsatisfiedwithmodernmethods(%)

Pregnancyanddeliverycare

Percentageofwomenaged15−49yearswithalivebirthinagiventimeperiodwhoreceivedantenatalcare,fourtimesormorefromanyprovider

n/a

Childimmunization

Percentageofinfantsreceivingthreedosesofdiphtheria-tetanus-pertussiscontainingvaccine

SDG3.b.1:Proportionofpopulationcoveredbyallvaccinesincludedinnationalprogrammes(DTP3,MCV2,PCV3)(%)

Seepage49

Childtreatment Percentageofchildrenunder5yearsofagewithsuspectedpneumonia(coughanddifficultbreathingNOTduetoaproblemfromblockednose)inthetwoweeksprecedingthesurveytakentoanappropriatehealthfacilityorprovider

n/a

Infectiousdiseases

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Tuberculosistreatment

Percentageofincidencetuberculosiscasesthataredetectedandsuccessfullytreatedinagivenyear

n/a

HIVtreatment PercentageofpeoplecurrentlyreceivingARTamongtheestimatednumberofadultsandchildrenlivingwithHIV

n/a

MalariaPrevention

Percentageofpopulationinmalaria-endemicareaswhosleptunderaninsecticide-treatednetthepreviousnight(onlyforcountrieswithmoderatetohighmalariatransmissioninsub-SaharanAfrica)

n/a

Waterandsanitation

Percentageofhouseholdsusingatleastbasicsanitationfacilities

n/a

Non-communicablediseases

Preventionofcardiovasculardiseases

Age-standardizedprevalenceofraisedbloodpressureamongpersonsaged18+years(definedassystolicbloodpressure≥140mmHgand/ordiastolicbloodpressure≥90mmHg)

WHA66.10:Prevalenceofraisedbloodpressureinadultsaged18+

Seepage70

Managementofdiabetes

Age-standardizedmeanfastingplasmaglucose(mmol/L)foradultsaged18yearsandolder

n/a

Tobacco Age-standardizedprevalenceofadults≥15yearsnotsmokingtobaccointhepast30days

SDG3.a.1:Prevalenceoftobaccouseinadultsaged15+(%)

Seepage48

RescalingadjustedasSDG3.8.1method[50%–100%](0–100%)didnotincludeallMSvalues

Therescalingoftheprevalenceofnon-useoftobaccohasbeenadjustedtoincludeallobservedvalues(since2000).Theminimumobservedvalueoftobacconon-useof32%isrescaledto

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representzeroservicecoverage,and100%torepresent100%servicecoverage.

Servicecapacityandaccess

Hospitalaccess Numberofhospitalbedsper10000population

n/a

Healthworkerdensity

Numberofhealthprofessionals(physicians,nurses,andmidwives)per10000population

SDG3.c.1:Densityofhealthworkers(doctors;nurseandmidwives;pharmacists;dentistsper10000population)

Seepage51

Adjustedindicatorfromphysicians,psychiatristsandsurgeonstophysiciansandnurses/midwives

Rescaledusingamaximumdensityof155per10000population,whichisthe95thpercentileacrossallnationaldensitiesfrom2000to2017.Densitiesabovethatlevelareresetat100%.TheindicatorreplacestheSDG3.8.1tracerforphysicians,psychiatristsandsurgeonsforwhichdataavailabilityispoor,andwhichneglectsthelargeandimportantcategoryofnurses.

Healthsecurity InternationalHealthRegulations(IHR)corecapacityindex,whichistheaveragepercentageofattributesof13corecapacitiesthathavebeenattained

SDG3.d.1:InternationalHealthRegulations(IHR)capacityandhealthemergencypreparedness

Seepage53

FinancialHardship

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Healthexpenditures

Proportionofpopulationwithhouseholdhealthexpendituresasashareoftotalhouseholdexpenditureorincome>10%

SDG3.8.2:Populationwithhouseholdexpendituresonhealth>10%oftotalhouseholdexpenditureorincome(%)

Seepage39

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UHCBillion:FamilyPlanning

Indicatordefinition Proportionofmarriedwomenorin-union(aged15–49)havingneedforfamilyplanningsatisfiedwithmodernmethods(%)

Numerator Numberofwomenaged15-49whoaremarriedorin-unionwhousemodernmethods

Denominator Totalnumberofwomenaged15-49whoaremarriedorin-unioninneedoffamilyplanning

MainDataSources Population-basedhealthsurveys

MethodofMeasurement Householdsurveysincludeaseriesofquestionstomeasuremoderncontraceptiveprevalencerateanddemandforfamilyplanning.Totaldemandforfamilyplanningisdefinedasthesumofthenumberofwomenofreproductiveage(15–49years)whoaremarriedorinaunionandwhoarecurrentlyusing,orwhosesexualpartneriscurrentlyusing,atleastonecontraceptivemethod,andtheunmetneedforfamilyplanning.Unmetneedforfamilyplanningistheproportionofwomenofreproductiveage(15–49years)eithermarriedorinaconsensualunion,whoarefecundandsexuallyactivebutwhoarenotusinganymethodofcontraception(modernortraditional),andreportnotwantinganymorechildrenorwantingtodelaythebirthoftheirnextchildforatleasttwoyears.Includedare:1.Allpregnantwomen(marriedorinaconsensualunion)whosepregnancieswereunwantedormistimedatthetimeofconception.2.Allpostpartumamenorrhoeicwomen(marriedorinconsensualunion)whoarenotusingfamilyplanningandwhoselastbirthwasunwantedormistimed.3.Allfecundwomen(marriedorinconsensualunion)whoareneitherpregnantnorpostpartumamenorrhoeic,andwhoeitherdonotwantanymorechildren(wanttolimitfamilysize),orwhowishtopostponethebirthofachildforatleasttwoyearsordonotknowwhenoriftheywantanotherchild(wanttospacebirths),butarenotusinganycontraceptivemethod.Modernmethodsincludefemaleandmalesterilization,theintrauterinedevice(IUD),theimplant,injectables,oralcontraceptivepills,maleandfemalecondoms,vaginalbarriermethods(includingthediaphragm,cervicalcapandspermicidalfoam,jelly,creamandsponge),lactationalamenorrhoeamethod(LAM),emergencycontraceptionandothermodernmethodsnotreportedseparately.

MethodofEstimation TheUnitedNationsPopulationDivisionproducesasystematicandcomprehensiveseriesofannualestimatesandprojectionsofthepercentageofdemandforfamilyplanningthatissatisfiedamongmarriedorin-unionwomen.ABayesianhierarchicalmodelcombinedwithcountry-specificdataisusedtogeneratetheestimates,projectionsanduncertaintyassessmentsfromsurveydata.Themodelaccountsfordifferencesbydatasource,samplepopulationandcontraceptivemethods.Seeherefordetails:http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml

UHCBillionRelatedNotes n/a

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UHCBillion:Pregnancyanddeliverycare

Indicatordefinition Percentageofwomenaged15-49yearswithalivebirthinagiventimeperiodwhoreceivedantenatalcarefourormoretimes

Numerator Numberofwomenaged15−49yearswithalivebirthinagiventimeperiodwhoreceivedantenatalcarefourormoretimes

Denominator Totalnumberofwomenaged15−49yearswithalivebirthinthesameperiod.

