Monitoring the Building Blocks of Health Systems: a Handbook of Indicators and their Measurement Strategies

In recent years, significant progress has been achieved in delivering health-related interventions that are designed to achieve goals relating to improving maternal and child health, and reducing mortality and ill-health due to HIV/AIDS, tuberculosis and malaria. It is increasingly apparent, however, that the gains have been neither universal nor sufficiently broad-based and sustainable.

While this increased attention to the strengthening of health systems is welcome, it would not be sustainable in the absence of a sound monitoring strategy that enables decision-makers to accurately track health progress and performance, evaluate impact, and ensure accountability at country and global levels. Moreover, the use of results-based financing mechanisms by major global donors has created a further demand for timely and reliable data. There is also increasing in-country demand for data in the context of annual health sector reviews. 

Information is needed to track how health systems respond to increased inputs and improved processes, and the impact they have on improved health indicators. This implies the need to define core indicators of health system performance while developing and implementing appropriate sustainable measurement strategies to generate the required data. However, on the supply side, there are major gaps in data availability and quality. Few developing countries are able to produce data of sufficient quality to permit the regular tracking of progress in scaling-up health interventions and strengthening health systems. Data gaps span the range of “input”, “process”, “output”, “outcome” and “impact” indicators: e.g. few countries carry out regular national health accounts studies; data on the availability and distribution of health workers are often incomplete, inaccurate and out of date; few countries have systems that can monitor service delivery; and data on population access to essential services are limited.

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