Indicators and Reference Data: A Practical Tool for Project

Managers in Humanitarian Aid

Malteser InternationalOperational Guideline

www.malteser-international.org

AuthorsMarie Theres Benner

K. Peter Schmitz

Design and LayoutEsther Suchanek

Published by Malteser International,Cologne, Germany

2009

Disclaimer The idea, design and contents of this guideline have been purely driven by the context Malteser International is working in. Many of the indicators and standards in this booklet have been used from the World Health Organization (WHO), the SPHERE project, the World Bank, Centre for Disease Control and Prevention, Atlanta (CDC), the United Nations High Commissioner for Refugees (UNHCR) and others, but also from own practical experience in the field of humanitarian aid.

The tool is aimed to support project managers and health personnel in effective planning and result oriented managing of programmes by selecting appropriate and practical indicators. It covers the sector of health, nutrition, immunisation, psycho-social care, mental health and water, sanitation and hygiene. Malteser International fully endorses the international standards already produced and considers them as important references; nevertheless, this guideline is aimed to be as practical as possible and should be used as a flexible tool and adapted to the local context.

Acknowledgements We gratefully acknowledge the support of all Malteser health staff who provided their contribution and invaluable input for this tool. We specifically show our appreciation towards our colleagues who participated in the regional health workshops where much of their invaluable input was given.

Finally, the editors would like to thank Prof. François Nosten from the Shoklo Malaria Research Unit (Mae Sot, Thailand) for his contribution on the malaria indicators and Dr. Osman Eltayeb (former Malteser Country Health Coordinator for Myanmar) for his contribution on the TB indicators.

Copyright Copyright for this document is held by Malteser International. Copying of all parts is permitted provided that the source is acknowledged.

3

Foreword

This manual is intended to help project managers alike to assess and plan hu-manitarian aid projects throughout all phases, from the emergency situation up to the developmental phase. The manual provides a set of compiled stan-dards and key indicators, which have been developed by many people for va-rious sectors and have reached a remarkable consensus in the humanitarian world. It gives practical advice for on-the-ground interventions. Additional some references have been made on further information sources.

Although this manual is a technical toolkit with a focus on standards and indicators, it does not neglect the importance of the human rights approach and the principles addressed in the Humanitarian Charter and the Code of Coduct, which has been signed by Malteser International. It rather con-fesses the strong commitment for quality, accountability and the respect of those affected by disaster or conflict.

I hope that this manual will support Malteser International staff and en-courage other humanitarian aid organisations to increasingly use standards and indicators to show their effectiveness of work and to be accountable for those in need. It is a shared responsibility.

Ingo RadtkeSecretary GeneralMalteser International

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Table of contents

1. Introduction 6

2. How to give meaning to data in a complex situation 62.1 Possible information sources to obtain health relevant data 7

3. Population estimations 7

4. Planning a programme with limited available information 94.1 Reproductive Health 114.2 Nutrition 134.3 Immunisation 16

5. Indicators 185.1 Indicators should be 19

6. Indicator Matrix 19

7. Annex 687.1 Case definition 687.2 Glossary of terms 68

8. References and web addresses 778.1 Health 778.2 Reproductive Health 798.3 Sexual gender based violence (SGBV) and Mental Health 808.4 Nutrition 81

Weekly morbidity/mortality surveillance form 82

5

1. Introduction

Health Indicators are an important tool of project management, monitoring and evaluation in humanitarian aid and development. Measuring outcomes, results and effectiveness of interventions helps not only the programme manager to identify the most appropriate response according to the affected population, context and culture; it is also an increasing requirement of donors to reflect the agency’s work and the overall quality and to show accountability towards the beneficiaries.

However, before planning and designing a project, it is imminent to get some information on the situation. The following section describes some approaches.

2. How to give meaning to data in a complex situation

Especially in complex emergencies, information systems are often interrupted, data are invalid and deficient, standards are not available and therefore health information are often not used even when large amounts of data are available. Even in extreme situations such as in Afghanistan, Sudan or the D.R. Congo, health data, although incomplete, of variable quality and collected with different stakeholders, are available. However, the capacity and the coordination to make meaning out of those scattered information is a challenge and often not practiced (Pavignani E and Colombo A, 2001).

The registration of absolute numbers of deaths or patients with specific diseases during a disaster or emergency is not very informative, unless they are reported in relation to the relevant population and reported in rates or ratios. This helps to make the death and disease pattern clearer. Data, which are collected over time, may even show change and may provide useful information for the respective aid programmes. Further dividing data by sex, age groups, ethnic or social groups (i.e. migrants or non-migrants) or working activities, may suggest factors behind the vulnerability of the affected population. However, collecting and manipulating data in the hope that something ‘appealing’ comes up is not giving the real evidence to make decisions and therefore not very useful (Pavignani E and Colombo A, 2001).

6

The following section will provide some ideas on where to collect information and how to make use of available data for decision making.

2.1 Possible information sources to obtain health relevant data

Ministry of Health: collects routinely data; availability has to be assessed

Ministry of Foreign Affairs: may collect information on specific social groups such as refugees or foreign migrants

WHO in respective country: collects routine country specific data and may support the country health information system

Standardised national surveys: such as Demographic and Health Surveys (DHS); sometimes published in relevant journals

Survey data: assess if surveys have been conducted in the country; they may be relevant for the programme planning and do not necessarily require another survey

Surveillance system: sometimes implemented by the health authorities and WHO and part of the national surveillance system

3. Population estimations

To find out the total number of the target population and the breakdown by age and sex is always a challenge in emergencies and post-conflict situations. Rarely, exact figures can be attained. On the other hand, it is of utmost importance to decide on the number of people to be served – i.e. the target

Key Message 1: Assess if and what information is already available through the relevant ministries, WHO or other NGOs. Take into account available information before planning your own survey or assessment.

7

population. The population is the basis to decide on the denominator, which gives an idea on quantities of commodities and services to be organised in a given timeframe. A helpful tool is to find out the number of health facilities and the estimated total population number in a specific area such as a district or province. If one has to plan just for a small population group within the province, look at the number of health facilities in this specific area and divide those by the total number of health facilities to get the percentage out of the total; this is also your estimated percentage of population to use as a denominator. Look at the following example:

EXAMPLE: the province in this example provides the baseline in- formation while the district estimated population has been calculated out of the province data

Province No. of total health facilities Estimated Population A 56 850,000

District A 24 (43%) out of 56 484,500 (43% of total 850,000)

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The following table gives some indications for a more or less normal distributed population.

Table 1: Estimated population figures in a “normal” distributed society

Group % of population Remarks by the authors0-4 years 12 Might be higher in societies with high

birth rates --> 12 – 20 %5-9 years 12 Might be higher in societies with high

birth rates10-14 years 11 Might be higher in societies with high

birth rates15-19 years 10 Might be higher in societies with high

birth rates20-59 4960 + 7Pregnant Women 2.5 – 4 Might be higher in societies with high

fertility ratesBreastfeeding Women 2.5 Might be higher in societies with high

fertility ratesPeople living with disabilities

Male : Female Ratio

5-10

51 : 49

Depends on definition, may include mental health. Distinguish those in need of assistance.

Source: adapted from SPHERE Handbook, 2004; p. 190

Key Message 2: With the size of the population (denominator) and the common age distribution and some information about standard frequen-cies, the target population and therefore the situation can be better descri-bed. It is for example possible to estimate the number of deliveries to be expected in a given time period. This helps to identify and to understand expected upcoming problems and to plan a relevant intervention.

4. Planning a programme with limited available information

The following section provides information on what to expect when setting up a humanitarian aid programme in a region where only limited information are available. The following tables provide an overview on the

9

estimated health status in the various regions (Table 2), what might be expected in terms of reproductive health issues (Table 3) and what can be considered for planning a health care programme.

Table 2: Reference to annual rates and ratios by regionIndicator Sub-

Saharan Africa

South-East Asia

Industrialised Countries

Crude Birth Rate / 1,000 pop. 44 26 13Neonatal Mortality Rate / 1,000 live births

53 36 5

Perinatal Mortality Rate / 1,000 live births

83 51 8

Maternal Mortality Ratio / 100,000 live births

971 447 31

Infant Mortality Rate / 1,000 live births

97 50 14

Coverage of Antenatal Care (%) 63 65 95Low Birth Weight Percentage / 100 live births

16 15 6

Births attended by trained health personnel (%)

42 53 99

Institutional deliveries (% of live births)

20 41 98

Unsafe abortion (1,000 women 15-49 yrs.)

26 15 1

Anaemia in pregnant women (%) 52 57 18Coverage of Tetanus Vaccination (Pregnant Women)

46 49 -

STI Incidence rate / 1,000 pop.AIDS Cases / 100,000

25494

16080

7727

Source: United Nations Development Programme. Human Development Report. New York: United Nations, 1997. IN: Centre for Disease Control and Prevention, Atlanta. 2003. Public Health Surveillance applied to reproductive health; Epidemiology Series Module 1. Atlanta: CDC

10

4.1 Reproductive Health

Table 3: Reproductive Health reference rates and ratiosHealth Outcome Estimates Remarks Labor and delivery complications

15% of all pregnancies will require some type of intervention at delivery

3%-7% of all pregnancies will require caesarean section

10%-15% of all women will have some degree of cephalopelvic disproportion (higher in poorer socio-economic populations)

10% of deliveries will involve a secondary postpartum haemorrhage (within 24h of delivery)

0.1%-1% of deliveries will involve a secondary postpartum haemorrhage (occurring 24 h or more after delivery)

0.1%-0.4% of deliveries result in uterine rupture0.25%-2.4% of all deliveries will result in some type of

birth trauma to the baby1.5% of all births will have a congenital

malformation (does not incl. cardiac malformations diagnosed later in neonatal period)

31% of these malformations will result in death

Hypertensive Disorder of Pregnancy (HDP) or Pre-eclampsia

5%-20% of all pregnancies develop HDP/ pre-eclampsia (5%-25% in primigravida)

Spontaneous Abortions

10%-15%

90%15%-20%

of all pregnancies may spontaneously abort before 20 weeks gestationof these will occur during the first 3 monthsof all spontaneous abortions require medical interventions

Source: adapted from reproductive health in refugee settings: an inter-agency field manual. Geneva: UNHCR, 1999 IN: Centre for Disease Control and Prevention, Atlanta. Public Health Surveillance applied to reproductive health; Epidemiology Series Module 1. Atlanta: CDC. 2003, p. 79.

11

Key Message 3: Use reference data if none are available for planning your intervention. If you work in sub-Saharan Africa and you plan a repro-ductive health care programme in a certain district, you may expect that only 46% (Table 2) of the pregnant women are fully immunised against tetanus. You may also expect that about up to 7% of the pregnant women (Table 3) may need a caesarean section. Use those references only if there are none available through the Ministry of Health or WHO in the country. However, you have to assess in your area if e.g a caesarean section is actually possible? Is there a facility in your area where women can go for caesarean section? If not, how can you as an organisation address those needs? Dis-cuss with the Ministry of Health and /or WHO how to address the need for e.g. for caesarean section to reduce morbidity and mortality.However, be aware that you can not solve all problems yourself but you can advocate.

12

4.2 Nutrition

In emergencies, it is aimed to provide sufficient food baskets to avoid severe malnutrition for a specific target group during a period of time. The aim is not to balance the general inadequate food availability by selective feeding. (Connolly M.A., 2005, p. 69).

The following table (4) provides some indication of the nutrition status by using weight/height as a reference.

Table 4: Nutrition ClassificationMeasure severe moderateWeight for Height severe wasting moderate wasting%median < 70% 70-79%z-scores <-3 SD <-2 SD

Weight for Age severely stunting moderate stunting%median <85% 85-89%z-scores <-3 SD <-2 SDSource: WHO, 1999, p. 4

Rapid nutrition surveys using MUAC (mid-upper arm circumference) or weight/height are helpful to identify the major risk persons while selective supplementing (additional ration) and therapeutic (for rehabilitation for severe malnourished persons) feeding programmes are the major intervention tools. Blanket feeding is only recommended when the prevalence of malnutrition exceeds 15% or 10% if other influencing factors are present such as measles or a diarrhoea outbreak. Targeted feeding focuses on extra food rations for selected individuals and vulnerable groups if the prevalence of malnutrition exceeds 10%, or 5% if other influencing factors are present (Connolly M.A., 2005).

13

WHO Classification of Severity for Acute Malnutrition Wasting, measured by weight for height

severity prevalence in <5 populationacceptable <5%poor 5-9%serious 10-14%critical >15%

‘emergency’ refers to acute malnutrition rates >20%

WHO Criteria for Severity for Chronic Malnutrition Stunting, measured by height for age

severity prevalence in <5 populationlow <20%medium 20-29.9%high 30-39.9%very high >40%

WHO Criteria for Severity of Iodine-Deficiency (Goitre)severity prevalence in populationnormal <5%mild 5.0-19.99%moderate 20.0-29.9%severe >30%

WHO Proposed Criteria for Severity of Anemiaseverity prevalence in populationhigh >40%medium 20-40%low 5.0-20%

14

WHO Classification of Severity for Vitamin A Deficiencypublic health problem prevalence in <5 years age groupnight blindness >1%conjunctival xerosis, Bitot spots >0.5%Corneal xerosis, ulceration, keratomalacia

>0.01%

corneal scars >0.05%

WHO Classification of Severity of Thiamine Deficiency severity prevalence in populationmild > 1 clinical casemoderate 1-4% of populationsevere >5% of population

WHO Classification of Severity of Niacin Deficiency severity prevalence in populationmild > 1 clinical casemoderate 1-4% of populationsevere >5% of population

WHO Classification of Severity of Vitamin C Deficiency severity prevalence in populationmild > 1 clinical casemoderate 1-4% of populationsevere >5% of population

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4.3 Immunisation

The most important vaccines in emergency situations are those against measles, meningococcal meningitis and yellow fever (Connolly M.A., 2005). Every mass vaccination campaign should be coordinated with the respective communities, the national Ministry of Health, WHO, UNICEF and other relevant partners. To plan a vaccination campaign, the number of doses is based on the size of the targeted coverage, proportion of vaccine lost during mass campaign (15%), and reserves to be held (25%).

Key Message 4: Adequate nutrition is a basic right and is reflected in the Humanitarian Charter. Malnutrition and micronutrition deficiency are the major causes of morbidity and mortality while adequate and timely in-terventions can drastically reduce diseases such as diarrhoea, respiratory in-fections and severe anaemia among others. When carrying out assessments, always include, where possible and if not done earlier, a rapid nutrition survey. When planning a nutrition programme always consider priority groups and needs, the respective food culture and an exit strategy. Integra-ting local groups in the assessment and implementation is vital.

16

Table 5: Calculation for vaccine campaignTotal Population 50,000Target Population i.e. 6 months to 15 years for measles (45%);Target Population for Meningitis i.e. 2 to 30 years (70% of total)

22,500

35,500

Target for coverage: 100% 22,500 (for measles)Number of doses to administer 22,500Including expected loss of 15% (22,500/85%)

26,470

Adding reserve of 25% (26470 x 125%)

33,088

TO ORDER: 34,000 DOSES (if 50 doses per vial order 680 vials)

Source: Connolly MA. Communicable disease control in emergencies. A field manual. Geneva: World Health Organization, 2005, p. 76.

Cold chain material, monitoring equipment (thermometers, refrigerator control sheets) and vaccination cards are mandatory.

Key Message 5: Immunisation programmes are of high priority in all health interventions in emergencies, conflict and post-conflict. Plan and implement those programmes in cooperation with the Ministry of Health, UNICEF, WHO and other NGOs. Be clear on your target group for pro-per planning purposes (see Table 5). In case of a meningococcal menigitis outbreak contact the International Coordinating Group for Vaccine Provi-sion (ICG) through the Ministry of Health, which ensures rapid access to vaccine since this vaccine is usually not available in country.ICG website: http://www.who.int/csr/disease/meningococcal/ICG_guide-lines_2008_02_09.pdf

17

5. Indicators

The following section is aimed at helping managers planning, monitoring and evaluating their programmes.

Definition “Indicator”:”Variable that indicates or shows a given situation, and hence can be used to measure change” (Pavignani E and Colombo A, 2001) or “signals, that measure the impact of processes used and programmes implemented. The indicators may be qualitative or quantitative in nature.” (The SPHERE Project, 2004, p. 8)

In all projects, Malteser International uses indicators to measure and to monitor the implementation process and the effectiveness of the chosen interventions. However, a lot of difficulties on identifying and selecting the right and appropriate indicators are still the reality; but this is normal since there are a lot of international debates on what indicators are measuring where and when, and most important, how it can be achieved that indicators are applied according to an agreed definition in order to make them comparable in different contexts and situations.

However, indicators used need to be, where possible, tested, and adapted before they are accepted for general use. The final decision always depends on the practicality and what information is gained by the indicator on one hand and its reliability, availability and respective costs on the other. Country specific demographic, health, economic and social data are collected routinely at the Ministry of Health, WHO or elsewhere. These data are helpful to compare with own data and are possibilities to use them as a reference.