Maindatasources Householdsurveysandroutinefacilityinformationsystems.

Methodofmeasurement Dataonfourormoreantenatalcarevisitsisbasedonquestionsthataskifandhowmanytimesthehealthofthewomanwascheckedduringpregnancy.HouseholdsurveysthatcangeneratethisindicatorincludeDHS,MICS,RHSandothersurveysbasedonsimilarmethodologies.Service/facilityreportingsystemscanbeusedwherethecoverageishigh,usuallyinhigherincomecountries.

Methodofestimation WHOmaintainsadatabaseoncoverageofantenatalcare:

https://www.who.int/gho/maternal_health/reproductive_health/antenatal_care/en/

UHCBillionRelatedNotes Ideallythisindicatorwouldbereplacedwithamorecomprehensivemeasureofpregnancyanddeliverycare,forexampletheproportionofwomenwhohaveaskilledproviderattendthebirthoraninstitutionaldelivery.Achallengeinmeasuringskilledattendanceatbirthisdeterminingwhichprovidersare“skilled”.WHOandUNICEFarecurrentlyleadingaprocesstocometoagreementacrosscountriesaboutthedefinitionofaskilledprovider,afterwhichamorecomprehensiveindicatorofpregnancyanddeliverycarecouldbeincorporatedintotheindex.Oncecomparablevaluesareavailableacrosscountries,SDG3.1.2willbeused.

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UHCBillion:ChildImmunization

Indicatordefinition Percentageofinfantsreceivingthreedosesofdiphtheria-tetanus-pertussiscontainingvaccine

Cross-referencedOutcomeIndicator

MetadataidenticaltoSDG3.b.1

UHCBillionRelatedNotes Thereisvariabilityinnationalvaccineschedulesacrosscountries.Giventhis,oneoptionformonitoringfullchildimmunizationistomonitorthefractionofchildrenreceivingvaccinesincludedintheircountry’snationalschedule.Asecondoption,whichmaybemorecomparableacrosscountriesandtime,istomonitorDTP3coverageasaproxyforfullchildimmunization.Diphtheriatetanus-pertussiscontainingvaccineoftenincludesothervaccines,e.g.,againstHepatitisBandHaemophilusinfluenzatypeB,andisareasonablemeasureoftheextenttowhichthereisarobustvaccinedeliveryplatformwithinacountry.

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UHCBillion:Childtreatment(care-seekingforsymptomsofpneumonia)

Indicatordefinition Percentageofchildrenunder5yearsofagewithsuspectedpneumonia(coughanddifficult

breathingNOTduetoaproblemfromablockednose)inthetwoweeksprecedingthesurveytakentoanappropriatehealthfacilityorprovider

Numerator Numberofchildrenwithsuspectedpneumoniainthetwoweeksprecedingthesurveytakentoanappropriatehealthprovider.

Denominator Numberofchildrenwithsuspectedpneumoniainthetwoweeksprecedingthesurvey.

Maindatasources Householdsurveys

Methodofmeasurement DuringtheUNICEF/WHOMeetingonChildSurvivalSurvey-basedIndicators,heldinNewYork,17–18June2004,itwasrecommendedthatacuterespiratoryinfections(ARI)bedescribedas“presumedpneumonia”tobetterreflectprobablecauseandtherecommendedinterventions.ThedefinitionofpresumedpneumoniausedintheDemographicandHealthSurveys(DHS)andintheMultipleIndicatorClusterSurveys(MICS)waschosenbythegroupandisbasedonmothers’perceptionsofachildwhohasacough,isbreathingfasterthanusualwithshort,quickbreathsorishavingdifficultybreathing,excludingchildrenthathadonlyablockednose.Thedefinitionof“appropriate”careprovidervariesbetweencountries.

WHOmaintainsadatabaseofcountry-levelobservationsfromhouseholdsurveysthatcanbeaccessedhere:http://www.who.int/gho/child_health/prevention/pneumonia/en/

Methodofestimation Therearecurrentlynointernationallycomparableestimatesforthisindicator.

UHCBillionRelatedNotes Thisindicatorisnottypicallymeasuredinhigherincomecountrieswithwell-establishedhealthsystems.Forcountrieswithoutobserveddata,coveragewasestimatedfromaregressionthatpredictscoverageofcare-seekingforsymptomsofpneumonia(onthelogitscale),obtainedfromtheWHOdatabasedescribedabove,asafunctionofthelogoftheestimatedunder-fivepneumoniamortalityrate,whichcanbefoundhere:https://www.who.int/healthinfo/global_burden_disease/estimates/en/index2.html

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UHCBillion:TuberculosisTreatment

Indicatordefinition PercentageofincidenceTBcasesthataredetectedandsuccessfullytreatedinagivenyear

Numerator Numberofnewandrelapsecasesdetectedinagivenyearandsuccessfullytreated

Denominator Numberofnewandrelapsecasesinthesameyear

Maindatasources Facilityinformationsystems,surveillancesystems,population-basedhealthsurveyswithTBdiagnostictesting,TBregisterandrelatedquarterlyreportingsystem(orelectronicTBregisters)

Methodofmeasurement Thisindicatorrequiresthreemaininputs:

(1)ThenumberofnewandrelapseTBcasesdiagnosedandtreatedinnationalTBcontrolprogrammesandnotifiedtoWHOinagivenyear.

(2)ThenumberofincidentTBcasesforthesameyear,typicallyestimatedbyWHO.

(3)PercentageofTBcasessuccessfullytreated(curedplustreatmentcompleted)amongTBcasesnotifiedtothenationalhealthauthorities.

Thefinalindicator==(1inyeart)/(2inyeart)x(3inyeart-1)

Methodofestimation EstimatesofTBincidenceareproducedthroughaconsultativeandanalyticalprocessledbyWHOandarepublishedannually.Theseestimatesarebasedonannualcasenotifications,assessmentsofthequalityandcoverageofTBnotificationdata,nationalsurveysoftheprevalenceofTBdiseaseandinformationfromdeath(vital)registrationsystems.Estimatesofincidenceforeachcountryarederived,usingoneormoreofthefollowingapproachesdependingonavailabledata:

1.incidence=casenotifications/estimatedproportionofcasesdetected;

2.incidence=prevalence/durationofcondition;

3.incidence=deaths/proportionofincidentcasesthatdie.

TheseestimatesofTBincidencearecombinedwithcountry-reporteddataonthenumberofcasesdetectedandtreated,andthepercentageofcasessuccessfullytreated,asdescribedabove.

UHCBillionRelatedNotes TocomputetheindicatorusingWHOestimates,onecanaccessnecessaryfileshere:http://www.who.int/tb/country/data/download/en/,andcomputetheindicatoras=c_cdrinyeartxc_new_tsrinyeart-1

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UHCBillion:HIVTreatment

Indicatordefinition Percentageofpeoplecurrentlyreceivingantiretroviraltherapy(ART)amongtheestimatednumberofadultsandchildrenlivingwithHIV

Numerator NumberofadultsandchildrenwhoarecurrentlyreceivingARTattheendofthereportingperiod

Denominator NumberofadultsandchildrenlivingwithHIVduringthesameperiod

Maindatasources Facilityreportingsystems,sentinelsurveillancesites,population-basedsurveys

Methodofmeasurement Numerator:Thenumeratorcanbegeneratedbycountingthenumberofadultsandchildrenwhoreceivedantiretroviralcombinationtherapyattheendofthereportingperiod.Datacanbecollectedfromfacility-basedARTregistersordrugsupplymanagementsystems.Thesearethentalliedandtransferredtocrosssectionalmonthlyorquarterlyreportswhichcanthenbeaggregatedfornationaltotals.PatientsreceivingARTintheprivatesectorandpublicsectorshouldbeincludedinthenumerator.

Denominator:DataonthenumberofpeoplewithHIVinfectionmaycomefrompopulation-basedsurveysor,asiscommoninsub-SaharanAfrica,surveillancesystemsbasedonantenatalcareclinics.

Methodofestimation EstimatesofantiretroviraltreatmentcoverageamongpeoplelivingwithHIVin2015arederivedaspartofthe2016UNAIDS'estimationroundor,insomelimitedinstances,takenfromdatasubmittedtoUNAIDSthroughtheGlobalAIDSResponseProgressReportingtool.

ToestimatethenumberofpeoplelivingwithHIVacrosstimeinhighburdencountries,UNAIDSincollaborationwithcountriesusesanepidemicmodel(Spectrum)thatcombinessurveillancedataonprevalencewiththecurrentnumberofpatientsreceivingARTandassumptionsaboutthenaturalhistoryofHIVdiseaseprogression.

SinceARTisnowrecommendedforallindividualslivingwithHIV,monitoringARTcoverageislesscomplicatedthanbefore,whenonlythosewithacertainlevelofdiseaseseveritywereeligibletoreceiveART.

EstimatesofARTcoveragecanbefoundhere:http://aidsinfo.unaids.org/

UHCBillionRelatedNotes ComparableestimatesofARTcoverageinhighincomecountries,inparticulartimetrends,arenotalwaysavailable.

84

UHCBillion:MalariaPrevention

Indicatordefinition Percentageofpopulationinmalaria-endemicareaswhosleptunderanITNthepreviousnight.

Numerator Numberofpeopleinmalaria-endemicareaswhosleptunderanITNthepreviousnight.

Denominator Totalnumberofpeopleinmalariaendemicareas.

Maindatasources DataonhouseholdaccessanduseofITNscomefromnationallyrepresentativehouseholdsurveyssuchasDemographicandHealthSurveys,MultipleIndicatorClusterSurveys,andMalariaIndicatorSurveys.DataonthenumberofITNsdeliveredbymanufacturerstocountriesarecompiledbyMillinerGlobalAssociates,anddataonthenumberofITNsdistributedwithincountriesarereportedbyNationalMalariaControlPrograms.

Methodofmeasurement ManyrecentnationalsurveysreportthenumberofITNsobservedineachrespondenthousehold.OwnershipratescanbeconvertedtotheproportionofpeoplesleepingunderanITNusingalinearrelationshipbetweenaccessandusethathasbeenderivedfromsurveysthatcollectinformationonbothindicators.

Methodofestimation MathematicalmodelscanbeusedtocombinedatafromhouseholdsurveysonaccessandusewithinformationonITNdeliveriesfrommanufacturersandITNdistributionbynationalmalariaprogrammestoproduceannualestimatesofITNcoverage.WHOusesthisapproachincollaborationwiththeMalariaAtlasProject.MethodologicaldetailscanbefoundintheAnnexoftheWorldMalariaReport2019:https://www.who.int/publications-detail/world-malaria-report-2019

UHCBillionRelatedNotes WHOproducescomparableITNcoverageestimatesfor40highburdencountries.Forothercountries,ITNcoverageisnotincludedintheUHCservicecoverageindexduetodatalimitations.However,futureresearchwillfocusonestimatingITNcoverageamongthoseatriskincountriesoutsideofAfricawith(potentiallylocalized)malariaburden.

85

UHCBillion:WaterandSanitation

Indicatordefinition Percentageofhouseholdsusingatleastbasicsanitationfacilities

Numerator Populationlivinginahouseholdwith:flushorpour-flushtopipedsewersystem,septictankorpitlatrine;ventilatedimprovedpitlatrine;pitlatrinewithslab;orcompostingtoilet.


Maindatasources Population-basedhouseholdsurveysandcensuses

Methodofmeasurement Household-levelresponses,weightedbyhouseholdsize,areusedtocomputepopulationcoverage.

Methodofestimation TheWHO/UNICEFJointMonitoringProgrammehasproducedregularestimatesofcoverageofimprovedsanitationforMDGmonitoring.Aftercompilingadatabaseofavailabledatasources,foreachcountry,simplelinearregressionsarefittedtothecountry’sdataseriestoobtainanin-sampleestimate,aswellastoproducea2-yearextrapolationbeyondthelastavailabledatapoint,afterwhichcoverageisheldconstantfor4yearsandthenassumedmissing.Thisisdoneseparatelyforurbanandruralregions,andthencombinedtoobtainnationalcoverageestimates.Detailsofthemethodologyandmostrecentestimatescanbefoundhere:http://www.wssinfo.org/

UHCBillionRelatedNotes TheSDGindicatorforsanitation(SDG6.2.1)isanexpandedversionoftheMDGindicator,incorporatingthequalityofsanitationfacilities.Oncecountrydataandestimatesareavailableforthisnewindicator,itcouldbeusedforUHCmonitoringinlieuoftheMDGindicatordefinitiondescribedabove.Ajointindicatorthatidentifiestheproportionofhouseholdswithaccesstobothsafewaterandsanitationcouldalsobeconsidered.