“It is better to be vaguely right than precisely wrong” John Maynard Keyes

18

5.1 Indicators should be• directly linked with the programme or intervention• straightforward and relevant to measure progress• sensitive to changes and based on best practices• cost-effective (worth to spent time and money)• easy to understand (Definition!)• reliable• technically feasible (consistent with data available and the data

collection capacity)The indicators given in this booklet are divided for different periods and sectors within the project cycle and therefore are suitable for the emergency phase, early recovery, relief and rehabilitation and developmental approaches. We emphasized on a minimum set of context indicators (Chapters1 & 2 in the matrix), which are essential for an overall situation analysis and outcome /process indicators (Chapters 3-11 in the matrix).

6. Indicator Matrix

The following matrix provides a set of indicators which are most relevant in Malteser International programmes; they are divided by different phases and or sectors.

19

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20

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21

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aff e

cted

po

pula

tion

need

to b

e in

clud

ed.

Stak

ehol

der l

ists a

re im

port

ant p

roje

ct d

ocum

ents

whi

ch h

elp

not l

oosin

g re

leva

nt in

form

atio

n an

d ke

e-pi

ng c

onta

cts a

nd p

artn

ers u

p to

dat

e.

Mee

tings

,in

terv

iew

s,sta

keho

lder

lis

t

2. B

ASI

C S

ET O

F “M

INIM

UM

IN

DIC

ATO

RS“

*

Popu

latio

n by

ag

e an

d se

xTo

tal n

umbe

r of p

opu-

latio

n by

age

and

sex

in

the

proj

ect /

catc

hmen

t ar

ea

See

SPH

ERE

hand

book

, 20

04, p

. 300

Hav

e po

pu-

latio

n da

ta

by a

ge g

roup

as

soon

as

poss

ible

tode

cide

on

deno

min

ator

.

Age

grou

ps c

ould

be

initi

ally

div

ided

into

less

than

5

yrs.

and

abov

e 5

yrs.

and

late

r ada

pted

as n

eede

d (e

.g.

<1; 1

-5; 6

-10;

10-

14; 1

5-19

; 20-

24; >

24).

Incl

ude

estim

ates

on

vuln

erab

le g

roup

s, pe

ople

with

di

sabi

litie

s, el

der p

erso

ns, t

hose

livi

ng w

ith c

hron

ic

dise

ase,

pre

gnan

t wom

en a

nd la

ctat

ing

mot

hers

.

Pre-

exist

ing

loca

l sta

ti-sti

cs

22

Info

rmat

ion

on to

tal p

opul

atio

n is

esse

ntia

l - if

no

acur

ate

data

are

ava

ilabl

e: E

STIM

ATE

base

d on

initi

al

asse

ssm

ent

Num

ber o

f bir-

ths e

xpec

ted

Tota

l num

ber o

f birt

hs

expe

cted

in th

e pr

ojec

t/ca

tchm

ent a

rea

in a

gi

ven

time

perio

d

rang

es a

roun

d 2.

5 - 4

%

from

the

tota

l po

pula

tion

/ ye

ar

E.g.

2.5

% o

ut o

f 10,

000

pop.

=250

esti

mat

ed b

irth/

year

Estim

ated

no.

of b

irths

is m

atch

ing

with

the

no. o

f pr

egna

nt w

omen

in th

e co

mm

unity

. Th e

pro

port

ion

can

be >

2.5

% in

soci

etie

s with

a h

ighe

r fer

tility

rate

.

Asse

ssm

ent,

loca

l sta

ti-sti

cs,

EST

IMA-

TES

Cru

de D

eath

R

ate

Num

ber o

f all

deat

hs /

1,00

0 po

p. /

year

by

sex

in p

roje

ct /

catc

hmen

t ar

ea

11-1

5 / 1

,000

/ y

ear

Num

erat

or: N

umbe

r of t

otal

dea

th d

urin

g a

give

n tim

e pe

riod

Den

omin

ator

: Tot

al p

opul

atio

n in

the

com

mun

ity

(mid

-yea

r pop

ulat

ion)

dur

ing

the

sam

e pe

riod

May

com

pare

with

dai

ly o

r mon

thly

rate

s in

emer

gen-

cies

and

chr

onic

cris

es.

Prec

ondi

tion

is ex

isten

ce o

f an

emer

genc

y su

rvei

llanc

e sy

stem

, i.e

. coo

rdin

ate

and

com

mun

icat

e in

form

atio

n on

bod

y co

unts

and

mor

talit

y fi g

ures

bet

wee

n or

gani

-sa

tions

.

Dea

th ra

tes,

loca

l sta

ti-sti

cs,

body

cou

nts

23

* Th

e m

inim

um in

dica

tors

shou

ld h

elp

to g

ive

an o

vera

ll sit

uatio

n an

alys

is of

the

proj

ect a

rea

and

furt

her h

elp

to d

evel

op th

e pr

ojec

t pla

n. A

sses

smen

ts / S

urve

ys o

r a

revi

ew o

f nat

iona

l sta

tistic

s are

nec

essa

ry fo

r a c

onte

xt sp

ecifi

c sit

uatio

n an

alys

is

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

ceN

umbe

r of

heal

th fa

cilit

ies

(HF)

Prim

ary

Hea

lth C

are

Cen

tre (P

HC

): pr

o-vi

sion

of e

ssen

tial

drug

s, bi

rth

spac

ing,

Im

mun

isatio

n, A

NC

&

PNC

,Vit.

A, c

urat

ive

care

, hea

lth p

rom

otio

n,

wat

er, s

anita

tion

&

hygi

ene

Cen

tral

Hea

lth F

acili

-ty

: sam

e as

PH

C p

lus

min

or su

rger

y, bl

ood

tran

sfusio

n, la

bora

tory

1 Pr

imar

y H

ealth

Car

e C

entre

for

10,0

00 p

op.

1 C

entr

al

Hea

lth F

acili

-ty

for 5

0,00

0 po

p.

Dep

ends

ver

y m

uch

on th

e lo

cal a

nd c

ultu

ral c

onte

xt.

Get

info

rmat

ion

on c

ount

ry sp

ecifi

c he

alth

syste

m a

nd

the

serv

ices

pro

-vid

ed in

the

vario

us h

ealth

faci

litie

s (H

F). U

sual

ly th

ere

is a

prim

ary,

seco

ndar

y an

d te

rtia

ry

leve

l; th

e te

rtia

ry le

vel i

s a re

ferr

al c

entre

whe

re m

ost

spec

ialis

ed se

rvic

es a

re o

ff ere

d, th

e se

cond

ary

leve

l is

the

distr

ict h

ospi

tal w

here

em

erge

ncy

inte

rven

tion

and

som

e ge

nera

l ope

rativ

e se

rvic

es a

re o

ff ere

d. Th

ere

may

be

no

oper

atio

ns c

arrie

d ou

t at t

ertia

ry le

vel.

On

asse

ssm

ent i

t is u

sefu

l to

fi nd

out w

heth

er th

e H

F ha

s inp

atie

nt b

eds a

nd w

heth

er th

ey c

ondu

ct d

eliv

erie

s.

Nat

iona

l sta

tistic

s,H

IS d

ata

of

the

heal

th

faci

litie

s,pa

tient

re

cord

s, as

sess

men

t

Func

tiona

lity

of

Hea

lth S

yste

m

(faci

litie

s)

Prim

ary

Leve

lSe

cond

ary

leve

lTe

rtia

ry L

evel

Giv

e a

brie

f fun

ctio

nal d

escr

iptio

n of

the

heal

th fa

cili-

ties b

y co

nsid

erin

g: d

rugs

ava

ilabi

lity,

staffi

ng, s

ervi

ce

prov

ided

, use

r fee

s, fu

nctio

nalit

y of

refe

rral

s, eq

uip-

men

t, ge

ogra

phic

al d

istrib

utio

n, fu

ndin

g.

Supe

rviso

ry

chec

klist

s or

HF

chec

k lis

ts G

eogr

aphi

c Ac

cess

to h

ealth

fa

cilit

ies (

in %

of

tota

l pop

.)

Dist

ance

to H

F in

km

an

d w

alki

ng ti

me

in

perc

enta

ge

Th e

perc

en-

tage

of t

he

popu

latio

nliv

ing

< 5k

m

or w

ithin

one

ho

ur w

alk

to

the

HF

Num

erat

or: N

umbe

r of p

opul

atio

n liv

e <

5km

or l

ess

than

one

hou

r wal

k fro

m h

ealth

faci

lity

Den

omin

ator

: Tot

al ta

rget

pop

ulat

ion

NB

: HF

loca

ted

at a

long

er d

istan

ce m

ay b

e m

ore

easy

to

reac

h be

caus

e th

ey m

ay b

e sit

uate

d at

mai

n ro

ad

with

bus

and

taxi

serv

ices

ava

ilabl

e.

Geo

gra-

phic

al d

ata,

m

aps,

asse

ssm

ent

24

Hea

lth W

or-

ker C

over

age

prop

ortio

nal

to p

opul

atio

n (S

taff

dens

ity)

Th e

num

ber o

f hea

lth

prof

essio

nals

per p

opu-

latio

n

1 qu

alifi

ed

HW

/ 10

,000

po

p.

2 au

xilia

ry

nurs

es /

10,0

0010

CH

W /

10,0

00

1 m

edic

al d

oc-

tor /

10,

000

50,0

00 p

op.

Num

erat

or: N

umbe

r of m

edic

al d

octo

rs/n

urse

s/au

xil-

lary

nur

ses/

CH

W/m

idw

ives

Den

omin

ator

: Num

ber o

f pop

ulat

ion

and

then

mul

ti-pl

ied

by 1

0,00

0 or

50,

000

Che

ck st

aff e

stabl

ishm

ent v

ersu

s act

ual s

taff

pres

ent i

n th

e H

F.C

heck

no.

of e

ach

staff

cate

gory

ava

ilabl

e, in

clud

e m

idw

ifes a

nd th

eir s

tatu

s (on

ly m

idw

ife o

r nur

se &

m

idw

ife).

Get

info

rmat

ion

on n

o. o

f aux

iliar

y nu

rsin

g sta

ff an

d th

eir q

ualifi

cat

ion

and

lega

l com

pete

nces

.

Staff

list

s,lo

cal s

tati-

stics

H

F da

ta,

asse

ssm

ent

Wat

er a

vaila

bili-

ty/ p

erso

n / d

ayRe

gula

r ade

quat

e am

ount

of w

ater

ava

ila-

ble

daily

see

SPH

ERE

hand

book

, 20

04, p

. 64

Min

imum

of

15 l

/ per

son

/ day

Num

erat

or: L

itre

of w

ater

ava

ilabl

eD

enom

inat

or: T

otal

pop

ulat

ion

Key

indi

cato

r to

be a

djus

ted

to th

e co

ntex

t and

env

i-ro

nmen

t, i.e

. if r

esid

ent p

opul

atio

n is

used

to 5

ltr.

per

day,

the

IDPs

shou

ld g

et a

sim

ilar a

mou

nt Im

port

ant

aspe

ct fo

r the

ass

essm

ent i

s the

qua

ntity

of w

ater

av

aila

ble,

qua

lity

of w

ater

, and

wat

er so

urce

s suc

h as

su

rface

wat

er, w

ells

clos

ed o

r ope

n, p

iped

wat

er. M

eans

of

dist

ribut

ion,

wat

er tr

ucki

ng, r

eser

voir

are

impo

rtan

t in

form

atio

n to

o.

Asse

ssm

ent,

refe

renc

e do

cum

ents,

rapi

d ho

useh

old

asse

ssm

ent

25

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

ce

Acce

ss to

la

trin

esA

max

imum

of 2

0 pe

op-

le u

se o

ne la

trin

e / t

oile

t(s

epar

ated

by

men

and

w

omen

)

1 la

trin

e fo

r 20

per

sons

(n

ot m

ore

than

50

met

res f

rom

dw

ellin

gs)

best

optio

n is:

on

e la

trin

e pe

r fa

mily

Num

erat

or: T

otal

pop

ulat

ion

Den

omin

ator

: 20

popu

latio

n

Part

icip

atio

n of

loca

l pop

ulat

ion

esse

ntia

l in

desig

n an

d bu

ildin

g; re

spec

t cul

ture

and

cus

tom

and

ens

ure

sepa

rate

faci

litie

s for

wom

en a

nd m

en.

Tech

nica

l asp

ects

to b

e co

nsid

ered

like

gro

und

wat

er

leve

l; de

sign;

aff o

rdab

ility

; tec

hnic

ally

soun

d th

roug

hlo

cal a

vaila

ble

mat

eria

l.

Asse

ssm

ent,

tech

nica

l re-

fere

nce

and

stand

ards

Secu

rity

Situ

a-tio

n1.

no

rmal

ope

ratio

n2.

re

stric

ted

mov

e-m

ent /

pre

caut

ion

3.

min

imal

ope

ratio

n

Secu

rity

situa

tion

need

s to

be re

-ass

esse

d re

gula

rly.

Mak

e cl

ear r

efer

ence

to se

curit

y le

vels

as se

t in

the

par-

ticul

ar c

onte

xt. C

omm

unic

ate

to a

ll sta

ff m

embe

rs.

Con

text

an

alys

is (s

ee

Mal

tese

r In

tern

atio

-na

l sec

urity

gu

idel

ines

)Li

tera

cy ra

te(b

y se

x)%

of p

opul

atio

n lit

erat

e (b

y se

x)Th

is in

form

atio

n is

ofte

n av

aila

ble

in g

over

nmen

t offi

-ce

s or t

hrou

gh n

atio

nal s

tatis

tics.

Nat

iona

l sta

tistic

s,ho

useh

old

surv

eyH

DI

Aver

age

mon

th-

ly in

com

e pe

r pe

rson

Aver

age

inco

me

/ per

son

/ mon

thTh

is in

form

atio

n he

lps t

o es

timat

e th

e pu

rcha

sing

pow

-er

of t

he p

opul

atio

n. It

is u

sefu

l to

colle

ct in

form

atio

n on

mon

thly

sala

ries o

f typ

ical

func

tions

like

teac

her,

nurs

e, d

river

, uns

kille

d w

orke

r.

Nat

iona

l sta

tistic

s,ho

useh

old

Surv

ey

26

Gen

eral

gov

ern-

men

t exp

en-

ditu

re o

n he

alth

as

% o

f tot

al

gove

rnm

ent

expe

nditu

re /

year

Budg

et sp

ent a

nnua

lly

by th

e re

spec

tive

coun

-tr

y on

hea

lth a

s % o

f to

tal b

udge

t

NB

: Nee

d of

34

US$

/cap

ita a

re e

ssen

tial f

or b

asic

he

alth

car

e se

rvic

es (J

eff re

y Sa

chs,

Col

umbi

a U

nive

r-sit

y, N

ew Y

ork)

, but

in m

any

deve

lopi

ng c

ount

ries t

he

expe

nditu

re o

n he

alth

is le

ss th

an 1

0 U

S$/c

apita

/a.

Nat

iona

l sta

tistic

s,de

velo

pmen

t re

port

s,H

DI

U 5

mor

talit

y ra

teD

eath

of c

hild

ren

less

5

yrs.

/ 1,0

00 li

ve b

irths

/ y

ear

Aver

age:

Indu

stria

lised

cou

ntrie

s: 6

/ 1,0

00 li

ve b

irths

Dev

elop

ing

coun

trie

s:79

/ 1,

000

live

birt

hs

< 40

/ 1,

000

live

birt

hs /

year

Num

erat

or: D

eath

of c

hild

ren

unde

r 5 y

ears

in a

giv

en

time

perio

dD

enom

inat

or: N

umbe

r of l

ive

birt

h du

ring

the

sam

e tim

e pe

riod

Rem

ark:

Den

omin

ator

can

als

o be

the

tota

l num

ber

of c

hild

ren

< 5

yrs w

ithi

n th

e po

pula

tion

; mak

e de

nom

inat

or c

lear

whe

n re

port

ing.

Mon

thly

sta

tistic

s/ro

utin

e D

ata

Sour

ce,

loca

l HF

mor

bidi

ty

/ mor

talit

y da

ta,

HIS

Cru

de D

eath

R

ate

Num

ber o

f all

deat

hs /

1,00

0 po

p. /

year

OR

tota

l num

ber o

f de

ath

per d

ay p

er

10,0

00 p

opul

atio

n(s

ee u

nder

TO

P 6

Emer

-ge

ncy,

p. 1

1)

1,00

0 / y

ear

Num

erat

or: N

umbe

r of t

otal

dea

th d

urin

g a

give

n tim

e pe

riod

Den

omin

ator

: Tot

al p

opul

atio

n in

the

com

mun

ity

(mid

-yea

r pop

ulat

ion)

dur

ing

the

sam

e pe

riod

NB

: Dea

th ra

tes c

an re

late

to d

iff er

ing

time

perio

ds

and

diff e

ring

popu

latio

ns.

May

com

pare

with

dai

ly o

r mon

thly

rate

s in

emer

gen-

cies

and

chr

onic

cris

es.

Mon

thly

sta

tistic

s/ro

utin

e D

ata

Sour

ce

27

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

ce3.