86

UHCBillion:Preventionofcardiovasculardisease

Indicatordefinition Age-standardizedprevalenceofraisedbloodpressureamongpersonsaged18+years(definedassystolicbloodpressure≥140mmHgand/ordiastolicbloodpressure≥90mmHg)


MetadataidenticaltoWHA66.10withnoteddifferencebelow

UHCBillionRelatedNotes Prevalenceestimatesareconvertedtotheprevalenceofnon-raisedbloodpressureforincorporationintotheUHCindexandAverageServiceCoverage,sothatavalueof100%istheoptimaltarget.Thisiscomputedas:non-raisedbloodpressureprevalence=100–raisedbloodpressureprevalence.Theaboveestimatesaredoneseparatelyformenandwomen;fortheUHCtracerindicatorasimpleaverageofvaluesformenandwomeniscomputed.Prevalenceofnon-raisedbloodpressureisthenrescaledusingaminimumvalueof50%whencalculatingtheUHCindexandAverageServicecoverage(rescaledvalue=(X-50)/(100-50)*100).Non-raisedbloodpressureisthesumofthepercentageofindividualswhodonothavehypertension,andthepercentageofindividualswhosehypertensioniscontrolledbymedication.Theabsenceofhypertensionisaresultofpreventioneffortsviapromotionofphysicalactivityandhealthydiets,aswellasotherfactors.Hypertensioncontrolledwithmedicationisaresultofeffectivetreatment.Thisindicatoristhusaproxyforbotheffectivehealthpromotionandeffectivemedicalservices.Asmoredatabecomeavailable,thisindicatorwilllikelybereplacedbythefractionofpopulationwithhypertensionreceivingtreatment.

87

UHCBillion:Managementofdiabetes

Indicatordefinition Age-standardizedmeanfastingplasmaglucoseforadultsaged18yearsandolder

Maindatasources Population-basedsurveysandsurveillancesystems

Methodofmeasurement Fastingplasmaglucose(FPG)levelsaredeterminedbytakingabloodsamplefromparticipantswhohavefastedforatleast8hours.Otherrelatedbiomarkers,suchashemoglobinA1c(HbA1c),wereusedtohelpcalculateestimates(seebelow).

Methodofestimation Forproducingcomparablenationalestimates,dataobservationsbasedonmeanFPG,oralglucosetolerancetest(OGTT),HbA1c,orcombinationstherein,areallconvertedtomeanFPG.ABayesianhierarchicalmodelisthenfittedtothesedatatocalculateage-sex-year-countryspecificprevalences,whichaccountsfornationalvs.subnationaldatasources,urbanvs.ruraldatasources,andallowsforvariationinprevalenceacrossageandsex.Age-standardizedestimatesarethenproducedbyapplyingthecrudeestimatestotheWHOStandardPopulation.Methodologicaldetailscanbefoundhere:https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00618-8/fulltext

UHCBillionRelatedNotes Meanfastingplasmaglucose,whichisacontinuousmeasure(unitsofmmol/L),isconvertedtoascaleof0to100usingtheminimumtheoreticalbiologicalrisk(5.1mmol/L)andobservedmaximumacrosscountries(7.1mmol/L)whencalculatingtheUHcindexorAverageServiceCoverage(rescaledvalue=(7.1-originalvalue)/(7.1-5.1)*100).Anindividual’sFPGmaybelowbecauseofeffectivetreatmentwithglucose-loweringmedication,orbecausetheindividualisnotdiabeticasaresultofhealthpromotionactivitiesorotherfactorssuchasgenetics.MeanFPGisthusaproxyforbotheffectivepromotionofhealthydietsandbehaviorsandeffectivetreatmentofdiabetes.Asmoredatabecomeavailable,thisindicatorwillbereplacedbythefractionofpopulationwithdiabetesundertreatment.Theaboveestimatearedoneseparatelyformenandwomen;fortheUHCtracerindicatorasimpleaverageofvaluesformenandwomeniscomputed.

88

UHCBillion:Tobacco

Indicatordefinition Age-standardizedprevalenceofadultsaged15yearsandoldernotsmokingtobaccoinlast30days


MetadataidenticaltoSDG3.a.1withnoteddifferencebelow

UHCBillionRelatedNotes Prevalenceofnotsmokingtobaccoiscomputedas1minustheprevalenceoftobaccosmoking.Prevalenceofnon-useoftobaccoisrescaledusingaminimumvalueof32%whencalculatingaverageservicecoverage.

Rescaledvalue=(X-32)/(100-32)*100

.

89

UHCBillion:Hospitalaccess

Indicatordefinition Totalnumberofhospitalbedsper10000population

Numerator Numberofhospitalbeds(shouldexcludelaboranddeliverybeds)


Maindatasources Administrativesystems/Healthfacilityreportingsystem

Methodofmeasurement Countryadministrativesystemsareusedtototalthenumberofhospitalbeds,whicharedividedbythetotalestimatedpopulation,andmultipliedby10,000.

Methodofestimation n/a

UHCBillionRelatedNotes WhencalculatingtheUHCindexandAverageServicecoverage,theindicatoriscomputedrelativetoathresholdvalueof18hospitalbedsper10,000population.ThisthresholdisbelowtheobservedOECDhighincomecountryminimum(sinceyear2000to2015)of20per10,000andtendstocorrespondtoaninpatienthospitaladmissionrateofaround5per100peryear.Thisindicatorisdesignedtocapturelowlevelsofhospitalcapacity;themaximumthresholdisusedbecauseveryhighhospitalbeddensitiesarenotnecessaryanefficientuseofresources.Theindicatoriscomputedasfollows,usingcountrydataonhospitalbeddensity(x),whichresultsinvaluesrangingfrom0to100:

• Countrywithahospitalbeddensityx<18per10,000peryear,theindicator=x/18*100.• Countrywithahospitalbeddensityx>=18per10,000peryear,theindicator=100.

Analternativeindicatorcouldbehospitalin-patientadmissionrate,relativetoamaximumthreshold.However,thatindicatoriscurrentlynotreportedwidelyacrossregions,inparticulartheAfricanRegion.Incountrieswherebothhospitalbedspercapitaandin-patientadmissionratesareavailable,theyarehighlycorrelated.

90

UHCBillion:HealthWorkerDensity

Indicatordefinition Densityofhealthworkers(doctors,nursesandmidwivesper10000population).


MetadataidenticaltoSDG3.c.1withnoteddifferencebelow

UHCBillionRelatedNotes Adjustedindicatorfromphysicians,psychiatristsandsurgeonstophysiciansandnurses/midwives.WhencalculatingtheUHCindexandAverageServiceCoverage,healthworkerdensityiscappedatmaximumthresholds,andvaluesabovethisthresholdareheldconstantat100(rescaledhealthworkersper10,000=minimum(100,originalvalue/155*100)).

91

UHCBillion:HealthSecurity

Indicatordefinition InternationalHealthRegulations(IHR)corecapacityindex,whichistheaveragepercentageofattributesof13corecapacitiesthathavebeenattained


MetadataidenticaltoSDG3.d.1


92

UHCBillion:HealthExpenditure

Indicatordefinition Proportionofpopulationwithhouseholdhealthexpendituresasashareoftotalhouseholdexpenditureorincome>10%


MetadataidenticaltoSDG3.8.2


93

AverageServiceCoverage

Indicator

Coverageofessentialhealthservices(definedastheaveragecoverageofessentialservicesbasedontracerinterventionsthatincludereproductive,maternal,newbornandchildhealth,infectiousdiseases,non-communicablediseasesandservicecapacityandaccess)

Definition

Coverageofessentialhealthservices(definedastheaveragecoverageofessentialservicesbasedontracerinterventionsthatincludereproductive,maternal,newbornandchildhealth,infectiousdiseases,non-communicablediseasesandservicecapacityandaccess).Theindicatorisanindexreportedonaunitlessscaleof0to100,whichiscomputedasthearithmeticmeanof14tracerindicatorsofhealthservicecoverage.


Thisindexindicatoriscomputedwitharithmeticmeansandrequiresfirstpreparingthe14tracerindicatorssothattheycanbecombinedintotheindex,andthencomputingtheindexfromthosevalues.The14tracerindicatorsarefirstallplacedonthesamescale,with0beingthelowestvalueand100beingtheoptimalvalue.Formostindicators,thisscaleisthenaturalscaleofmeasurement,e.g.,thepercentageofinfantswhohavebeenimmunizedrangesfrom0to100percent.However,forafewindicatorsadditionalrescalingisrequiredtoobtainappropriatevaluesfrom0to100,asfollows:Rescalingbasedonanon-zerominimumtoobtainfinerresolution(this“stretches”thedistributionacrosscountries):

- prevalenceofnon-raisedbloodpressureisrescaledusingaminimumvalueof50%.rescaledvalue=(X-50)/(100-50)*100;

- prevalenceofnon-useoftobaccoisrescaledusingaminimumvalueof32%.rescaledvalue=(X-32)/(100-32)*100

Rescalingforacontinuousmeasure:meanfastingplasmaglucose,whichisacontinuousmeasure(unitsofmmol/L),isconvertedtoascaleof0to100usingtheminimumtheoreticalbiologicalrisk(5.1mmol/L)andobservedmaximumacrosscountries(7.1mmol/L).rescaledvalue=(7.1-originalvalue)/(7.1-5.1)*100Maximumthresholdsfordensityindicators:hospitalbeddensityandhealthworkerdensityarebothcappedatmaximumthresholds,andvaluesabovethisthresholdareheldconstantat100.rescaledhospitalbedsper10,000=minimum(100,originalvalue/18*100)rescaledhealthworkersper10,000=minimum(100,originalvalue/155*100)Notethatincountrieswith,thetracerindicatorforuseofinsecticide-treatednetsisdroppedfromthecalculation.Oncealltracerindicatorvaluesareonascaleof0to100,arithmeticmeansarecomputedwithineachofthefourhealthserviceareas,andthenanarithmeticmeanistakenofthosefourvalues.

Numerator Thisindicatorisbasedonaggregateestimates.

Denominator Thisindicatorisbasedonaggregateestimates.

94


Manyofthetracerindicatorsofhealthservicecoveragearemeasuredbyhouseholdsurveys.However,administrativedata,facilitydata,facilitysurveys,andsentinelsurveillancesystemsareutilizedforcertainindicators.


Disaggregation

Nodisaggregation


Datacollectionvariesfromevery1to5yearsacrosstracerindicators.Forexample,countrydataonimmunizationsandHIVtreatmentarereportedannually,whereashouseholdsurveystocollectinformationonchildtreatmentmayoccurevery3-5years,dependingonthecountry.

Limitations

Datatype

Index

Relatedlinks

95

Section3:HealthEmergenciesBillion

96

Table3.HealthEmergenciesBillionIndicators

Indicator Definition Cross-referencedOutcomeIndicator

EmergencyPrepareIndicator

(IHRCoreCapacity)

Theemergencyprepareindicatormeasurescountrypreparednessforemergencies.Itisthepercentageofattributesof13corecapacitiesthathavebeenattainedataspecificpointintime.

SDG3.d.1:InternationalHealthRegulations(IHR)capacityandhealthemergencypreparednessSeepage53

EmergencyPreventIndicator

Theemergencypreventindicatormeasureseffortstopreventhealthemergenciesviavaccinationcoverage.Theindicatorisaweightedaverageofroutineandcampaignvaccinationsfordiseaseslinkedwithepidemicsandpandemics.ItsincludespriorityinfectiondiseasesCholera,YellowFever,Meningitis,Polio,Measlesplusotherneededemergencyvaccines.

HealthEmergencies:VaccinecoverageforepidemicpronediseasesSeepage64

EmergencyDetectandRespondIndicator(Timeliness)

Theemergencydetect&respondindicatormonitorsthetimelinessofdetection,notification,andresponsetoeventswithseriouspublichealthimpact,includingallIHRnotifiableevents.Itiscalculatedfrom

• timetodetect• timetonotify• timetorespond

n/a

97

HealthEmergenciesBillion:EmergencyPrepareIndicator(IHRCoreCapacity)

Indicatordefinition Theemergencyprepareindicatormeasurescountrypreparednessforemergencies.Itisthepercentageofattributesof13corecapacitiesthathavebeenattainedataspecificpointintime.


MetadataidenticaltoSDG3.d.1

Notes n/a

98

HealthEmergenciesBillion:EmergencyPreventIndicator

Indicatordefinition Theemergencypreventindicatormeasureseffortstopreventhealthemergenciesviavaccinationcoverage.Theindicatorisaweightedaverageofroutineandcampaignvaccinationsfordiseaseslinkedwithepidemicsandpandemics.ItsincludespriorityinfectiondiseasesCholera,YellowFever,Meningitis,Polio,Measlesplusotherneededemergencyvaccines.


MetadataidenticaltoHealthEmergencies:Vaccinecoverageforepidemicpronediseases

Notes n/a

99

HealthEmergenciesBillion:EmergencyDetectandRespondIndicator(Timeliness)

Indicator EmergencyDetectandRespondIndicator(Timeliness)

Indicatordefinition Theemergencydetect&respondindicatormonitorsthetimelinessofdetection,notification,andresponsetoeventswithseriouspublichealthimpact,includingallIHRnotifiableevents.Theindicatorfocusesonthreekeyaspectsoftimeliness:

• timetodetection(t0)• timetonotification(t1)• timetorespond(t2).

Theseareconvertedtolevelsandthenaveragedtogiveanoverallmeasureoftimeliness.

Maindatasources DatafromtheEventinformationsite(EIS):aweb-basedplatformthatallowssecurecommunicationbetweenWHOandtheIHRnationalfocalpoints(NFPs),asdefinedinArticle11.1oftheIHR(2005).DatafromtheEventmanagementsystem(EMS):WHO’scentralinternalelectronicsystemforentering,accessingandmanaginginformationforallpotentialandsubstantiatedeventsItishopedtoaddnewcapabilitytoadditionallyrecordtimelinessinformationforeventswithseriouspublichealthimpactwithinEMS.