EM

ERG

ENC

Y PH

ASE

(Che

ck c

ase

defi n

ition

and

stan

dard

repo

rtin

g fo

rms -

kee

p it

clea

r and

sim

ple)

Mor

talit

y

Dea

ths o

f U 5

ye

ars /

10,

000

/ day

Prop

ortio

n of

tota

l nu

mbe

r of d

eath

s < 5

yr

s per

10,

000

popu

lati-

on p

er d

ay

< 1

/ 10,

000

/ day

(pre

-cris

is ra

te

coul

d be

use

d)

Num

erat

or: D

eath

s of c

hild

ren

< 5

yrs.

X n

umbe

r of

days

Den

omin

ator

: Tot

al n

umbe

r of c

hild

ren

< 5

yrs d

u-rin

g sa

me

time

fram

e

NB

: Sen

sitiv

e pa

ram

eter

to a

n up

com

ing

crisi

s

Dai

ly st

atis-

tics f

rom

HF,

co

mm

unity

an

d ce

met

e-ry

staff

,bo

dy c

ount

s

All d

eath

s /

10,0

00 /

day

Cru

de M

orta

lity

Rat

e (C

MR

)

Prop

ortio

n of

tota

l nu

mbe

r of d

eath

s per

10

,000

pop

ulat

ion

per

day

< 0.

3-0.

5 /

10,0

00 /

day

Num

erat

or: A

ll de

aths

dur

ing

give

n tim

e pe

riod

Den

omin

ator

: Tot

al p

opul

atio

n du

ring

sam

e tim

e pe

riod

Dai

ly st

atis-

tics f

rom

HF,

co

mm

unity

an

d ce

met

e-ry

staff

Fo

od

Food

supp

lySu

ffi ci

ent f

ood

that

pe

ople

are

use

d to

of d

e-fi n

ed q

ualit

y is

avai

labl

e

2,10

0 kc

al /

pers

on /

day

Incl

. 12%

pro

tein

, 17%

fat,

thia

min

e, io

dine

salt,

Vit.

C

, nia

cin;

div

ersit

y of

food

shou

ld b

e m

ajor

inte

rven

-tio

n.C

onsid

er c

ultu

ral t

radi

tiona

l con

text

; foo

d in

take

be

havi

our.

Sphe

re st

anda

rds o

n fo

od a

nd fo

od se

curit

y to

be

appl

ied.

Asse

ssm

ent,

nu

triti

onal

su

rvey

28

Mal

nutr

ition

ra

te%

of c

hild

ren

with

gl

obal

(mod

erat

e pl

us

seve

re) m

alnu

triti

on

NB

: New

ant

hrop

ome-

tric

refe

renc

e da

ta h

ave

been

pub

lishe

d re

cent

ly

by W

HO

< 10

% in

ch

ildre

n 6-

59 m

onth

s

Num

erat

or: N

umbe

r of c

hild

ren

with

a Z

-sco

re -3

or

-2 (<

70%

or <

80%

of m

edia

n)D

enom

inat

or: N

umbe

r of c

hild

ren

< 59

mon

thN

B: W

eigh

t per

hei

ght;

Acut

e m

alnu

triti

on m

ay ri

se

with

out s

ubsta

ntia

l inc

reas

es in

mor

talit

y (4

.5).

Th e

caus

e of

and

the

exte

nt o

f mal

nutr

ition

nee

d to

be

un-

ders

tood

to c

hoos

e ap

prop

riate

resp

onse

. Con

sider

also

m

alnu

triti

on a

dole

scen

ts an

d ad

ults

in fa

min

e re

late

d em

erge

ncie

s.

Rap

id a

nth-

ropo

met

ric

surv

ey

Vita

min

A C

o-ve

rage

For s

uppl

emen

tatio

n:

< 1

yr. 4

00,0

00 IU

/ in

fi r

st ye

ar1-

5 yr

s. 20

0,00

0 IU

/ ev

ery

3 m

onth

sLa

ctat

ing

mot

hers

: 20

0,00

0 IU

afte

r birt

h

> 95

% c

o-ve

rage

Num

erat

or: C

hild

ren

in re

spec

tive

age

grou

ps re

ceiv

ed

Vita

min

AD

enom

inat

or: T

otal

chi

ldre

n in

resp

ectiv

e ag

e gr

oups

NB

: In

emer

genc

ies,

do n

ot w

aste

tim

e as

sess

ing

Vita

min

A d

efi c

ienc

y bu

t rat

her i

nclu

de V

itam

in A

in a

m

easle

vac

cina

tion

cam

paig

n.

Dai

ly /

wee

kly

stati-

stics

,cl

inic

al

asse

ssm

ent

Imm

unis

atio

n

Mea

sles V

acci

-na

tion

cove

rage

% o

f chi

ldre

n co

vere

dIf

avai

labl

e in

form

atio

n su

gges

t tha

t cov

erag

e w

as <

90%

, mea

sles

vacc

inat

ion

shou

ld b

e a

PRIO

RIT

Y.Se

e SP

HER

E ha

ndbo

ok,

2004

, p. 2

75

At le

ast 9

5%

of c

hild

-re

n ag

ed 6

m

onth

s to

15

year

s rec

eive

d m

easle

s vac

ci-

natio

n

Num

erat

or: N

umbe

r of c

hild

ren

imm

unise

d in

resp

ec-

tive

age

grou

pD

enom

inat

or: T

otal

num

ber o

f chi

ldre

n in

the

resp

ec-

tive

age

grou

ps im

mun

ised

NB

: Chi

ldre

n w

ith H

IV a

re m

ore

succ

eptib

le to

mea

s-le

s, th

eref

ore

ensu

re th

at th

ey re

ceiv

e tw

o do

ses.N

B:

Age

depe

nds o

n na

tiona

l pol

icy;

how

ever

, age

gro

up

shou

ld b

e ex

pand

ed w

here

rout

ine

mea

sles v

acci

natio

n is

low

; re-

vacc

inat

e at

9 m

onth

s; ot

her v

acci

natio

n ca

mpa

igns

can

be

adde

d ac

cord

ingl

y.

Dai

ly /

wee

kly

stati-

stics

29

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

ceVa

ccin

atio

n co

vera

gePr

opor

tion

of C

hild

ren

imm

unise

d ag

ains

t M

easle

s, D

PT, P

olio

, BC

G a

nd H

epat

itis B

(a

nd a

dditi

onal

vac

cine

such

as Y

ellow

feve

r or

Japa

nese

Ence

phal

itis

acco

rdin

g to

the r

espec

tive

coun

try p

roto

col)

> 90

%N

umer

ator

: Num

ber o

f chi

ldre

n im

mun

ised

with

re

spec

tive

antig

ens

Den

omin

ator

: Tot

al n

umbe

r of c

hild

ren

in th

e re

spec

-tiv

e ag

e gr

oup

NB

: Fol

low

Nat

iona

l pro

toco

l for

EPI

. Rep

ort o

n an

ti-ge

n co

vera

ge ra

te a

nd/o

r EPI

cov

erag

e ra

te.

Rout

ine

Dat

a So

urce

,EP

I cha

rts,

hous

ehol

d su

rvey

Com

mun

icab

le d

isea

se c

ontr

ol a

nd p

ublic

hea

lth

issu

es

Dise

ase

Con

trol

Iden

tify

outb

reak

th

resh

old

for r

elev

ant

com

mun

icab

le d

iseas

es

in th

e re

gion

.

Defi

ne

outb

reak

al

ert l

evel

s (th

resh

old

or

inde

x ca

se)

A qu

antifi

ed

defi n

ition

of o

utbr

eaks

for a

ll di

seas

es

does

not

exi

st. H

owev

er, i

f the

num

ber i

ncre

ases

hig

her

than

exp

ecte

d in

a d

efi n

ed p

opul

atio

n an

d de

fi ned

ge

ogra

phic

al a

rea,

it m

ay in

dica

te a

n ou

tbre

ak.

For t

he fo

llow

ing

dise

ases

a si

ngle

cas

e m

ay in

dica

te a

n ou

tbre

ak: c

hole

ra, m

easle

s, ye

llow

feve

r, sh

igel

la, v

iral

haem

orrh

agic

feve

r and

men

ingo

cocc

al m

enig

itis.

Epid

emio

lo-

gica

l dat

a,co

ordi

natio

n,H

IS

Mor

bidi

tyM

alar

iaN

umbe

r of p

ositi

ve c

on-

fi rm

ed te

sted

mal

aria

ca

ses i

n pr

opor

tion

to

popu

latio

n (in

per

cent

)

Prev

ent

incr

ease

of

mal

aria

cas

es

and

resp

ond

to o

utbr

eaks

Num

erat

or: N

umbe

r of c

ases

with

a p

ositi

ve m

alar

ia

smea

r or r

apid

test

in a

giv

en ti

mef

ram

eD

enom

inat

or: T

otal

pop

ulat

ion

Loca

l mal

aria

epi

dem

iolo

gy n

eeds

to b

e an

alys

ed re

fer-

ring

to m

obid

ity, p

atte

rns o

f tra

nsm

issio

n, p

reve

ntio

n an

d tre

atm

ent.

Dai

ly /

wee

kly

stati-

stics

,as

sess

men

t an

d cl

inic

al

data

of H

F

30

Acce

ss to

long

-la

sting

inse

ctic

i-da

l net

s

No.

of h

ouse

hold

s tha

t ha

ve a

t lea

st on

e im

p-re

gnat

ed n

et.

Net

s are

ava

ilabl

e in

di

ff ere

nt si

zes s

o th

at a

ll ho

useh

old

mem

bers

are

pr

otec

ted.

Full

cove

rage

of

all

peop

le

at ri

sk o

f m

alar

ia

Num

erat

or: N

umbe

r of h

ouse

hold

s rec

eive

d lo

ng-

lasti

ng-im

preg

nate

d ne

tsD

enom

inat

or: T

otal

num

ber o

f hou

seho

lds

NB

: Ide

ntify

risk

gro

ups a

nd se

t prio

ritie

s for

LLI

Ns

distr

ibut

ion;

Sca

ling

up o

f mal

aria

pre

vent

ion

thro

ugh

free

or

high

ly su

bsid

ized

dis

trib

utio

n of

LL

INs e

ithe

r di

rect

ly o

r th

roug

h vo

uche

rs a

ccom

pa-

nied

wit

h in

form

atio

n se

ssio

ns o

n ut

ilisa

tion

.

Long

-lasti

ng in

sect

icid

es (L

LIT

N) r

ecco

men

ded

by

WH

O a

re P

erm

aNet

® &

Oly

sset

Net

® with

a b

iolo

gica

l effi

cac

y of

at l

east

thre

e ye

ars.

Posit

ion

pape

r WH

O: h

ttp://

ww

w.w

ho.in

t/mal

aria

/do

cs/it

n/IT

Nsp

ospa

perfi

nal.p

df

Wee

kly

statis

tics,

hous

ehol

d su

rvey

,sp

ot c

heck

s &

cou

ntin

g

Shig

ella

dys

en-

tery

cas

e fa

talit

y ra

te

No.

of p

ositi

ve c

onfi r

-m

ed te

sted

case

s die

d

No.

of c

ases

with

blo

ody

diar

rhoe

a di

ed

See

SPH

ERE

hand

book

, 20

04, p

. 281

< 1%

of S

hi-

gella

cas

esN

umer

ator

: Num

ber o

f pos

itive

teste

d Sh

igel

la in

fec-

tions

in a

giv

en ti

me

perio

d di

edD

enom

inat

or: N

umbe

r of

tota

l sh

igel

la c

ases

NB

: Man

y ou

tbre

aks h

ave

occu

rred

in S

ub-S

ahar

an

Afric

a an

d w

ere

the

mai

n ca

use

of d

eath

.

Onc

e Sh

igel

la h

as b

een

iden

tifi e

d in

an

emer

genc

y, it

can

be a

ssum

ed th

at b

lood

y di

arrh

oea,

i.e.

dys

ente

ry

case

s are

cau

sed

by sh

igel

la.

Che

ck se

nsiti

vity

/ re

sista

nce

of a

ntib

iotic

s.

Dai

ly /

wee

kly

stati-

stics

,la

bora

tory

te

sts fo

r di-

agno

sis a

nd

sens

itivi

ty o

f an

tibio

tics,

coor

dina

tion

31

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

ceC

hole

ra c

ase

fata

lity

rate

No.

of c

ases

with

“ric

e w

ater

dia

rrho

ea”

died

(the

colo

r doe

s not

ne-

cess

arily

look

onl

y lik

e ‚ri

ce w

ater

‘; th

e co

lor c

an

be y

ello

w o

r gre

enas

wel

l)

See

SPH

ERE

hand

book

, 20

04, p

. 281

-282

< 1%

of c

hole

-ra

cas

esN

umer

ator

: Num

ber o

f cas

es w

ith “r

ice

wat

er d

iar-

rhoe

a” in

a g

iven

tim

e pe

riod

died

Den

omin

ator

: Num

ber o

f tot

al c

hole

ra c

ases

dur

ing

the

sam

e tim

e pe

riod

NB

: Cho

lera

is a

sens

itive

dia

gnos

e fo

r a re

gion

or

coun

try

aff e

cted

. Con

fi rm

atio

n by

labo

rato

ry is

of

grea

t im

port

ance

. Onc

e co

nfi rm

ed fo

r som

e ca

ses,

it ca

n be

ass

umed

that

the

case

s of w

ater

y di

arrh

oea

are

chol

era

case

s.

Dai

ly /

wee

kly

stati-

stics

,la

bora

tory

te

sts,

clin

ical

as

sess

men

t,co

ordi

natio

n

Mor

bidi

ty

Men

ingo

cocc

al

Men

ingi

tis

No.

of p

ositi

ve c

onfi r

-m

ed te

sted

case

s

See

SPH

ERE

hand

book

, 20

04, p

. 281

-283

Stra

tegy

in o

utbr

eak:

pr

even

t dea

th w

ith c

ase

man

agem

ent;

prev

en-

tion

of n

ew c

ases

with

re

activ

e im

mun

isatio

n (K

ey m

essa

ge 5

, p.1

7)

< 5

case

s / 1

00,0

00 /

wee

k (d

e-pe

nds o

n re

gion

)

Num

erat

or: N

umbe

r of M

M c

ases

in a

giv

en ti

me

perio

dD

enom

inat

or: T

otal

pop

ulat

ion

NB

: Dur

ing

outb

reak

s, ca

se fa

talit

y ra

tes c

an b

e as

hig

h as

20%

or m

ore.

Aler

t thr

esho

ld in

Afri

can

Belt:

5 c

ases

/ 10

0,00

0 /

wee

kEp

idem

ic in

Afri

can

Belt:

> 1

0 ca

ses /

100

,000

/ w

eek

Dai

ly /

wee

kly

statis

tic,

clin

ical

as

sess

men

t,co

ordi

natio

n

Wat

ery

diar

-rh

oea

in c

hild

-re

n <

5 ye

ars

No.

of c

hild

ren

< 5

yrs.

with

> 3

tim

es w

ater

y di

arrh

oea

in 2

4 ho

urs

< 10

0 ca

ses

/ per

1,0

00

child

ren

< 5

yrs.

Num

erat

or: N

umbe

r of c

hild

ren

< 5

yrs.

with

wat

ery

diar

rhoe

a in

a g

iven

tim

e pe

riod

Den

omin

ator

: Tot

al n

umbe

r of c

hild

ren

< 5

yrs.

in th

e sa

me

time

perio

d

Dai

ly /

wee

kly

stati-

stics

32

Wat

er

Wat

er q

ualit

yN

umbe

r of

col

iform

ba

cter

ia in

100

ml fi

lte-

red

wat

erSe

e SP

HER

E ha

ndbo

ok,

2004

, p. 6

6-67

, wat

er

qual

ity E

CH

O G

uide

-lin

e

No

faec

al

colif

orm

es

per 1

00 m

l at

poin

t of

deliv

ery

Che

ck w

ater

qua

lity

alon

g th

e su

pply

cha

in –

mai

nly

at

the

poin

t of u

se.

NB

: Ens

ure

qual

ity w

ith a

disi

nfec

tant

so th

at th

ere

is a

free

chlo

rine

resid

ual a

t the

tap

of 0

.5 m

g pe

r litr

e an

d tu

rbid

ity is

bel

ow 5

NT

U.