Methodofcalculation Thetimetodetect,notifyandrespondaredeterminedfrom

Eventstart:Thetruestartoftheevent.IFthetruestartdateisnotfullyknown,aproxystartdateforaneventwillbeused.,e.g.thesymptomonsetoftheearliestreasonablyidentifiedcase.

Eventdetection:Thedatewhentheeventwasfirstdetected.IfdetectedbyWHOandreportedtotheMemberState,theearliestdetectiondatewillbeused.

Eventnotification:DatewhentheeventwasreportedtoWHObytheMemberStateunderIHR.IfthereisnoreportingbyMemberState,thiswillbethedatewhentheverificationrequestwassenttotheMemberState.

Eventresponse:Datewheneventwasfirstrespondedto,e.g.earliestdateofanypublichealthintervention.

Timetodetect=eventdetection-eventstartTimetonotify=eventnotification-eventdetectionTimetorespond=eventresponse–eventdetection

Thetimesareconvertedtolevelsasshowninthetablebelow,withLevel5beingshortestdelayandLevel2thelongestdelay.Level1isusedtoindicatethatnodatawererecordedfortheevent.UseoftimetonotifywillonlyapplyforIHRevents.

Thedetect&respondindicator(timeliness)isthencalculatedastheaverageofthetimelinessmeasures,rescaledbetween0and100.ForIHReventsthiswillbethreevalues,forothereventsifwillbetheaverageoftimetodetectandtimetorespond(timetonotifywillnotapply).

𝐷𝑒𝑡𝑒𝑐𝑡&𝑟𝑒𝑝𝑜𝑛𝑑𝑖𝑛𝑑𝑖𝑐𝑎𝑡𝑜𝑟 = 𝐴𝑣𝑒𝑟𝑎𝑔𝑒𝑜𝑓𝑡𝑖𝑚𝑒𝑙𝑖𝑛𝑒𝑠𝑠𝑙𝑒𝑣𝑒𝑙×20

Thedetect&respondindicatorisonascale0-100andmayalsobeshownaslevels.

100

Level

Timeliness sub-indicators range (detection, notification,

and response)

(days)

Detect & respond indicator range

l Level 5 ≤1 indicator ≥ 90

l Level 4 1< t ≤7 70≤ indicator <90

l Level 3 7 < t ≤14 50≤ indicator <70

l Level 2 >14 30≤ indicator <50

l Level 1 no date reported Indicator <30

Limitations Detect&respondtimelinessisanewindicator.Thedefinitionandmeasurementoftimelinessischallenging.Keyeventmilestonesmaybeunknownandevenproxiescanbedifficulttodefine.Theproposedindicatorisexpectedtoevolve.Definitionsofsubindicatorsmayneedtobelinkedtothetypeofevent

ThenumberandnatureofeventsvariesenormouslybetweenMemberStates.Theveryvariablenatureofeventsmakesthisindicatorsensitivetoasingleevent.Thiswillbemitigatedbyincludingasmanyeventsaspossible(byincludingnationalhealthevents).

Thereisaneedtoextendthesourcesofdataused,inordertoincreasethenumberofeventsincludedintheDetectandRespondindicatorandtoimprovethequalityofeventtimelinessdata.

101

Section4:HealthierPopulationsBillion

102

Table4.HealthierPopulationsBillionIndicators*

*Note:SixteenGPW13outcomeindicatorsareusedtomeasuretheHealthierPopulations(HPOP)Billion. MetadataforHPOPindicatorsareembeddedwithinSection1(OutcomeIndicators).Forthehealthierpopulationcalculations,allindicatorsarerepresentedonascaleofhealthinessfrom0to100,with0%beingtheleasthealthyand100%beingthehealthiest.Forexample,forSDG3.a.1Prevalenceoftobaccouse,theindicator,x,willbetransformedto100–x.Avalueof0%,theleasthealthy,wouldmeaneveryoneusestobacco,andavalueof100%,thehealthiest,wouldmeannooneusestobacco.Thisinversionisrequiredfortobaccouse,stunting,wastingandoverweightinunder5s,obesity,intimatepartnerviolence,andviolenceagainstchildren.FiveoftheselectedindicatorsarenotmeasuresofprevalencebutareincludedintheHPOPBillionbecauseeachisakeycontributortoglobalhealthiness.Theseincludealcoholconsumption,roadsafety,meanparticulates(cleanair),transfats,suicidesmortality(mentalhealth).

GPW13Indicatorsselected(Indicatorshortname)

Definition TransformationtoBillion(ifapplicable)

Correspondingpagenumber

SDG2.2.1 Childhoodstunting<5

Prevalenceofstuntingamongchildrenunder5yearsofage

n/a

Seepage14

SDG2.2.2 Childhoodwasting<5

Prevalenceofwastingamongchildrenunder5yearsofage

n/a

Seepage15

SDG2.2.2 Childhoodoverweight<5

Prevalenceofoverweightamongchildrenunder5yearsofage

n/a

Seepage16

SDG3.4.2 Suicidesmortality Suicidemortalityrate Thenumberofadditionallyhealthierliveswillbecountedastheestimatednumberofpeopleavoidingsuicideorasuicideattempt.

Seepage31

SDG3.5.2 Alcoholconsumption

Alcoholpercapitaconsumption(15+years)withinacalendaryearinlitersofpurealcohol

Populationsaredeemedhealthier(intermsofalcoholconsumption)ifeitherheavyepisodicdrinkingisdecreasedorabstinenceisincreased–bothimplyingareducedalcoholconsumption.Thetransformationforalcoholwillthereforerelatechangesinmeanalcoholconsumptiontochangesinprevalenceofabstainersandofheavyepisodicdrinkers,usingthisasameasureoftheproportionofthepopulationthatcanbeconsideredhealthier.

Seepage33

103

SDG3.6.1 Roaddeaths Deathrateduetoroadtrafficinjuries

Additionalpopulationavoidingroadinjuryordeathwillbecountedashealthier.

Seepage35

SDG3.a.1 Tobaccouse Prevalenceofcurrenttobaccouseamongpersonsaged15yearsandolder**

n/a

Seepage47

SDG4.2.1 Developmentallyontrack<5

Proportionofchildrenunder5developmentallyontrackinhealth,learningandpsychosocialwell-being

n/a

Seepage55

SDG5.2.1 Intimatepartnerviolence

Proportionofever-partneredwomenaged15-49yearssubjectedtointimatepartnerviolence

n/a

Seepage56

SDG6.1.1 Safelymanagedwater

Proportionofpopulationusingsafelymanageddrinkingwaterservices

n/a

Seepage59

SDG6.2.1 Safelymanagedsanitation

Proportionofpopulationusingsafelymanagedsanitationservices

n/a

Seepage61

SDG7.1.2 Cleanhouseholdfuels

Proportionofpopulationwithprimaryrelianceoncleanfuelsandtechnology

n/a

Seepage45

SDG11.6.2 Meanparticulates(PM2.5)

Annualmeanlevelsoffineparticulatematter(PM2.5)incities

AreductionofPM2.5by100µg/m3isequatedto100%ofthepopulationbeinghealthier.SmallerchangescontributetotheHPOPBillioninaproportionalmanner.