Mon

thly

/bi

-mon

thly

sc

reen

ing,

asse

ssm

ent

Jerr

y C

an a

vaila

-bi

lity

Jerr

y C

ans a

vaila

ble

for

each

hou

seho

ldSe

e SP

HER

E ha

ndbo

ok,

2004

, p. 6

9

Each

ho

useh

old

has

at le

ast t

wo

10-2

0 lit

re

Jerr

y C

ans

Num

erat

or: N

umbe

r of 2

0 l J

erry

Can

s ava

ilabl

eD

enom

inat

or: N

umbe

r of h

ouse

hold

sH

ouse

hold

su

rvey

,as

sess

men

t

Dist

ance

to n

ext

wat

er d

istrib

uti-

on p

oint

Dist

ance

to th

e ne

xt

wat

er d

istrib

utio

n po

int

shou

ld n

ot b

e m

ore

than

15

min

utes

wal

kSe

e S

PHER

E ha

nd-

book

200

4, p

. 63

< 50

0 m

.N

umbe

r of f

amili

es w

ho w

alk

< 50

0 m

. to

wat

er p

oint

pe

r tot

al n

o. o

f fam

ilies

Geo

grap

hi-

cal s

urve

y,as

sess

men

t

Num

ber o

f di

strib

utio

n po

ints

Dist

ribut

ion

poin

ts w

hich

pro

vide

safe

and

ad

equa

te W

ater

See

SPH

ERE

hand

-bo

ok, 2

004,

p. 6

5 gu

idan

ce n

ote

One

dist

ribu-

tion

poin

t for

25

0 pe

ople

Num

erat

or: T

otal

pop

ulat

ion

Den

omin

ator

: 250

Po

pula

tion

estim

ates

, as

sess

men

t

33

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

ce

Hyg

iene

& S

anit

atio

n

Han

d w

ashi

ng

know

ledg

e%

of p

erso

ns w

ashi

ng

thei

r han

ds a

t lea

st at

3

of th

e 5

criti

cal t

imes

per d

ay

Han

d w

ashi

ng

at le

ast 3

of

the

5 cr

itica

ltim

es p

er d

ay

Num

erat

or: n

umbe

r of r

espo

nden

ts w

ashi

ng h

ands

at

leas

t 3 ti

mes

dai

lyD

enom

inat

or: n

umbe

r of s

urve

ypa

rtic

ipan

ts

Crit

ical

Tim

es:

1.

Afte

r def

ecat

ing

2.

Befo

re e

atin

g3.

Af

ter c

hang

ing

diap

ers

4.

Befo

re p

repa

ring

food

5.

Befo

re fe

edin

g in

fant

Hou

seho

ld

Surv

ey,

obse

rvat

ion

Repo

rts

of C

HW

an

d ho

me

visit

ors

Dia

rrho

ea

Tran

smiss

ion

Kno

wle

dge

% o

f res

pond

ents

kno-

win

g at

leas

t tw

o w

ays

to p

reve

nt d

iarr

hoea

Resp

onde

nts

know

at l

east

two

way

s to

prev

ent d

iar-

rhoe

a

Num

erat

or: n

umbe

r of r

espo

nden

ts kn

owin

g at

leas

t 2

prev

entio

n m

etho

dsD

enom

inat

or: n

umbe

r of s

urve

y pa

rtic

ipan

ts

NB

: Tra

nsm

issio

n Ro

utes

: “F”

Dia

gram

= co

ntam

ina-

ted

fi eld

s, fl u

ids,

fl ies

, fi n

gers

and

food

Hou

seho

ld

Surv

ey,

exit

inte

r-vi

ews a

t HF,

esta

blish

w

ater

safe

ty

plan

s.Ac

cess

to so

apSo

ap is

ava

ilabl

e in

su

ffi ci

ent q

uant

ities

See

SPH

ERE

hand

book

, 20

04, p

. 69

250

mg

bar o

f so

ap /

pers

on

/ mon

th

Can

be

less

soap

; also

dep

ends

on

the

purc

hasin

g po

wer

an

d th

e m

arke

t situ

atio

nH

ouse

hold

su

rvey

OR

di

strib

utio

n re

giste

r

34

Acce

ss to

gen

der

sens

itive

ba-

thin

g fa

cilit

ites

for m

en a

nd

wom

en

See

SPH

ERE

hand

-bo

ok, 2

004,

p.6

9-70

Num

ber,

loca

tion

and

desig

n de

pend

s on

the

need

s.

Shou

ld b

e di

scus

sed

with

com

mun

ity a

nd sp

ecifi

cally

w

ith w

omen

and

ado

lesc

ent g

irls o

r wom

en o

rgan

isa-

tions

.

Com

mun

ity

surv

ey,

map

ping

obse

rvat

ion

repo

rts o

f C

HW

and

ho

me

visit

orW

ashi

ng b

asin

sTh

ere

is at

leas

t one

w

ashi

ng b

asin

ava

ilabl

e fo

r 100

peo

ple

See

SPH

ERE

hand

book

, 20

04, p

.69

1 ba

sin p

er

100

popu

la-

tion

Num

erat

or: T

otal

pop

ulat

ion

Den

omin

ator

: 100

NB

: Lau

nder

ing

area

s sho

uld

be a

vaila

ble

for w

omen

to

was

h an

d dr

y un

derg

arm

ents

and

sani

tary

clo

thes

.

Hou

seho

ld

surv

ey

Latr

ine

cove

rage

Latr

ine/

toile

t per

20

peop

le

See

SPH

ERE

hand

book

, 20

04, p

.71-

75

1 la

trin

e pe

r 20

per

sons

Fo

r hea

lth

faci

litie

s: 1

latr

ine

for 2

0 in

patie

nts o

r 50

out

patie

nts

Num

erat

or: P

opul

atio

nD

enom

inat

or: 2

0 O

R n

o. o

f bed

s in

HF

or n

o. O

PD

case

s in

a da

y

Map

ping

obse

rvat

ion,

da

ta

Envi

ronm

ent/

Vec

tor

Con

trol

Area

was

te

man

agem

ent

Abou

t 10-

15 fa

mili

es

have

acc

ess t

o re

fuse

bin

co

ntai

ner n

ot m

ore

than

100

met

re fr

om

thei

r hou

seSe

e SP

HER

E ha

ndbo

ok,

2004

, p. 8

3-85

At le

ast o

ne

100

litre

refu

-se

bin

co

ntai

ner f

or

10 fa

mili

es

Num

erat

or: N

umbe

r of f

amili

esD

enom

inat

or: 1

0 O

R 1

5C

omm

unity

su

rvey

35

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

ceC

omm

unity

w

aste

man

age-

men

t

Fina

l disp

osal

are

a1

refu

se p

it

2m x

5m

de

ep p

er 5

00

pers

ons

Shou

ld b

e di

scus

sed

with

com

mun

ity; p

refe

rabl

y ou

t-sid

e co

mm

unity

.

Che

ck a

vaila

bilit

y, sa

fety

and

pro

tect

ion

of th

e ar

ea.

Com

mun

ity

surv

ey,

obse

rvat

ion

repo

rts

Med

ical

was

te

man

agem

ent

Inci

nera

tor f

or sa

fe d

is-po

sal o

f all

med

ical

was

te a

vaila

ble

1 in

cine

rato

r pe

r hea

lthfa

cilit

y

Che

ck a

vaila

bilit

y an

d fu

nctio

n of

inci

nera

tor.

Com

mun

ity

/ hos

pita

l su

rvey

Mos

quito

net

co

vera

ge (l

ong-

lasti

ng

inse

ctic

idal

net

s)

No.

of L

LIN

s dist

ribu-

ted

1 ne

t / 2

-3

pers

ons

Get

qua

ntifi

ed in

form

atio

n on

whe

ther

peo

ple

are

used

to L

LIN

s bef

ore

distr

ibut

ion

(see

gui

danc

e no

te

Com

mun

icab

le D

iseas

e/Pu

blic

Hea

lth a

bove

).

Year

ly

hous

ehol

d su

rvey

s

Den

gue

cont

rol

by C

onta

iner

In

dex

(CI)

or

Hou

seho

ld

Inde

x (H

I)

% o

f wat

er h

oldi

ng

cont

aine

rs in

feste

d w

ith la

rvae

or p

upae

(O

R h

ouse

s inf

este

d by

la

rvae

)

CAV

EAT:

CI a

nd H

I do

pro

vide

info

rmat

ion

on th

e ge

nera

l dist

ribu-

tion

but d

o no

t pro

vide

in

form

atio

n on

the

dyna

mic

of t

he d

iseas

e.

Of t

he sc

ree-

ned

cont

aine

r, le

ss th

an 1

0%

are

cont

ami-

nate

d w

ith

aede

s agy

pti

Num

erat

or: N

umbe

r of c

onta

iner

s inf

este

d w

ith la

rvae

or

pur

pae

Den

omin

ator

: Num

ber o

f con

tain

ers i

nspe

cted

NB

: For

Hou

seho

ld In

dex

the

num

bers

of h

ouse

s inf

es-

ted

divi

ded

by n

umbe

r of h

ouse

s che

cked

; mul

tiplie

d by

100

Mon

thly

su

rvey

s of

wat

er c

onta

i-ne

rs

36

Site

pla

nnin

g

Spac

e fo

r she

lter,

hous

ing

and

serv

ices

Area

for c

amp

cons

truc

-tio

n av

aila

ble

divi

ded

by

popu

latio

n

See

SPH

ERE

hand

book

, 20

04, p

. 215

-218

45 sq

m. /

pe

rson

with

at

leas

t 2m

bet

-w

een

shel

ters

Incl

udin

g al

l pub

lic p

lace

s exc

ept g

arde

n ar

eaC

omm

unity

su

rvey

,sit

e in

spec

-tio

n

Shel

ter

Cov

ered

Sh

elte

rSe

e SP

HER

E ha

ndbo

ok,

2004

, p. 2

19-2

213.

5 sq

m /

pers

onM

ater

ial s

houl

d be

ado

pted

to th

e sit

uatio

n su

ch a

s w

inte

rized

tent

s in

cold

clim

ates

.C

omm

unity

su

rvey

,sit

e in

spec

-tio

nEm

erge

ncy

tem

-po

rary

shel

ter

4m x

6m

sh

eet (

tarp

au-

lins)

per

ho

useh

old

of

5 pe

ople

Th is

is a

quic

k in

itial

shor

t-ter

m so

lutio

n fo

r acu

te

emer

genc

ies.

It ha

s to

be re

plac

ed b

y sh

elte

r acc

ordi

ng

to m

inim

um st

anda

rds a

s soo

n as

pos

sible

.

Com

mun

ity

surv

ey

Prof

essi

onal

staff

dep

loye

d

Num

ber o

f co

mm

unity

he

alth

wor

kers

1 C

HW

/ 1,

000

popu

la-

tion

Ensu

re fe

mal

e sta

ff C

HW

can

be

trai

ned

on si

te.

Staff

reg

ister

, as

sess

men

t

Num

ber o

f tr

aine

d bi

rth

atte

ndan

ts

1 tr

aine

d bi

rth

atte

ndan

t /

2,00

0 po

pula

-tio

n

Trad

ition

al m

idw

ives

are

NO

T in

clud

ed.

Che

ck n

o. o

f del

iver

ies a

ssist

ed b

y T

BA/m

onth

!

Staff

reg

ister

, as

sess

men

t

37

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

ceN

umbe

r of

qual

ifi ed

hea

lth

wor

kers

(clin

i-ci

an)

See

SPH

ERE

hand

book

20

04, p

. 266

1 qu

alifi

ed

heal

th w

orke

r fo

r 50

cons

ul-

tatio

ns /

day

Ensu

re fe

mal

e sta

ff - q

ualifi

ed

heal

th w

orke

rs a

re p

ro-

fess

iona

l nur

ses,

med

ical

doc

tors

or m

edic

al a

ssist

ants.

Staff

reg

ister

, as

sess

men

t

Num

ber o

f la

bora

tory

tech

-ni

cian

s

1 la

bora

tory

te

chni

cian

/ 10

,000

pop

.

Staff

reg

ister

, as

sess

men

t

Num

ber o

f in

patie

nt h

ealth

fa

cilit

ies

1 ce

ntra

l he

alth

faci

lity

/ 10,

000

pop.

Num

ber o

f HF

with

inpa

tient

bed

s and

tota

l num

ber

of b

eds p

er H

F to

be

asse

ssed

.H

ealth

au

thor

ities

, as

sess

men

tN

umbe

r of

heal

th c

entre

s1

heal

th c

en-

tre /

10,0

00

pop.

Hea

lth

auth

oriti

es,

asse

ssm

ent

Num

ber o

f se

nior

cam

p m

anag

ers

1 ca

mp

man

a-ge

r / 1

0,00

0 po

p.

Staff

reg

ister

, as

sess

men

t

Cas

e M

anag

emen

t

Stan

dard

ised

es-

sent

ial d

rug

list

is es

tabl

ished

by

the

lead

hea

lth

auth

ority

Esse

ntia

l dru

gs th

at

satis

fy th

e pr

imar

y he

alth

car

e ne

eds o

f the

po

pula

tion.

See:

EC

HO

FPA

on

proc

urem

ent o

f med

i-ci

nes

Esse

ntia

l D

rug

list

used

Esse

ntia

l med

icin

es a

re se

lect

ed w

ith d

ue re

gard

to

dise

ase

prev

alen

ce, e

vide

nce

on e

ffi ca

cy a

nd sa

fety

, and

co

st-eff

ect

iven

ess.

Esse

ntia

l med

icin

es a

re a

vaila

ble

with

in th

e co

ntex

t of f

unct

ioni

ng h

ealth

syste

ms a

t all

times

in a

dequ

ate

amou

nts,

in th

e ap

prop

riate

dos

age

form

s, w

ith a

ssur

ed q

ualit

y, an

d at

a p

rice

the

indi

vidu

-al

and

the

coom

unity

can

aff o

rd.

Nat

iona

l gu

idel

ine

38

Stan

dard

ised

case

man

age-

men

t pro

toco

ls

are

avai

labl

e

Cas

e m

anag

emen

t gu

idel

ines

are

bas

ed o

n di

seas

e pa

ttern

s, av

aila

bilit

y of

dia

g-no

stics

and

trea

tmen

t op

tions

.

Cas

e m

anag

e-m

ent e

stabl

is-he

d an

d us

ed

Nat

iona

l tre

atm

ent g

uide

lines

nee

d to

be

resp

ecte

d an

d fo

llow

ed. a

ll ac

tors

hav

e to

col

lect

rele

vant

info

rmat

ion.

Th

ere

mig

ht b

e a

need

to c

heck

effi

cacy

of m

edic

ines

an

d re

sista

nce

patte

rn.

Nat

iona

l Tr

eatm

ent

prot

ocol

s

4. H

EALT

H S

YST

EM A

ND

IN

FRA

STR

UC

TU

RE

Out

patie

nt

utili

satio

n ra

teN

umbe

r of N

EW c

ases

O

R v

isits

/ pop

ulat

ion

/ yea

rN

B: E

xpec

t 50

– 10

0 ne

w c

onsu

ltatio

ns /

10,0

00 p

er d

ay

See

SPH

ERE

hand

book

20

04, p

. 302

0.5

– 1

new

ca

se O

R v

isit

/ pop

ulat

ion

/ yea

r

Num

erat

or: N

umbe

r of n

ew c

ases

OR

new

visi

ts in

on

e w

eek

x 52

Den

omin

ator

: To

tal p

opul

atio

n

Very

goo

d in

dica

tor t

o as

sess

acc

ess t

o he

alth

serv

ices

an

d to

pla

n no

. of p

atie

nts t

o be

exp

ecte

d in

a H

F.

Util

isatio

n ra

te v

arie

s and

may

get

up

to 5

in a

cute

em

erge

ncie

s and

in a

refu

gee

cam

p sit

uatio

n.

Mon

thly

St

atist

ics a

nd

HF

patie

nt

reco

rds

Bed

occu

panc

y ra

teAc

tual

util

izatio

n of

a

inpa

tient

hea

lth fa

cilit

y fo

r a g

iven

tim

e pe

riod

expr

esse

d in

per

cent

> 80

%N

umer

ator

: Sum

of d

aily

inpa

tient

s for

365

day

sD

enom

inat

or: B

ed d

ays a

vaila

ble

(num

ber o

f bed

s x

365

days

)R

emar

k: I.

e. a

dmiss

ion

in th

e ev

e ni

ng a

nd d

ischa

rged

ne

xt m

orni

ng c

ount

s 2 d

ays!

Con

sider

to c

ombi

ne w

ith A

LS (a

vera

ge le

ngth

of s

tay)

to

get

the

real

pic

ture

.

Mon

thly

St

atist

ics

39

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

ce

Num

ber o

f tra

i-ne

d he

alth

staff

/

popu

latio

n

Num

ber o

f qua

lifi e

d sta

ff re

com

men

ded

to

mee

t the

nee

ds w

ithin

PH

C se

rvic

e pr

ovisi

on

for t

he p

opul

atio

n

See

SPH

ERE

hand

book

20

04, p

. 266

-267

Prim

ary

Hea

lth C

en-

tre: m

in. 2

- 5

skill

ed st

aff

Cen

tral

H

ealth

Fac

ili-

ty: m

inim

um

5 sk

illed

staff

Ensu

re e

qual

bal

ance

of f

emal

e: m

ale

heal

th w

orke

rs

and

appr

opria

te sk

ills m

ix.

Are

the

posts

of t

he st

aff e

stabl

ishm

ent fi

lled

or v

acan

t?

Staff

esta

-bl

ishm

ent,

staff

lists

and

staff

pres

ent

in th

e H

F

Con

sulta

tion

per s

kille

d he

alth

wor

ker

(by

doct

or,

clin

ical

ass

istan

t, nu

rse)

No.

of c

onsu

ltatio

ns

divi

ded

by sk

illed

hea

lth

wor

ker w

orki

ng fu

ll tim

e in

hea

lth fa

cilit

y pe

r day

Not

mor

e th

an 5

0 co

n-su

ltatio

n / d

ay

Num

erat

or: N

umbe

r of a

ll co

nsul

tatio

ns /d

ayD

enom

inat

or: N

umbe

r of s

kille

d he

alth

wor

kers

/day

A sk

illed

hea

lth w

orke

r sho

uld

not c

onsu

lt m

ore

than

50

pat

ient

s per

day

. If t

his t

hres

hold

is e

xcee

ded

mor

e sta

ff ne

eds t

o be

recr

uite

d.

Mon

thly

St

atist

ics,

staff

esta

b-lis

hmen

t

Num

ber o

f sta

ff re

ceiv

ed tr

ai-

ning

per

yea

r

Hea

lth c

are

staff

are

trai

ned

and

supe

rvise

d in

the

rele

vant

topi

cs

At le

ast o

ne

trai

ning

per

sta

ff pe

r yea

r

Hea

lth w

orke

rs sh

ould

hav

e th

e pr

oper

trai

ning

and

sk

ills f

or th

eir l

evel

of r

espo

nsib

ility

. Hea

lth p

rovi

ders

ha

ve th

e ob

ligat

ion

to tr

ain

staff

to e

nsur

e th

eir k

now

-le

dge

is up

-to-d

ate W

here

pos

sible

trai

ning

shou

ld b

e sta

ndar

dise

d an

d lin

ked

to n

atio

nal p

rogr

amm

es.

Staff

list

s,H

F re

cord

s

5. R

EPR

OD

UC

TIV

E H

EALT

H I

ND

ICAT

OR

S &

MO

RTA

LIT

Y R

ATES

Age-

spec

ifi c

fert

ility

rate

Num

ber o

f liv

e bi

rths

in

each

age

gro

up d

ivid

ed

by th

e to

tal f

emal

e po

-pu

latio

n (in

thou

sand

s)

No

targ

et

defi n

ed.

Fert

ility

rate

s ar

e hi

gh in

Rat

e gi

ven

per t

hous

and

wom

en in

the

part

icul

ar a

ge

grou

p. V

arie

s fro

m a

ppro

x. 1

00 fo

r the

age

gro

up 1

5 –

19 y

ears

ove

r 300

for t

he a

ge 2

5 –

29 a

nd b

elow

100

fo

r the

age

gro

up o

lder

45

year

s.

Nat

iona

l an

din

tern

atio

nal

data

40

in e

ach

5 ye

ar a

ge g

roup

deve

lopi

ng

coun

trie

s and

w

ithin

pov

er-

ty c

onte

xt

Anal

yse

in d

evel

opm

ent c

onte

xt li

nkin

g w

ith U

5 m

or-

talit

y an

d m

ater

nal m

orta

lity.

Tota

l fer

tility

ra

teN

umbe

r of c

hild

ren

born

to a

wom

en d

urin

g he

r life

time

(glo

bal

aver

age

is 2.

6)

No

targ

etVa

ries f

rom

cou

ntry

to c

ount

ry: h

ighe

st in

Mal

i with

7.

34 a

nd lo

w in

Ger

man

y w

ith 1

.41.

Anal

yse

in d

evel

opm

ent c

onte

xt li

nkin

g w

ith U

5 m

or-

talit

y an

d m

ater

nal m

orta

lity.

Nat

iona

l an

din

tern

atio

nal

data

Birt

h ra

teN

umbe

r of b

irth

per

1,00

0 po

pula

tion

per

year

(glo

bal a

vera

ge is

20

.19)

No

targ

et

Birt

h ra

te is

a

good

pro

xy

for e

stim

ates

on

pop

ulat

ion

grow

th.

Annu

al b

irth

rate

can

be

expr

esse

d in

per

cent

age:

glo

-ba

lly 2

.02%

, Afg

hani

stan

4.50

%, K

enya

3.8

9%,

Indi

a 2.

2%.

Use

birt

h ra

te to

esti

mat

e no

.pf p

regn

anci

es a

nd d

eliv

e-rie

s to

be e

xpec

ted.

Anal

yse

in d

evel

opm

ent c

onte

xt li

nkin

g w

ith U

5 m

or-

talit

y an

d m

ater

nal m

orta

lity.

Nat

iona

l an

din

tern

atio

nal

data

41

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

ceH

IV S

erop

reva

-le

nce

and

inci

-de

nce

(che

ck fo

r sp

ecifi

c gr

oups

: ag

e gr

oup,

pre

g-na

nt w

omen

, ID

U, C

SW e

tc)

% o

f a sp

ecifi

ed p

op.

who

se b

lood

tests

are

H

IV p

ositi

ve (r

epor

t as

prev

alen

ce o

r inc

iden

ce)

Typi

cal s

entin

el su

rvey

ar

e in

clud

ing

preg

nant

w

omen

atte

ndin

g AN

C

visit

s, pa

tient

s in

STI

clin

ics,

bloo

d do

nors

. Th

e pr

eval

ence

in th

ese

grou

ps sh

ow a

tren

d ov

er y

ears

.

Prev

ent a

nd

redu

ce fu

rthe

r tr

ansm

issio

n of

HIV

PR

EVA

LEN

CE:

Num

erat

or: N

umbe

r of p

erso

ns w

ith a

pos

itive

HIV

sta

tus i

n th

e sp

ecifi

c gr

oup

Den

omin

ator

: Tot

al n

umbe

r of s

peci

fi c g

roup

inve

sti-

gate

d (a

ge g

roup

, pre

gnan

t wom

en e

tc.)

INC

IDEN

CE:

Num

erat

or: N

umbe

r of N

EW p

erso

ns w

ith a

pos

itive

H

IV st

atus

in th

e sp

ecifi

c gr

oup

(coh

ort)

durin

g gi

ven

time

fram

eD

enom

inat

or: T

otal

num

ber o

f spe

cifi c

gro

up (c

ohor

t) fo

llow

ed o

ver s

ame

time

perio

d (a

ge g

roup

, pre

gnan

t w

omen

etc

.)N

B: H

IV d

ata

are

sens

itive

dat

a. M

ake

sure

that

they

ar

e us

ed a

ppro

pria

tely.

Nat

iona

l sta

tistic

s and

H

IS

Inci

denc

e an

d pr

eva-

lenc

e da

ta

are

offi c

ially

re

port

ed b

y go

vern

men

ts.

STI p

reva

lenc

e (1

5-49

)%

of p

op. a

ged

15-4

9 tre

ated

for S

TIs

< 1%

Num

erat

or: N

umbe

r of p

erso

ns tr

eate

d in

the

age

15-

49 fo

r ST

Is in

a sp

ecifi

c tim

e pe

riod

Den

omin

ator

: Tot

al n

umbe

r of p

op. 1

5-49

yea

rsN

B: 5

% p

reva

lenc

e of

ST

Is m

ay b

e re

alist

ic in

som

e co

untr

ies.

STI p

re-

vale

nce

in

ANC

(RPR

po

s. ra

te)

Birt

h sp

acin

g co

vera

ge%

of w

omen

of r

epro

-du

ctiv

e ag

e (1

5-49

) who

ar

e us

ing

(or w

hose

pa

rtne

r is u

sing)

a b

irth

spac

ing

met

hod

at a

pa

rtic

ular

poi

nt in

tim

e

40-7

5%N

umer

ator

: Wom

en a

ge 1

5-49

pra

ctic

e bi

rth

spac

ing

at a

giv

en ti

me

perio

dD

enom

inat

or: T

otal

fem

ale

pop.

age

d 15

-49

durin

g th

e sa

me

time

perio

dN

B: B

irth

spac

ing

refl e

cts a

ll m

etho

ds—

trad

ition

al &

na

tura

l.

Rout

ine

data

so

urce

, ho

useh

old

surv

ey

42

Birt

h sp

acin

g fo

cuse

s on

safe

mot

herh

ood

and

allo

ws

suffi

cien

t tim

e be

twee

n pr

egna

ncie

s; th

is in

terv

entio

n ha

s an

imm

ense

impa

ct o

n th

e re

duct

ion

of c

hild

and

m

ater

nal d

eath

. Inf

orm

atio

n an

d ed

ucat

ion

on th

e m

etho

ds a

re e

sent

ial.

Nut

ritio

n sta

tus

in c

hild

ren

% o

f chi

ldre

n m

al-

nour

ished

(Wei

ght f

or

heig

ht in

child

ren

< 5

year

s; co

nsid

er sp

ecifi

c ag

e gr

oup)

W

eigh

t / h

eigh

t refl

ect

s bo

dy p

ropo

rtio

n an

dis

part

icul

arly

sens

i-tiv

e to

acu

te g

row

th

distu

rban

ce. I

n ch

roni

c m

alnu

triti

on, w

eigh

t or

heig

ht fo

r age

is re

com

-m

ende

d; B

MI (

body

m

ass i

ndex

)

Mal

nutr

ition

of

:< 5

% (a

c-ce

p ta

ble)

5-9%

(poo

r)10

-14%

(ser

i-ou

s )>

15%

(cri-

tical

)

Num

erat

or: N

umbe

r of c

hild

ren

in re

spec

tive

age

grou

p w

ith m

oder

ate

or se

vere

mal

nutr

ition

resp

ec-

tivel

yscr

eene

d at

one

poi

nt in

tim

e D

enom

inat

or: T

otal

num

ber o

f chi

ldre

n sc

reen

ed in

re

spec

tive

age

grou

p at

the

sam

e tim

e pe

riod

Defi

nit

ion:

Perc

ent o

f med

ian:

70

-80%

= m

oder

ate

(-2

Z sc

ores

)<

70%

= se

vere

(- 3

Z sc

ores

)

Surv

eys i

n ge

ogra

phi-

cal a

reas

or

popu

latio

n su

b-gr

oups

Del

iver

ies a

tten-

ded

by tr

aine

d pe

rson

nel

% o

f birt

hs a

ttend

ed

by sk

illed

/trai

ned

heal

th w

orke

r suc

h as

a

doct

or, n

urse

, mid

wife

(e

xclu

ded

are

trai

ned

or

untr

aine

d T

BA’s)

40 –

80%

of

tota

l del

iver

ies

Num

erat

or: N

umbe

r of b

irths

atte

nded

by

trai

ned

pers

onne

l in

a gi

ven

time

perio

dD

enom

inat

or: T

otal

num

ber o

f birt

hs d

urin

g th

e sa

me

time

perio

d

Mon

thly

sta

tistic

s/

Rout

ine

Dat

a So

urce

43

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

ceD

eliv

erie

s in

HF

% o

f HF

base

d vs

%

hom

e de

liver

ies

< 10

% h

ome

deliv

erie

sU

natte

nded

hom

e de

liver

ies b

ear a

hig

h ris

k fo

r the

m

othe

r and

the

new

born

. Th e

refo

re p

rom

otio

n of

fa

cilit

y ba

sed

deliv

erie

s sho

uld

be p

rom

oted

.

Safe

mo-

ther

hood

as

sess

men

t re

port

s,ro

utin

e da

taD

eliv

erie

s ass

is-te

d by

trai

ned

or

untr

aine

d T

BA

or o

ther

s with

no

trai

ning

Num

ber o

f del

iver

ies a

t-te

nded

by

the

indi

vidu

al

TBA

per

mon

th /

year

Qua

lity

of T

BA d

epen

ds

on w

heth

er th

ey a

re

linke

d to

a H

F.

< 60

% o

f tot

al

deliv

erie

s

TBA

regi

ste-

red

at H

F

TBA

may

be

very

exp

erie

nced

bas

ed o

n th

e fre

quen

cy

they

are

invo

lved

in p

regn

anci

es a

nd d

eliv

erie

s.

Avai

labi

lity

of C

EOC

and

ope

rativ

e se

rvic

es p

lays

a

cruc

ial r

ole

in re

duci

ng in

fant

and

mat

erna

l dea

th.

TBA

repo

rts

Prev

alen

ce o

f an

aem

ia in

wo-

men

age

d 15

-49

(can

also

focu

s on

pre

gnan

t/ no

n-pr

egna

nt

wom

en)

% o

f wom

en o

f rep

ro-

duct

ive

age

(15-

49)

with

a h

aem

oglo

bin

leve

l bel

ow 1

10g/

l (p

regn

ant)

and

120g

/l (n

on-p

regn

ant)

< 30

%N

umer

ator

: Num

ber o

f (pr

egna

nt) w

omen

(or 1

5-49

ye

ars)

scre

ened

hav

ing

a ha

emog

lobi

n<

110g

/ l O

R 1

20g/

lD

enom

inat

or: T

otal

num

ber o

f (pr

egna

nt)

wom

en

OR

thos

e ag

ed 1

5-49

yea

rs

Can

be

also

lim

ited

to p

regn

ant w

omen

onl

y; c

urre

nt

glob

al a

naem

ia in

abo

ut 5

0%.

Mon

thly

sta

tistic

s/

Rout

ine

data

Teta

nus

Imm

unisa

tion

cove

rage

in

perc

ent

Prop

ortio

n of

wom

en in

ch

ildbe

arin

g ag

e (1

5-49

) im

mun

ised

agai

nst T

eta-

nus (

TT

2 or

boo

ster)

OR

pro

port

ion

of p

reg-

nant

wom

en w

ho h

ave

Hig

h le

vel

of c

over

age

aim

ing

at 1

00

% fo

r TT

2 (tw

o do

sis o

f te

tanu

s tox

oid

Num

erat

or: N

umbe

r of d

oses

adm

inist

ered

Den

omin

ator

: Esti

mat

ed n

umbe

r of n

ewbo

rns (

in

unsta

ble

setti

ngs)

OR

num

ber o

f wom

en 1

5-49

(in

stabl

e se

tting

s)

Rout

ine

data

44

rece

ived

at l

east

TT

2+

durin

g th

e m

ost r

ecen

t pr

egna

ncy

rece

ived

)N

umer

ator

: Num

ber o

f pre

gnan

t wom

en w

ho h

ave

rece

ived

TT

2+ T

T3+

TT

4+T

T5

/ 4 (=

aver

age)

dur

ing

a gi

ven

timef

ram

eD

enom

inat

or: N

umbe

r of p

regn

ant w

omen

dur

ing

the

sam

e tim

e pe

riod

Ante

nata

l car

e co

vera

ge (A

NC

co

vera

ge)

% o

f wom

en w

ho

atte

nded

at l

east

thre

e or

mor

e (3

+) A

NC

visi

ts du

ring

her m

ost r

ecen

t pr

egna

ncy.

Th e

shar

e of

birt

hs a

t-te

nded

by

skill

ed h

ealth

sta

ff is

an in

dica

tor o

f a

heal

th sy

stem

’s ab

ility

to

prov

ide

adeq

uate

car

e fo

r pre

gnan

t wom

en.

> 50

%N

umer

ator

: Num

ber o

f pre

gnan

t wom

en w

ho a

t-te

nded

at l

east

thre

e vi

sits t

o tr

aine

d he

alth

per

sonn

el

durin

g he

r mos

t rec

ent p

regn

ancy

dur

ing

a gi

ven

time

perio

dD

enom

inat

or: T

otal

num

ber o

f birt

hs d

urin

g th

e sa

me

time

perio

dO

R e

xpec

ted

no. o

f pre

gnan

cies

in th

e sa

me

time

perio

d.

Goo

d an

tena

tal a

nd p

ostn

atal

car

e im

prov

e m

ater

nal

heal

th a

nd re

duce

mat

erna

l and

infa

nt m

orta

lity.

Mon

thly

sta

tistic

s /

Rout

ine

data

,su

rvey

s

Avai

labi

lity

of

basic

ess

entia

l ob

stetr

ic c

are

(BEO

C)

Num

ber o

f fac

ilitie

s w

ith fu

nctio

ning

bas

ic

esse

ntia

l obs

tetr

ic c

are

/ 50

0,00

0 po

pula

tion

Min

imum

4

BEO

C /

500,

000

pop.

Num

erat

or: N

umbe

r of f

acili

ties w

ith fu

nctio

ning

BE

OC

Den

omin

ator

: Tot

al p

opul

atio

n

NB

: It i

s of u

tmos

t im

port

ance

to e

nsur

e ac

cess

ible

BE

OC

for p

regn

ant w

omen

.

Basic

ess

entia

l obs

tetr

ic c

are

shou

ld in

clud

e pa

rent

eral

an

tibio

tics,

oxyt

ocic

s and

seda

tives

for e

clam

psia

; the

m

anua

l rem

oval

of p

lace

nta

and

reta

ined

pro

duct

s; an

d va

gina

l del

iver

y (in

cl. m

anua

l vac

uum

ext

ract

ion

or

forc

eps)

.

Rout

ine

data

, as

sess

men

t

45

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

ceAv

aila

bilit

y of

co

mpr

ehen

sive

esse

ntia

l obs

tet-

ric c

are

(CEO

C)

Num

ber o

f fac

ilitie

s th

at p

erfo

rm su

rger

y (c

aesa

rean

sect

ion)

and

bl

oodt

rans

fusio

n

1 C

EOC

/ 50

0,00

0 po

p.N

umer

ator

: Num

ber o

f fac

ilitie

s with

func

tioni

ng

CEO

CD

enom

inat

or: T

otal

pop

ulat

ion

If em

erge

ncy

inte

rven

tions

like

Cae

sare

an S

ectio

n (C

S)

can

not b

e pe

rform

ed, m

ater

nal m

orta

lity

will

not

de

clin

e!