Seepage46

SDG16.2.1 Violenceagainstchildren

Proportionofchildrenaged1-14yearswhoexperiencedphysical/psychologicalaggressionbycaregivers

n/a

Seepage63

WHA66.10 Transfatspolicy PresenceofaWHObest-practiceTFApolicy/regulation

Countrieswhichimplementbest-practiceTFApolicyduringtheGPW13periodwillcontribute2.1%oftheirpopulationtothebillion.

Seepage71

WHA66.10 Obesity Prevalenceofobesityamongadolescents(5-17)andadults

n/a

Seepage72

**notagestandardized

104

Section5:HealthyLifeExpectancy(HALE)

105

Healthylifeexpectancy(HALE)

Nameabbreviated Healthylifeexpectancy(HALE)

Indicatorname Healthylifeexpectancyatagex(e.g,atbirth,atage60years,etc)

Definition Averageremainingnumberofyearsthatapersoncanexpecttolivein“fullhealth”atacertainagebytakingintoaccountyearslivedinlessthanfullhealthduetodiseaseand/orinjury.

Methodofestimation/calculation HALEisametricbasedonmethodsbySullivan(1971).Itprovidesasinglesummarymeasureofpopulationhealthacrossallcauses,combinedbyweightingyearslivedwithameasureoffunctionalhealthlossbeforedeath,andisthemostcomprehensiveamongcompetingexpectancymetrics.HALEatagexisthesumofYWDifromi=xtow(thelastopen-endedageintervalinthelifetable)dividedbylx(survivorsatagex):

𝐻𝐴𝐿𝐸� = 𝑌𝑊𝐷8

l

8��

/𝐼�

𝑌𝑊𝐷� = 𝐿�(1 − 𝐷�)–Yearslivedwithoutdisability,equivalentyearsofhealthylifelivedbetweenagesxandx+5.𝐼�–Survivorsatagex.𝐿�–Totalyearslivedbythelifetablepopulationbetweenagesxandx+5.𝐷�–Equivalentlosthealthyyearfractionbetweenagesxandx+5.

Numerator Seeabove

Denominator Seeabove

Preferreddatasources Vitalregistrationsystemsthatrecorddeathswithsufficientcompletenesstoallowestimationofall-causedeathrates.Nationalhealthexaminationsurveysontheprevalenceofdiseases,injuries,anddisabilities.

Otherpossibledatasources Sampleregistrationsystems;verbalautopsy.

Disaggregation Bysex,location(urban/rural,majorregions/provinces),andsocio-economiccharacteristics(e.g.,education,wealthquintile).


Limitations Lackofreliabledataonmortalityandmorbidity,especiallyfromlowincomecountries.Lackofcomparabilityofself-reporteddatafromhealthinterviewsandthemeasurementofhealth-statepreferencesforsuchself-reporting.

Datatype Numberofyears

Relatedlinks WHOMethodsandDataSourcesforLifeTables(MathersandHo,2018);SystemicAnalysisfortheGlobalBurdenofDiseaseStudy2016(Hayetal.,2017);HSMHAHealthReports(Sullivan,1971);SystemicAnalysisfortheGlobalBurdenofDiseaseStudy2015(Kassebaumetal.,2016)

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Annex1:OutcomeIndicatorsandGPW132023Targets1

Target#

SDG# OutcomeIndicators GPW132023Targets

1. SDG1.5.1 Numberofdeaths,missingpersonsanddirectlyaffectedpersonsattributedtodisastersper100000population

Reducethenumberofdeaths,missingpersonsanddirectlyaffectedpersonsattributedtodisastersper100000population

2. SDG1.a.2 Proportionoftotalgovernmentspendingonessentialservices(education,healthandsocialprotection)

Increasetheshareofpublicspendingonhealthby10%

3. SDG2.2.1 Prevalenceofstunting(heightforage<-2standarddeviationfromthemedianoftheWorldHealthOrganization(WHO)ChildGrowthStandards)amongchildrenunder5yearsofage

Reducethenumberofstuntedchildrenunder5yearsofageby30%

4. SDG2.2.2 Prevalenceofmalnutrition(weightforheight>+2or<-2standarddeviationfromthemedianoftheWHOChildGrowthStandards)amongchildrenunder5yearsofage(wasting)

Reducetheprevalenceofwastingamongchildrenunder5yearsofagetolessthan5%

5. SDG2.2.2 Prevalenceofmalnutrition(weightforheight>+2or<-2standarddeviationfromthemedianoftheWHOChildGrowthStandards)

amongchildrenunder5yearsofage(overweight)

Haltandbegintoreversetheriseinchildhoodoverweight(0-4years)

6. SDG3.1.1 Maternalmortalityratio Reducetheglobalmaternalmortalityratioby30%

SDG3.1.2 Proportionofbirthsattendedbyskilledhealthpersonnel

7. SDG3.2.1 Under-5mortalityrate Reducethepreventabledeathsofnewbornsandchildrenunder5yearsofageby17%and30%,respectivelySDG3.2.2 Neonatalmortalityrate

8. SDG3.3.1 NumberofnewHIVinfectionsper1000uninfectedpopulation,bysex,ageandkeypopulations

ReducenumberofnewHIVinfectionsper1000uninfectedpopulation,bysex,age,andkeypopulationsby73%

108

Target#


9. SDG3.3.2 Tuberculosisincidenceper100000population Reduceby27%thenumberofnewTBcasesper100000population

10. SDG3.3.3 Malariaincidenceper1000population Reducemalariacaseincidenceby50%

11. SDG3.3.4 HepatitisBincidenceper100000population ReduceHepatitisBincidenceto0.5%forchildrenunder5years

12. SDG3.3.5 Numberofpeoplerequiringinterventionsagainstneglectedtropicaldiseases

Reductionofpeoplerequiringinterventionsby400million

13. SDG3.4.1 Mortalityrateattributedtocardiovasculardisease,cancer,diabetesorchronicrespiratory

diseases

20%relativereductionintheprematuremortality(age30-70years)fromNCDs(cardiovascular,cancer,diabetes,orchronicrespiratorydiseases)throughpreventionandtreatment

14. SDG3.4.2 Suicidemortalityrate Reducesuicidemortalityrateby15%

15. SDG3.5.1 Coverageoftreatmentinterventions(pharmacological,psychosocialandrehabilitationandaftercareservices)forsubstanceusedisorders