HF

data

,lo

cal s

tati-

stics

Infa

nt m

orta

lity

rate

D

eath

of c

hild

ren

less

th

an 1

yr.

/ 1,0

00 li

ve

birt

hs/ y

ear

59-7

9 / 1

,000

liv

e bi

rths

/ye

ar

Num

erat

or D

eath

s of c

hild

ren

less

than

one

yea

r old

pe

r yea

r D

enom

inat

or: N

umbe

r of l

ive

birt

hs in

the

sam

e ye

ar

Th e

mor

talit

y in

dica

tors

und

er T

OP

3 ar

e re

fl ect

ing

the

heal

th st

atus

of “

low

inco

me

“ co

untr

ies r

efer

ence

d by

th

e Wor

ld B

ank

(200

4).

Mon

thly

sta

tistic

s/Ro

utin

e da

ta

Perin

atal

mor

ta-

lity

rate

Dea

th o

f foe

tus o

r new

-bo

rn i

n th

e pe

rinat

al

perio

d / 1

,000

live

&

still

birt

hs /

year

Peri

nata

l Per

iod:

from

22

com

plet

ed w

eeks

of

gesta

tion

to 7

day

s afte

r bi

rth

30-3

5 / 1

,000

liv

e &

still

bi

rths

/ ye

ar

Num

erat

or: N

umbe

r of d

eath

dur

ing

perin

atal

per

iod

per y

ear

Den

omin

ator

: Num

ber o

f tot

al li

ve b

irth

and

still

birt

h du

ring

the

sam

e ye

ar

NB

: Per

inat

al m

orta

lity

is an

indi

cato

r ide

ntify

ing

prob

lem

s aris

ing

with

in th

e po

stnat

al p

erio

d, i.

e. th

e fi r

st da

ys in

the

life

of th

e ne

wbo

rn.

Perin

atal

mor

talit

y is

subs

tant

ially

con

trib

utin

g to

m

orta

lity

of a

ll ch

ildre

n un

der 5

yea

rs o

f age

. Ana

lyse

da

ta o

n ch

ild m

orta

lity

and

iden

tify

peak

s rel

ated

to

age

grou

p of

chi

ldre

n <

5 ye

ars o

f age

.

Mon

thly

sta

tistic

s/Ro

utin

e da

ta

46

Mat

erna

l dea

ths

No.

of m

ater

nal d

eath

s in

the

popu

latio

n

Defi

niti

on o

f ma-

tern

al d

eath

is o

ften

not k

now

n. U

nder

-re

port

ing

is co

mm

on!

No

mat

erna

l de

aths

Mat

erna

l dea

th is

a ra

re e

vent

and

it ta

kes p

lace

mos

tly

outsi

de th

e he

alth

faci

litie

s; bu

t if s

o, it

nee

ds to

be

repo

rted

to th

e he

alth

aut

horit

ies.

It is

reco

mm

ende

d to

con

duct

a v

erba

l aut

opsy

to a

naly

se th

e re

ason

s for

th

e de

ath.

Safe

mo-

ther

hood

as

sess

men

t

Mat

erna

l mor

ta-

lity

ratio

No.

of m

ater

nal d

eath

s pe

r 100

,000

live

birt

hs

in a

yea

r

(in L

DC

& L

LDC

25

0-15

00/1

00,0

00 li

ve

birt

hs; i

n D

C 1

0-20

/ 10

0,00

0 liv

e bi

rths

)

No

mat

erna

l de

aths

Num

erat

or: D

eath

s of w

omen

dur

ing

preg

nanc

y or

up

to 4

2 da

ys a

fter d

eliv

ery

in a

cou

ntry

per

yea

rD

enom

inat

or: N

umbe

r of l

ive

birt

hs in

the

coun

try

in

the

sam

e ye

arN

B: R

epor

t to

heal

th a

utho

ritie

s.R

ates

of m

ater

nal m

orta

lity

are

only

mea

sura

ble

on

natio

nal l

evel

bec

ause

it is

rela

ted

to a

hig

h nu

mbe

r of

live

birt

hs. H

owev

er, m

ater

nal m

orta

lity

ratio

is h

elpf

ul

for c

ompa

rison

reas

ons.

Impo

rtan

t ind

icat

or fo

r the

ove

rall

qual

ity a

nd a

vaila

bi-

lity

of h

ealth

serv

ices

in a

regi

on o

r cou

ntry

Nat

iona

l da

ta,

DH

S,m

orta

lity

surv

ey,

mon

thly

sta

tistic

s/Ro

utin

e da

ta

6. M

ALA

RIA

SPE

CIF

IC I

ND

ICAT

OR

S

Mal

aria

stra

tegy

Early

dia

gnos

is an

d tre

atm

ent

Redu

ce

mor

bidi

ty a

nd

mor

talit

y

Dep

endi

ng o

n th

e qu

ality

of c

are

and

acce

ssib

ility

of

heal

th se

rvic

es it

mig

ht ra

nge

from

: eve

ry fe

ver c

ase

is tre

ated

for m

alar

ia (d

on’t

miss

oth

er o

r add

i-tio

nal d

iseas

e, i.

e. p

neum

onia

); O

R o

nly

lab-

confi

rmed

cas

es a

re tr

eate

d fo

r mal

aria

as

soon

as p

ossib

le (p

reco

nditi

on is

24

h fu

nctio

ning

lab

diag

nosis

).

Loca

l or

regi

onal

m

alar

ia

strat

egie

s to

be fo

llow

ed

47

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

ceSl

ide

posit

ive

rate

% o

f mal

aria

cas

es c

on-

fi rm

ed b

y bl

ood

smea

r of

the

tota

l tes

ted

Num

erat

or: N

umbe

r of s

lides

pos

itive

Den

omin

ator

: Num

ber o

f tot

al sl

ides

scre

ened

NB

: Th i

ck d

rop

= G

old

Stan

dard

Labo

rato

ry

repo

rts

(Rap

id) T

est

posit

ive

rate

% o

f mal

aria

cas

es

confi

rmed

by

rapi

d te

st of

thos

e te

sted

Num

erat

or: N

umbe

r of p

ositi

ve ra

pid

tests

Den

omin

ator

: num

ber o

f tot

al ra

pid

tests

don

eN

B: R

DT

use

ful i

n ou

tbre

aks o

r whe

re n

o m

icro

sco-

pists

are

ava

ilabl

e.

Labo

rato

ry

repo

rts

Ende

mic

ity o

f m

alar

iaH

igh

or h

yper

end

emic

ar

eas w

ith p

eren

nial

or

seas

onal

tran

smiss

ion

See

Mal

aria

Con

trol i

n co

mpl

ex e

mer

genc

ies:

An in

ter-

agen

cy fi

eld

hand

book

. Gen

eva:

W

orld

Hea

lth O

rgan

iza-

tion,

200

5

Inci

denc

e of

sy

mpt

oma-

tic m

alar

ia

rem

ains

fairl

y co

nsta

nt

CAV

EAT:

Res

iden

t pop

ulat

ion

deve

lop

part

ial

imm

unity

ove

r tim

e; th

eref

ore

peop

le c

arry

mal

aria

pa

rasit

es w

ithou

t sho

win

g cl

inic

al sy

mpt

oms o

f dise

ase,

he

nce

pres

ence

of p

aras

ites i

s not

a c

lear

indi

cato

r tha

t m

alar

ia is

the

caus

e of

illn

ess.

Whi

le m

ore

than

60%

of

the

popu

latio

n m

ay b

e pa

rasit

e po

sitiv

e at

any

tim

e,

child

ren

are

at h

ighe

st ris

k fo

r sev

ere

mal

aria

. Rul

e ou

t ot

her d

iseas

e.

Low

or m

oder

ate

ende

-m

ic a

reas

< 10

% p

ara-

sitae

mia

in

popu

latio

n an

d se

ason

al p

eaks

of

mal

aria

in

cide

nce

No

or lo

w le

vel o

f im

mun

ity. A

pos

itive

test

for m

alar

ia

is lik

ely

to b

e m

alar

ia. T

rans

miss

ion

rate

may

be

unsta

-bl

e, o

utbr

eaks

may

occ

ur

48

Mal

aria

ass

ess-

men

t- T

rans

miss

ion

- Sea

sona

lity

- Epi

dem

ics V

ecto

r

Hig

h –

low

Wha

t per

iod

of th

e ye

ar

and

whe

reRe

serv

oir,

Vect

or, b

iting

tim

e, b

ree-

ding

Inci

denc

e, p

reva

lenc

e an

d tr

ansm

issio

n of

mal

aria

de

pend

on

the

geog

raph

ical

regi

on, a

ltitu

de, c

limat

e,

the

vect

or sp

ecie

s – th

ese

fact

ors n

eed

to b

e as

sess

ed to

pl

an p

reve

ntio

n an

d tre

atm

ent.

Shar

e in

form

atio

n an

d co

or-

dina

te w

ith

acto

rs in

the

heal

th se

ctor

Plas

mod

ium

Fa

lcip

arum

–

Plas

mod

ium

V

ivax

Rat

io

% o

f P. f

alci

paru

m c

ases

an

d %

of P

. viv

ax c

ases

of

the

tota

l dia

gnos

ed

Exam

ples

for

coun

trie

s:Af

ghan

istan

: 15

% p

.f./ 8

5%p.

vD

R C

ongo

: 9

5% p

.f. /

5% p

.m.+

p.o.

Tim

or L

este

: 60

% p

.f. /

40%

p.v.

P.v. m

alar

ia m

ight

requ

ire tr

eatm

ent w

ith p

rimaq

uine

Labo

rato

rysu

rvey

s

Mal

aria

pr

eval

ence

rate

Num

ber o

f con

fi rm

ed

mal

aria

cas

es p

er 1

,000

po

pula

tion/

yea

r

Num

erat

or: N

umbe

r of a

ll m

alar

ia c

ases

at a

giv

en

time

fram

eD

enom

inat

or: T

otal

pop

ulat

ion

at ri

sk a

t the

sam

e tim

e pe

riod

NB

: Con

sider

to re

port

cas

es b

y P.

falc

ipar

um; P

. viv

ax

and

othe

rs.

Get

info

rmat

ion

on la

bora

tory

con

fi rm

ed c

ases

vs.

clin

ical

ly d

iagn

osed

cas

es

Brea

kdow

n by

sex,

age

and

may

be g

roup

s (et

hnic

ity,

wor

kers

, mig

rant

s etc

.)

Wee

kly

or

mon

thly

he

alth

sta

tistic

s (E

pide

mic

co

ntro

l)

49

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

ceC

ases

of

unco

mpl

icat

ed

mal

aria

/ per

1,

000/

mon

th

Num

ber o

f cas

es p

er

1,00

0 po

pula

tion

per

mon

th

DEF

INIT

ION

: U

ncom

plic

ated

are

th

ose

wit

h Fe

ver,

Chi

lls,

Swea

ts, H

eada

ches

, N

ause

a an

d vo

miti

ng,

Body

ach

es &

gen

eral

m

alai

se.

Num

erat

or: N

umbe

r all

unco

mpl

.mal

aria

cas

es a

t a

give

n tim

e fra

me

Den

omin

ator

: Tot

al p

opul

atio

n at

risk

at t

he sa

me

time

perio

d

Brea

k do

wn

by a

ge/s

ex (C

DC

, Atla

nta

http

://w

ww.

cdc.

gov/

mal

aria

/dise

ase.

htm

#unc

ompl

icat

ed)

Wee

kly

or

mon

thly

he

alth

stat

i-sti

cs

Cas

es o

f com

pli-

cate

d m

alar

ia/

1,00

0/m

onth

Num

ber o

f cas

es p

er

1,00

0 po

pula

tion

per

mon

th

DEF

INIT

ION

: C

ompl

icat

ed a

re th

ose

wit

h C

ereb

ral m

alar

ia,

with

abn

orm

al b

eha-

viou

r, im

pairm

ent o

f co

nsci

ousn

ess,

seizu

res,

com

a, o

r oth

er n

euro

lo-

gica

l abn

orm

aliti

es;

Seve

re a

naem

ia, p

ul-

mon

ary

oede

ma

or

acut

e re

spira

tory

dist

ress

sy

ndro

me

(AR

DS)

.

Num

erat

or: N

umbe

r of a

ll co

mpl

icat

ed m

alar

ia c

ases

at

a g

iven

tim

e fra

me

Den

omin

ator

: Tot

al p

opul

atio

n at

risk

at t

he sa

me

time

perio

d

Wee

kly

or

mon

thly

he

alth

stat

i-sti

cs,

HF

reco

rds

50

Mal

aria

fata

lity

rate

/ per

1,0

00/

mon

th (w

eek)

No.

of c

onfi r

med

mal

a-ria

cas

es d

eath

s div

ided

by

no

. of c

onfi r

med

po

sitiv

e ca

ses p

er 1

,000

/ m

onth

(wee

k)

Num

erat

or: N

umbe

r of a

ll m

alar

ia c

ases

die

d pe

r m

onth

Den

omin

ator

: Tot

al p

ositi

ve m

alar

ia c

ases

at t

he sa

me

time

perio

d

Wee

kly

or

mon

thly

he

alth

stat

i-sti

cs,

HF

reco

rds

Mal

aria

pre

va-

lenc

e in

pre

g-na

nt w

omen

% o

f tot

al m

alar

ia c

ases

la

bora

tory

con

fi rm

ed in

pr

egna

nt w

omen

Num

erat

or: N

umbe

r of a

ll pr

egna

nt w

omen

with

po

sitiv

e m

alar

ia te

st in

a g

iven

tim

e pe

riod

Den

omin

ator

: Tot

al n

umbe

r of p

regn

ant w

omen

at

the

sam

e tim

e pe

riod

Wee

kly

or

mon

thly

he

alth

stat

i-sti

cs%

of p

regn

ant

wom

en re

cei-

ving

Inte

rmit-

tent

Pro

phyl

axis

Trea

tmen

t (IP

T)

% o

f tot

al p

regn

ant w

o-m

en re

ceiv

ing

mal

aria

pr

ophy

laxi

s

See:

Mal

aria

Con

trol i

n co

mpl

ex e

mer

genc

ies:

an in

ter-

agen

cy fi

eld

hand

book

. Gen

eva:

W

orld

Hea

lth O

rgan

iza-

tion,

200

5 (p

. 99-

101)

Num

erat

or: N

umbe

r of p

regn

ant w

omen

rece

ivin

g IP

T a

t a g

iven

tim

e fra

me

Den

omin

ator

: Tot

al n

umbe

r of p

regn

ant w

omen

at

the

sam

e tim

e pe

riod

NB

: Fol

low

nat

iona

l pro

toco

l; ot

herw

ise S

P fu

ll tre

atm

ent c

ours

e in

the

seco

nd a

nd th

ird tr

imes

ter h

as

prov

en to

be

eff e

ctiv

e .

CAV

EAT:

Wom

en w

ith H

IV a

ppea

r to

resp

ond

less

w

ell t

o IP

T w

ith S

P, th

eref

ore

IPT

shou

ld b

e gi

ven

on

a m

onth

ly b

asis.

Wee

kly

or

mon

thly

he

alth

stat

i-sti

cs

Sens

itivi

ty(Q

ualit

y C

on-

trol L

abor

ator

y)

% o

f slid

es c

orre

ctly

posit

ive

teste

d by

fi rs

t la

bora

tory

and

con

fi r-

med

by

cont

rol L

ab.

95-1

00%

A sa

mpl

e of

10-

30 m

alar

ia p

ositi

ve sl

ides

of t

otal

slid

es

shou

ld b

e co

ntro

lled

ever

y six

mon

ths.

Qua

lity

of L

abor

ator

y pl

ays a

cru

cial

rol

e in

mal

aria

co

ntro

l!

Refe

renc

e/C

ontro

l La

bora

tory

51

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

ceSp

ecifi

city

(Q

ualit

y C

on-

trol L

abor

ator

y)

% o

f slid

es c

orre

ctly

ne

gativ

e te

sted

by fi

rst

labo

rato

ry a

nd c

onfi r

-m

ed b

y co

ntro

l Lab

95-1

00%

A sa

mpl

e of

10-

30%

mal

aria

neg

ativ

e sli

des o

f tot

al

slide

s sho

uld

be c

ontro

lled

ever

y six

mon

ths.