Increaseservicecoverageoftreatmentinterventions(pharmacological,psychosocialandrehabilitationandaftercareservices)forsubstanceusedisorderstoxx%*

16. SDG3.5.2 Harmfuluseofalcohol,definedaccordingtothenationalcontextasalcoholpercapitaconsumption(aged15yearsandolder)withinacalendaryearinlitresofpurealcohol

ReductionwillbeinlinewithSDG2030target

17. SDG3.6.1 Deathrateduetoroadtrafficinjuries Reducethenumberofglobaldeathsandinjuriesfromroadtrafficaccidentsby20%

18. SDG3.7.1 Proportionofwomenofreproductiveage(aged15–49years)whohavetheirneedforfamilyplanningsatisfiedwithmodernmethods

Increasetheproportionofwomenofreproductiveage(15–49years)whohavetheirneedforfamilyplanningsatisfiedwithmodernmethodsto66%

19. SDG3.8.1 Coverageofessentialhealthservices(definedastheaveragecoverageofessentialservicesbasedontracerinterventionsthatincludereproductive,maternal,newbornandchildhealth,infectiousdiseases,noncommunicablediseasesandservicecapacityandaccess,among

Increasecoverageofessentialhealthservices

109

Target#


thegeneralandthemostdisadvantagedpopulation)

20. SDG3.8.2 Proportionofpopulationwithlargehouseholdexpendituresonhealthasashareoftotalhouseholdexpendituresorincome

Stoptheriseinpercentofpeoplesufferingfinancialhardship(definedasout-of-pocketspendingexceedingabilitytopay)inaccessinghealthservices

21. SDG3.9.1 Mortalityrateattributedtohouseholdandambientairpollution

Reducethenumberofdeathsandillnessesfromhazardouschemicalsandair,waterandsoilpollutionandcontamination

SDG3.9.2 Mortalityrateattributedtounsafewater,unsafesanitationandlackofhygiene(exposuretounsafeWater,SanitationandHygieneforAll(WASH)services)

SDG3.9.3 Mortalityrateattributedtounintentionalpoisoning

SDG7.1.2 Proportionofpopulationwithprimaryrelianceoncleanfuelsandtechnology

SDG11.6.2 Annualmeanlevelsoffineparticulatematter(e.g.PM2.5andPM10)incities(population

weighted)

22. SDG3.a.1 Age-standardizedprevalenceofcurrenttobaccouseamongpersonsaged15yearsandolder

ReductionwillbeinlinewithSDG2030target

23. SDG3.b.1 Proportionofthetargetpopulationcoveredbyallvaccinesincludedintheirnationalprogramme

Increasecoverageof2nddoseofmeaslescontainingvaccine(MCV2)to85%

24. SDG3.b.3 Proportionofhealthfacilitiesthathaveacoresetofrelevantessentialmedicinesavailableandaffordableonasustainablebasis

Increaseavailabilityofessentialmedicinesforprimaryhealthcare,includingtheonesfreeofchargeto80%

25. SDG3.c.1 Healthworkerdensityanddistribution Increasehealthworkforcedensitywithimproveddistribution

110

Target#


26. SDG3.d.1 InternationalHealthRegulations(IHR)capacityandhealthemergencypreparedness

IncreaseinmemberstatesInternationalHealthRegulationscapacities

27. SDG3.d.2 Percentageofbloodstreaminfectionsduetoantimicrobialresistantorganisms.

Reducethepercentageofbloodstreaminfectionsduetoselectedantimicrobialresistantorganismsby10%

28. SDG4.2.1 Proportionofchildrenunder5yearsofagewhoaredevelopmentallyontrackinhealth,learningandpsychosocialwell-being,bysex

Increasetheproportionofchildrenunder5yearsofagewhoaredevelopmentallyontrackinhealth,learningandpsychosocialwell-beingto80%

29. SDG5.2.1 Proportionofever-partneredwomenandgirlsaged15yearsandoldersubjectedtophysical,sexualorpsychologicalviolencebyacurrentorformerintimatepartnerintheprevious12months,byformofviolenceandbyage

Decreasetheproportionofever-partneredwomenandgirlsaged15-49yearssubjectedtophysicalorsexualviolencebyacurrentorformerintimatepartnerintheprevious12monthsfrom20%to15%

30. SDG5.6.1 Proportionofwomenaged15–49yearswhomaketheirowninformeddecisionsregardingsexualrelations,contraceptiveuseandreproductivehealthcare

Increasetheproportionofwomenaged15–49yearswhomaketheirowninformeddecisionsregardingsexualrelations,contraceptiveuseandreproductivehealthcareto68%

31. SDG6.1.1 Proportionofpopulationusingsafelymanageddrinkingwaterservices

Provideaccesstosafelymanageddrinkingwaterservicesfor1billionmorepeople

32. SDG6.2.1 Proportionofpopulationusing(a)safelymanagedsanitationservicesand(b)ahand-washingfacilitywithsoapandwater

Provideaccesstosafelymanagedsanitationservicesfor800millionmorepeople

33. SDG16.2.1 Proportionofchildrenaged1–17yearswhoexperiencedanyphysicalpunishmentand/orpsychologicalaggressionbycaregiversinthepastmonth

Decreasethenumberofchildrensubjectedtoviolenceinthepast12months,includingphysicalandpsychologicalviolencebycaregiversinthepastmonth,by20%

34. HealthEmergencies

Vaccinecoverageofat-riskgroupsforepidemicorpandemicpronediseases

Increaseimmunizationcoverageforcholera,yellowfever,meningococcalmeningitis,polioandpandemicinfluenza

35. HealthEmergencies


Increasetheavailabilityofhealthfacilitiesprovidingaminimumservicespackageto

111

Target#


peopleinfragile,conflict,orvulnerablesettingstoatleast80%

36. WHA68.3 Numberofcasesofpoliomyelitiscausedbywildpoliovirus(WPV)

Eradicatepoliomyelitis:zerocasesofpoliomyelitiscausedbywildpoliovirusandestablishacleartimetablefortheglobalwithdrawaloforalpoliovaccinesinordertostopoutbreakscausedbyvaccine-derivedpoliovirus

37. WHA68.7 Patternsofantibioticconsumptionatnationallevel

ACCESSgroupantibioticsat≥60%ofoverallantibioticconsumption

38. WHA66.10 Age-standardizedprevalenceofraisedbloodpressureamongpersonsaged18+years(definedassystolicbloodpressureof>140mmHgand/ordiastolicbloodpressure>90mmHg)andmeansystolicbloodpressure

20%relativereductionintheprevalenceofraisedbloodpressure

39. WHA66.10 Protectionofthepopulationofacountrybyeffectivepolicy/regulationonindustryproducedtrans-fattyacids(TFA)

AllcountriesimplementWHObestpracticepolicy

40. WHA66.10 Prevalenceofobesity Haltandbegintoreversetheriseinobesity

1GPW132023Targetstobeupdated

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