Refe

renc

e

/ Con

trol

Labo

rato

ry

No.

of m

icro

-sc

opist

s tra

ined

/un

derg

one

re-

fresh

er tr

aini

ng

No.

of m

icro

scop

ists

trai

ned

/ ref

resh

ertr

aini

ng

2-3

mic

ro-

scop

ist’s

for 1

0,00

0 po

pula

tion

Hea

lth

auth

oriti

es

or h

ealth

se

rvic

e pr

o-vi

der

No.

of s

lides

do

ne p

er m

icro

-sc

opist

s / d

ay

Num

ber o

f slid

es

divi

ded

by n

umbe

r of

mic

rosc

opist

s / d

ay

50-6

0 sli

des /

m

icro

scop

ist /

per d

ay

Base

d on

exp

erie

nce,

one

Lab

tech

nici

an c

an re

ad

abou

t 50-

60 sl

ides

per

day

(8-1

0 m

inut

es p

er sl

ide)

.La

bora

tory

7. T

UB

ERC

ULO

SIS

SPEC

IFIC

IN

DIC

ATO

RS

Cas

e D

etec

tion

rate

% o

f TB

case

s det

ecte

d fro

m th

e to

tal n

atio

nal

TB

case

s esti

mat

ed to

oc

cur c

ount

ryw

ide

each

ye

ar.

WH

O e

stim

ates

of

inci

denc

e fo

r eac

h co

untr

y.R

epor

t dat

a to

nat

io-

nal l

evel

.Se

e: W

HO

200

1. T

B/H

IV, A

clin

ical

man

ual

70%

of

exist

ing

case

s de

tect

ed

Num

erat

or: N

umbe

r of n

ew sm

ear-

posit

ive T

B ca

ses

dete

cted

Den

omin

ator

: Esti

mat

ed n

umbe

r of n

ew sm

ear-

posit

i-ve

TB

case

s cou

ntry

wid

e

NB

: Nat

iona

l pre

vale

nce

rate

nee

ds to

be

asse

ssed

to

calc

ulat

e th

e ca

se d

etec

tion

rate

. An

eff e

ctiv

e na

tiona

l T

B pr

ogra

mm

e ha

s a h

igh

cure

rate

and

a lo

w le

vel o

f ac

quire

d dr

ug re

sista

nce.

Nat

iona

l Tu

berc

ulos

is Re

giste

r

52

Cur

e ra

te o

f sm

ear p

ositi

vePT

B (P

ulm

ona-

ry T

uber

culo

sis)

% o

f tot

al n

ew P

TB

case

s who

was

initi

ally

smea

r pos

itive

and

who

w

as sm

ear n

egat

ive

in th

e la

st m

onth

of

treat

men

t

85%

of n

ew

dete

cted

cas

esN

umer

ator

: Num

ber o

f new

sput

um p

ositi

ve c

ases

in

a gi

ven

time

who

com

plet

ed tr

eatm

ent a

nd h

ad a

t lea

st tw

o sm

ear n

egat

ive

resu

ltsD

enom

inat

or: T

otal

num

ber o

f new

smea

r pos

itive

ca

ses d

urin

g th

e sa

me

time

TB

regi

ster,

HF

data

Trea

tmen

t com

-pl

eted

% o

f TB

case

s com

ple-

ted

treat

men

t but

did

not m

eet t

he c

riter

ia fo

r ‘cu

red’

or ‘

failu

re’

Num

erat

or: N

umbe

r of T

B ca

ses c

ompl

eted

trea

tmen

t in

a c

erta

in ti

me

perio

d.D

enom

inat

or: N

umbe

r of t

otal

TB

case

s und

er tr

eat-

men

t dur

ing

the

sam

e tim

e pe

riod

Trea

tmen

t suc

-ce

ss ra

te%

of t

otal

TB

case

s re

giste

red

in a

cer

tain

pe

riod

that

succ

essfu

lly

com

plet

ed tr

eatm

ent

whe

ther

with

bac

terio

lo-

gic

evid

ence

of s

ucce

ss

(‘cur

ed’)

or w

ithou

t (‘t

reat

men

t com

plet

ed’)

Num

erat

or: N

umbe

r of n

ew sm

ear-

posit

ive

pulm

onar

y T

B ca

ses r

egist

ered

in a

spec

ifi ed

per

iod

that

wer

e cu

red

plus

the

num

ber t

hat c

ompl

e te

d tre

atm

ent

Den

omin

ator

: Tot

al n

umbe

r of n

ew T

B ca

ses r

egist

e-re

d du

ring

the

sam

e tim

e

NB

: Th e

indi

cato

r mea

sure

s a p

rogr

amm

e’s c

apac

ity to

re

tain

pat

ient

s thr

ough

a c

ompl

ete

cour

se o

f che

mo-

ther

apy

with

a fa

vour

able

clin

ical

resu

lt. It

is th

e on

ly

outc

ome

indi

cato

r tha

t can

be

used

at a

ll le

vels.

TB

regi

ster,

HF

data

Trea

tmen

t fa

ilure

% o

f sm

ear p

ositi

ve T

B ca

ses u

nder

trea

tmen

tan

d w

here

the

sput

um

rem

aine

d p

ositi

ve o

r be

cam

e po

sitiv

e ag

ain

at le

ast 5

mon

ths a

fter

start

ing

treat

men

t

Num

erat

or: N

umbe

r of n

ew sp

utum

pos

itive

cas

es

who

rem

aine

d or

bec

ame

posit

ive

afte

r 5 m

onth

s of

treat

men

t or l

ater

Den

omin

ator

: Tot

al n

umbe

r of n

ew sm

ear p

ositi

ve

case

s dur

ing

the

sam

e tim

e

TB

regi

ster,

HF

data

53

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

ce

Def

aulte

r rat

e (r

etur

n af

ter

inte

rrup

tion

of

treat

men

t)

% o

f TB

case

s und

er

treat

men

t and

whe

retre

atm

ent w

as in

terr

up-

ted

for t

wo

cons

ecut

ive

mon

ths o

r mor

e

Num

erat

or: N

umbe

r of n

ew sp

utum

pos

itive

cas

es

who

se tr

eatm

ent w

asin

terr

upte

d fo

r 2 m

onth

s or m

ore

Den

omin

ator

: Tot

al n

umbe

r of n

ew sm

ear p

ositi

ve

case

s dur

ing

the

sam

e tim

e

TB

regi

ster,

HF

data

Tran

sferr

ed o

ut%

of T

B pa

tient

s tra

ns-

ferr

ed to

ano

ther

repo

rtin

g un

it an

d fo

r w

hom

the

treat

men

t ou

tcom

e is

not k

now

n

Num

erat

or: N

umbe

r of T

B pa

tient

s und

er tr

eatm

ent

& tr

ansfe

rred

to a

noth

er re

port

ing

unit

Den

omin

ator

: Num

ber o

f tot

al T

B pa

tient

s und

er

treat

men

t and

in th

e su

rvei

llanc

e sy

stem

TB

regi

ster,

HF

data

Mor

talit

y ra

te

thro

ugh

PTB

No.

of c

ases

that

die

d of

PT

B fro

m to

tal P

TB

case

s per

1,0

00 /

yr.

TB

regi

ster,

HF

data

Mul

ti D

rug

Re-

sista

nce

(MD

R)

% o

f PT

B un

der t

reat

-m

ent t

hat h

ave

deve

lo-

ped

MD

R

Ofte

n th

e ab

solu

t num

ber o

f MD

R c

ases

repo

rted

. M

DR

cas

es a

re re

sista

nt to

Ison

iazid

and

Rifa

mpi

cin.

Exes

sive

drug

resis

istan

ce a

re X

DR

cas

es. X

DR

cas

es

are

resis

tant

to a

ll fl u

oroq

uino

lone

s, Is

onia

zid a

nd R

i-fa

mpi

cin

as w

ell a

s to

seco

nd li

ne a

ntib

iotic

s (C

apre

o-m

ycin

, Kan

amyc

in a

nd A

mic

acin

).

TB

regi

ster,

HF

data

HIV

Ser

opre

va-

lenc

e am

ong

TB

patie

nts

% o

f all

new

ly re

giste

red

TB

patie

nts w

ith p

ositi

-ve

HIV

stat

us

Num

erat

or: T

otal

num

ber o

f all

new

ly re

giste

red

TB

patie

nts o

ver a

cer

tain

per

iod

who

are

HIV

pos

itive

Den

omin

ator

: Tot

al n

umbe

r of a

ll ne

wly

regi

stere

d T

B pa

tient

s ove

r the

sam

e tim

e pe

riod

who

wer

e te

sted

for H

IV a

nd in

clud

ed in

the

surv

eilla

nce

syste

m

Rout

ine

testi

ng o

f T

B pa

tient

s, se

ntin

el

met

hods

, or

spec

ial

54

NB

: It i

s rec

omm

ende

d to

test

all T

B ca

ses f

or H

IV

and

test

all H

IV p

ositi

ve p

erso

n fo

r TB.

surv

eys

Dru

g an

d eq

uipm

ent

supp

ly

Dru

g re

gim

ent f

ol-

low

ing

natio

nal p

roto

col

and

equi

pmen

t for

di

agno

stic

avai

labl

e

Uni

nter

rup-

ted

supp

ly o

f T

B es

sent

ial

drug

s and

di

agno

stic

mat

eria

ls en

sure

d

Supp

lies o

f med

icin

es fo

r TB

treat

men

t is e

ssen

tial.

It ne

eds t

o be

org

anise

d in

the

part

icul

ar D

OTs

(dire

ct

obse

rved

ther

apy,

shor

t cou

rse)

sche

me.

Blis

ter p

acs,

arra

nged

acc

ordi

ng to

com

bina

tion

ther

apy,

incr

ease

co

mpl

ianc

e an

d su

ppor

ts m

onito

ring.

TB

regi

ster,

HF

dara

Repo

rtin

g Sy

stem

Nat

iona

l rep

ortin

g gu

idel

ine

or in

tern

ati-

onal

stan

dard

s (W

HO

, U

NH

CR

etc

.) co

uld

be

esta

blish

ed a

nd fo

llow

ed

for t

he ti

me

bein

g

Stan

dard

ised

repo

rtin

g sy

s-te

m a

vaila

ble

Whe

re p

ossib

le sh

ould

follo

w n

atio

nal s

yste

m

Sens

itivi

ty

(Qua

lity

Con

-tro

l Lab

orat

ory)

% o

f TB

slide

s cor

rect

ly

posit

ive

teste

d by

fi rs

t la

bora

tory

and

con

fi r-

med

by

cont

rol l

ab.

100%

A sa

mpl

e of

10-

30%

TB

posit

ive

slide

s of t

otal

slid

es

shou

ld b

e co

ntro

lled

ever

y six

mon

ths.

Refe

renc

e

/ Con

trol

Labo

rato

ry

Spec

ifi ci

ty

(Qua

lity

Con

-tro

l Lab

orat

ory)

% o

f TB

slide

s cor

rect

ly

nega

tive

teste

d by

fi rs

t la

bora

tory

and

con

fi r-

med

by

cont

rol l

ab.

100%

A sa

mpl

e of

10-

30%

TB

nega

tive

slide

s of t

otal

slid

es

shou

ld b

e co

ntro

lled

ever

y six

mon

ths.

Refe

renc

e

/ Con

trol

Labo

rato

ry

55

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

ceD

OT

S co

vera

ge%

of t

he p

opul

atio

n liv

ing

in a

n ar

ea o

f bas

ic

man

agem

ent u

nits

im

plem

entin

g D

OT

S str

a-te

gy in

pro

port

ion

to to

tal p

opul

atio

n

1 ba

sic m

a-na

gem

ent u

nit

impl

emen

ting

DO

TS

per

50,0

00 p

opu-

latio

n

NB

: A b

asic

man

agem

ent u

nit i

s whe

re a

TB

regi

ster

is ke

pt a

nd q

uart

erly

repo

rts a

re m

ade.

Inte

rnat

iona

lly,

it is

reco

mm

ende

d to

hav

e a

basic

uni

t per

50,

000

to

150,

000

peop

le.

DO

TS

is a

com

mon

stra

tegy

in T

B co

ntro

l to

ensu

re

that

TB

patie

nts t

ake

thei

r med

icat

ion

regu

larly

and

on

time

to p

rohi

bit r

esist

ance

dev

elop

men

t. Th

e in

dica

tor

mea

sure

s the

ext

ent o

f a c

ount

ry’s

popu

latio

n co

vere

d by

DO

TS.

Loca

l hea

lth

auth

oriti

es

or fr

om th

e di

rect

hea

lth

serv

ice

pro-

vide

r.

Trai

ning

No.

of (

refre

sher

) tra

i-ni

ngs h

eld

for C

HW

s (c

omm

unity

hea

lth

wor

kers

)

CW

Hs s

houl

d ha

ve re

gula

r tra

inin

gs o

n PT

B an

d D

OT

S bu

t also

feed

back

on

thei

r wor

k.St

aff /

Tra

i-ni

ng d

ata

IEC

Info

rmat

ion,

Edu

catio

n an

d C

omm

unic

atio

n str

ateg

y to

war

ds P

TB

is en

sure

d

IEC

stra

tegy

de

velo

ped

and

esta

blish

ed

IEC

is a

ver

y im

port

ant i

nter

vent

ion

tool

in m

ost

heal

th p

rogr

amm

es, w

hich

nee

ds to

be

wel

l dev

elop

ed

and

esta

blish

ed a

ccor

ding

to th

e pr

oble

ms a

nd n

eeds

.

Prot

ocol

av

aila

bilit

y

8. H

IV/A

IDS

SPEC

IFIC

IN

DIC

ATO

RS*

HIV

Ser

opre

va-

lenc

e%

of a

spec

ifi ed

pop

. w

hose

blo

od te

sts a

re

HIV

pos

itive

(can

be

spec

ifi ed

by

age

grou

p)

Num

erat

or: N

o. o

f all

HIV

cas

es p

er y

ear

Den

omin

ator

: No.

of p

opul

atio

n at

risk

in th

e sa

me

year

C

AVEA

T: P

reva

lenc

e is

ofte

n re

port

ed a

s adu

lt pr

eva-

lenc

e ag

ed 1

5-49

or r

efer

s to

spec

ifi c

grou

ps su

ch a

s pr

egna

nt w

omen

or y

outh

15-

24 y

ears

.

Sent

inel

su

rvei

llanc

e an

d re

gula

r te

sting

56

HIV

inci

denc

e ra

te%

of n

ew H

IV in

fec-

tions

per

yea

rN

umer

ator

: No.

of n

ew H

IV in

fect

ions

per

yea

rD

enom

inat

or: N

o. o

f pop

ulat

ion

at ri

sk in

the

sam

e ye

ar

NB

: A c

ohor

t is v

ery

diffi

cult

to fo

llow

in u

nsta

ble

situa

tions

; it n

eeds

also

info

rmat

ion

on th

e po

pula

tion

expo

sed.

Annu

al

statis

tics

STI p

reva

lenc

e ra

te%

of S

TIs

in sp

ecifi

c po

pula

tion

grou

p (b

y ag

e or

sex

or so

cial

gr

oup)

STIs

am

ong

preg

nant

wom

en is

a v

ery

good

indi

cato

r to

ass

ess t

he S

TI s

ituat

ion

in a

pop

ulat

ion.

Peo

ple

ofte

n do

not

repo

rt S

TIs

bec

ause

of e

mba

rras

smen

t.

ANC

dat

a

Hea

rd a

bout

H

IV/A

IDS

% o

f res

pond

ents

who

ha

ve h

eard

of H

IV o

r AI

DS

Prev

alen

ce o

f ha

ving

som

e kn

owle

dge

of

AID

S

Base

line

surv

ey re

quire

d; c

an b

e as

sess

ed in

a sp

ecifi

c ag

e gr

oup

such

as y

oung

peo

ple

15-2

4 yr

s sin

ce in

ter-

vent

ions

are

mor

e eff

ect

ive

in y

oung

peo

ple.

Popu

latio

n su

rvey

,K

AP S

urve

ys

Acce

ptin

g At

ti-tu

de%

of r

espo

nden

ts sa

ying

that

they

wou

ld

be w

illin

g to

car

e fo

r a

fam

ily m

embe

r who

be

cam

e sic

k w

ith th

e AI

DS

viru

s

> 60

% h

ave

a po

sitiv

e at

ti-tu

de to

war

ds

carin

g fo

r a

fam

ily m

em-

ber i

nfec

ted

with

HIV

Base

line

surv

ey re

quire

d.Po

pula

tion

surv

ey

57

* Th

e WH

O c

ase

defi n

ition

for A

IDS

surv

eilla

nce

whe

re H

IV te

sting

is n

ot a

vaila

ble

is fu

lfi lle

d in

the

pres

ence

of a

t lea

st 2

maj

or a

nd a

t le

ast 1

min

or si

gn.

Maj

or si

gns:

wei

ght l

oss >

10%

of b

ody

wei

ght;

chro

nic

diar

rhoe

a m

ore

than

one

mon

th; p

rolo

nged

feve

r mor

e th

an o

ne m

onth

Min

or si

gn: p

ersis

tent

cou

gh m

ore

than

one

mon

th; g

ener

alise

d pr

uriti

c de

rmat

itis;

histo

ry o

f her

pes z

oste

r; or

opha

ryng

eal c

andi

dias

is;

chro

nic

prog

ress

ive

or d

issem

inat

ed h

erpe

s sim

plex

infe

ctio

n; g

ener

alise

d ly

mph

aden

opat

hy

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

ce

Kno

wle

dge

abou

t AID

S an

d re

ject

ing

misc

once

ptio

ns

in y

outh

15-

24

Th e

perc

ent o

f res

pon-

dent

s age

15-

24 y

rs.

who

cor

rect

ly id

entif

y th

e tw

o m

ajor

way

s of

prev

entin

g th

e se

xual

tr

ansm

issio

n of

HIV

(u

sing

cond

oms a

nd

limiti

ng se

x to

one

fa

ithfu

l, un

infe

cted

pa

rtne

r), w

ho re

ject

th

e tw

o m

ost c

omm

on

loca

l misc

once

ptio

ns

abou

t HIV

tran

smiss

ion,

an

d w

ho k

now

that

a

heal

thy-

look

ing

pers

on

can

have

HIV

Th is

indi

cato

r is c

onstr

ucte

d fro

m re

spon

ses t

o th

e fo

llow

ing

set o

f pro

mpt

ed q

uesti

ons:

• C

an th

e ris

k of

HIV

tran

smiss

ion

be re

duce

d by

ha

ving

sex

with

onl

y on

e fa

ithfu

l, un

infe

cted

p

artn

er?

• C

an th

e ris

k of

tran

smiss

ion

be re

duce

d by

usin

g co

dom

s?

• C

an a

hea

lthy-

look

ing

pers

on h

ave

HIV

? •

Can

a p

erso

n ge

t HIV

from

mos

quito

bite

s?

• C

an a

per

son

get H

IV b

y sh

arin

g a

mea

l with

so

meo

ne w

ho is

infe

cted

?

Onl

y resp

onde

nts w

ho a

nsw

er co

rrec

tly o

n al

l fi v

e pro

mp-

ted

quest

ions

are

inclu

ded

in th

enum

erat

or. Th

e d

enom

i-na

tor i

s all

resp

onde

nts,

rega

rdles

s of w

heth

er th

ey h

ave

ever

hea

rd o

f AID

S.

Popu

latio

n su

rvey

Cou

nsel

lors

tr

aine

dBe

cle

ar o

n qu

alifi

catio

n an

d le

vel o

f tra

inin

g of

co

unse

llors

who

mig

ht

be p

rofe

ssio

nal o

r lay

pe

ople

.

Cou

nsel

lors

are

mos

t im

port

ant i

n H

IV p

reve

ntio

n bu

t al

so to

off e

r psy

cho-

soci

al c

are

for P

LWH

A or

fam

ilies

aff

ect

ed.

Trai

ning

da

ta,

perfo

rman

ce

date

Peer

cou

nsel

lors

tr

aine

dPe

er c

ouns

ello

rs p

er n

o.

of p

eers

No.

of p

eer g

roup

s

No.

of p

eer

cous

ello

rs

trai

ned

Peer

cou

nsel

ling

and

educ

atio

n ha

s pro

ven

to b

e ve

ry

eff e

ctiv

e to

shar

e in

form

atio

n on

the

tran

smiss

ion

of

HIV

/AID

S in

the

com

mun

ity.

Trai

ning

da

ta,

perfo

rman

ce

data

58

No.

of V

CT

se

ssio

ns in

last

12 m

onth

% o

f pop

. 15-

49 y

rs.

that

wer

e te

sted

and

rece

ived

resu

lts

Num

erat

or: N

umbe

r of p

op. a

ged

15-4

9 te

sted

and

rece

ived

resu

ltD

enom

inat

or: P

opul

atio

n 15

-49

yrs.

Regu

lar

statis

tics o

r po

pula

tion

surv

eyN

o. o

f VC

T

sess

ions

for n

ewT

B pa

tient

sin

last

12

mon

th

% o

f new

TB

patie

nts

that

wer

e te

sted

and

rece

ived

resu

lts

Num

erat

or: N

umbe

r of n

ew T

B pa

tient

s tes

ted

for

HIV

dur

ing

last

12 m

onth

sD

enom

inat

or: T

otal

num

ber o

f new

TB

case

s in

last

12 m

onth

Mon

thly

he

alth

stat

i-sti

cs

Hea

lth p

rom

oti-

on -

IEC

strat

egy

is im

-pl

emen

ted

Info

rmat

ion,

Edu

catio

n an

d C

omm

unic

atio

n (I

EC) s

trat

egy

tow

ards

H

IV/A

IDS

is av

aila

ble

IEC

stra

tegy

de

velo

ped

and

esta

blish

ed.

Ove

rall

obje

ctiv

e is

beha

viou

r of

chan

ge

IEC

is a

ver

y im

port

ant i

nter

vent

ion

tool

in m

ost

heal

th p

rogr

amm

es w

hich

nee

ds to

be

wel

l dev

elop

ed

and

esta

blish

ed a

ccor

ding

to th

e pr

oble

ms a

nd n

eeds

.

Resp

ect c

ultu

re a

nd c

usto

ms o

f tar

get p

opul

atio

n.

Test

all I

CE-

mat

eria

ls in

the

loca

l con

text

.

Prog

ram

me

prot

ocol

ARV

trea

t-m

ent p

roto

col

avai

labl

e an

d el

igib

ility

crit

e-ria

esta

blish

ed

ARV

trea

t-m

ent p

roto

col

esta

blish

ed

and

follo

wed

Acce

ssab

ility

to A

RVs h

as to

be

stren

gthe

ned

and

treat

-m

ent n

eeds

to fo

llow

Nat

iona

l Gui

delin

es.

Follo

w

natio

nal

prot

ocol

,da

ta o

n AR

T

cove

rage

M

ater

nal o

r-ph

an p

reva

lenc

e%

of c

hild

ren

<15

year

s of

age

who

se n

atur

al

mot

her h

ad d

ied

Num

erat

or: N

o. o

f chi

ldre

n <1

5 ye

ars w

hose

mot

her

died

Den

omin

ator

: Tot

al n

o. o

f chi

ldre

n in

the

sam

e ag

e gr

oup

Dat

a on

nu

mbe

r of

OV

C (o

r-ph

ans a

nd

vuln

erab

le

child

ren)

59

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

ceN

o. o

f sch

o-la

rshi

ps fo

r or

phan

s

Amou

nt p

aid

/ Orp

han

/ yea

rAi

med

to

cove

r sch

ool

fee

and

livin

g co

sts

Aim

ed to

supp

ort o

rpha

ns. O

rpha

ns o

ften

have

oth

er

care

take

rs su

ch a

s gra

ndpa

rent

s who

may

not

be

able

to a

ff ord

scho

ol fe

es, w

hich

are

requ

ired

in m

ost

coun

trie

s.

Loca

l re-

cord

s

9. V

IOLE

NC

E AG

AIN

ST W

OM

EN A

ND

CH

ILD

REN

*

Con

fi den

tial

Dat

a Ba

seRe

cord

s of i

ncid

ence

s w

here

acc

ess i

s res

tric

-te

d to

the

resp

onsib

le

pers

on in

cha

rge

Defi

niti

on o

n w

hat i

s G

BV is

requ

ired

Cre

ate

a co

nfi d

entia

l da

ta b

ase

for

reco

rdin

g in

-ci

denc

es b

utal

so m

easu

res

take

n

Asse

ss a

nd u

se th

e da

ta to

impr

ove

the

situa

tion

for

mos

t lik

ely

wom

en a

nd c

hild

ren;

alw

ays c

oord

inat

e an

d ex

pand

resp

onse

to th

e m

ost p

ossib

le n

eeds

.

Dat

a on

pr

eval

ence

of

GBV

di

ffi cu

lt to

col

lect

, be

caus

e of

sti

gma

and

disc

rimin

a-tio

nR

ate

of se

xual

vi

olen

ceN

o. w

omen

& c

hild

ren

viol

ated

mul

tiplie

d by

10

0%, d

ivid

ed b

y to

tal

no. o

f the

se g

roup

s

Prev

entio

n,

care

and

su

ppor

t of

surv

ivor

s

Indi

cato

r can

also

add

ress

a sp

ecifi

c ag

e gr

oup

(15-

49;

15-6

5 et

c.)

Th e

prim

ary

aim

is th

at a

ll hu

man

itaria

n ac

tors

mus

t ta

ke a

ctio

n fro

m th

e ea

rlies

t sta

ges o

f an

emer

genc

y to

pr

even

t sex

ual v

iole

nce

and

prov

ide

appr

opria

te a

ssis-

tanc

e to

surv

ivor

s and

fam

ilies

.

Popu

latio

n su

rvey

or

regu

lar s

tati-

stics

No.

of w

omen

/ch

ildre

n m

edi-

cally

trea

ted

/ m

onth

Abso

lute

num

ber /

m

onth

To e

nsur

e pr

o-pe

r dia

gnos

tic,

treat

men

t and

ps

ycho

logi

cal

Con

duct

phy

sical

exa

min

atio

n on

ly w

ith th

e su

rviv

or‘s

cons

ent;

it sh

ould

be

com

pass

iona

te, s

yste

mat

ic, c

om-

plet

e an

d co

nfi d

entia

l.

Mon

thly

he

alth

stat

i-sti

cs

60

supp

ort

To p

reve

nt

tran

smiss

ion

of S

TIs

incl

u-di

ng H

IV

Con

sider

synd

rom

ic tr

eatm

ent o

f ST

Is a

nd /

or P

EP. I

n ca

se o

f inj

urie

s con

sider

refe

rral

to sp

ecia

lised

serv

ices

.

No.

of w

omen

re

ceiv

ed p

sych

o-so

cial

car

e

Abso

lute

num

ber /

mon

thsu

ppor

tive

coun

selli

ngdi

scus

s saf

ety

issue

s

With

the

surv

ivor

‘s co

nsen

t disc

uss r

efer

ral t

o sa

fety

zo

nes o

r oth

er so

cial

supp

ort.

Mon

thly

sta

tistic

s

No.

of w

omen

w

ho re

ceiv

edPE

P

Abso

lute

num

ber/

m

onth

To e

nsur

e ac

cess

to P

EP

if ap

plic

able

See

PEP

guid

elin

esM

onth

ly

statis

tics

No.

of w

omen

ca

me

for V

CT

Abso

lute

num

ber/

m

onth

Stro

ng re

com

men

datio

n in

a c

onte

xt w

here

HIV

pre

va-

lenc

e is

high

Mon

thly

sta

tistic

sN

o. o

f fam

ily

grou

p di

scus

-sio

ns

Abso

lute

num

ber/

m

onth

Rai

se a

wa-

rene

ss, o

ff er

supp

ort,

pre-

vent

stig

ma

Can

be

orga

nise

d an

d off

ere

d w

ithin

com

mun

ity

supp

ort a

nd a

war

enes

s pro

gram

mes

for d

iff er

ent t

arge

t gr

oups

.

Mon

thly

sta

tistic

s

* Th

e to

pic

refl e

cts t

he re

com

men

datio

ns m

ade

by th

e In

ter A

genc

y St

andi

ng C

omm

ittee

Tas

k Fo

rce

on G

ende

r and

Hum

anita

rian

Assis

tanc

e, G

enev

a, 2

005

61

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

ceIE

C c

ampa

igns

w

ith c

omm

u-ni

ties,

mili

tary

, po

lice

Sess

ions

don

e fo

r the

re

spec

tive

grou

ps in

a

mon

th

To p

reve

nt

GBV

thro

ugh

diss

imin

atio

n of

info

rmat

i-on

to p

oten

ti-al

per

petr

ator

s to

info

rm o

n ps

ycho

soci

al

supp

ort a

nd

to re

duce

di

scrim

ina-

tion

Info

rm su

rviv

ors /

vict

ims a

bout

the

pote

ntia

l sev

ere

and

life

thre

aten

ing

cons

eque

nces

.

Info

rm c

omm

unity

abo

ut a

vaila

bilit

y of

serv

ices

, how

to

acc

ess t

hem

and

that

it w

ill sa

ve su

rviv

ors a

nd

fam

ilies

.

Build

trus

t in

the

com

mun

ity.

Info

rm th

e co

mm

unity

abo

ut h

e ne

ed to

pro

tect

and

ca

re fo

r sur

vivo

rs o

f vio

lenc

e an

d no

t to

disc

rimin

ate

them

.

Mon

thly

sta

tistic

s

No.

of w

omen

re

ceiv

ed le

gal

supp

ort

Abso

lute

num

ber /

mon

thAi

m fo

r hig

h co

vera

geAc

tion

coul

d be

take

n by

the

polic

e, se

curit

y, U

NH

CR

, N

GO

s and

CBO

s, le

gal a

dvic

e in

stitu

tions

, hum

an

right

s gro

ups l

ocal

lead

ers o

r hea

lth c

are

prov

ider

s.

Dep

ends

on

the

resp

onsib

le

insti

tutio

nC

apac

ity B

uil-

ding

No.

of l

ocal

gro

ups

or p

erso

ns tr

aine

d in

SG

BV p

reve

ntio

n an

d re

spon

se

Mos

t sta

ff is

trai

ned

on

gend

er e

qual

i-ty

issu

es, G

BV,

guid

ing

prin

cipa

ls &

le

gal s

tan-

dard

s

Stre

ngth

en lo

cal c

apac

ity to

mon

itor a

nd n

etw

ork

to

rele

vant

sect

ors.

Dev

elop

a c

ompl

aint

mec

hani

sm a

nd in

vesti

gatio

n str

ateg

y.

Min

imise

risk

of s

exua

l exp

loita

tion

of b

enefi

cia

ry

com

mun

ity b

y hu

man

itaria

n w

orke

rs a

nd p

eace

keep

ers.

Repo

rts o

n ac

tiviti

es

62

10. P

SYC

HO

-SO

CIA

L C

AR

E A

ND

MEN

TAL

HEA

LTH

No.

of p

sych

o-so

cial

supp

ort

serv

ices

ava

ila-

ble

(indi

vidu

al o

r in

stitu

tion)

Serv

ice

whi

ch is

off e

red

by la

y co

unse

llors

or

othe

r per

sonn

el tr

aine

d on

men

tal h

ealth

or

psyc

hoso

cial

supp

ort

To p

rovi

de so

-ci

al a

nd e

mo-

tiona

l sup

port

w

ithin

the

com

mun

ities

To p

reve

nt

stres

s diso

rder

Peop

le in

nee

d in

clud

es th

ose

who

are

vul

nera

ble,

liv

ing

with

disa

bilit

ies,

men

tal h

ealth

pro

blem

s or

chro

nic

dise

ases

and

/or n

eed

assis

tanc

e in

dai

ly li

fe

refe

rrin

g to

mob

ility

, per

sona

l hyg

iene

, foo

d in

take

and

pr

otec

tion.

Asse

smen

t re

port

s

No.

of p

erso

ns

trai

ned

on

psyc

ho-s

ocia

l su

ppor

t or m

en-

tal h

ealth

No.

of l

ay c

ouns

ello

rs

and

supe

rviso

rs fo

r PSC

av

aila

ble

in th

e co

mm

u-ni

ty o

r in

the

aff e

cted

po

pula

tion

To c

over

em

o-tio

nal s

uppo

rt

with

in th

e co

mm

uniti

es

Com

mun

ity m

embe

rs a

re tr

aine

d to

iden

tify

and

asse

ss

PSC

nee

ds in

the

com

mun

ity b

ased

on

the

crite

ria.

Th ey

pro

vide

soci

al a

nd e

mot

iona

l sup

port

. PSC

pro

vi-

ders

them

selv

es n

eed

supp

ort a

nd su

perv

ision

.

Repo

rts

Num

ber o

f pe

ople

who

are

in

nee

d of

soci

al

and

emot

iona

l su

ppor

t

Th os

e aff

ect

ed b

y di

-sa

ster a

nd c

onfl i

ct w

ho

cann

ot c

ope.

See:

IASC

gui

delin

es o

n PS

C a

nd M

enta

l Hea

lth

To a

sses

s and

qu

antif

y th

e ne

ed fo

r PSC

an

d m

enta

l he

alth

supp

ort

PSC

is a

cro

ss-

cutti

ng is

sue

and

clus

ter i

n H

uman

itaria

n As

sista

nce

Nee

d fo

r Psy

cho-

Soci

al C

are

(PSC

) is d

epen

ding

on

to w

hat e

xten

d th

e co

ping

stra

tegi

es o

f the

com

mun

ity

are

over

stret

ched

.

Poss

ible

crit

eria

for

ass

essin

g ne

eds f

or P

SC in

a c

om-

mun

ity a

re:

• lo

ss o

f hom

e / h

ouse

• da

mag

e of

the

hous

e •

loss

and

/or d

amag

e of

bel

ongi

ngs

• in

jurie

s and

dea

ths o

f rel

ativ

es

• w

itnes

sing

mat

eria

l and

hum

an lo

sses

of n

eigh

-bo

urs a

nd fr

iend

s

Repo

rts,

asse

ssm

ent

63

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

cePe

ople

livi

ng

with

disa

bilit

ies

Pers

on w

ith a

ny k

ind

of

disa

bilit

y an

d/or

chr

onic

di

seas

e.

5 –

10%

of t

he p

opul

ati-

on m

ight

live

with

disa

-bi

litie

s. N

eeds

atte

ntio

n du

ring

asse

ssm

ent a

nd

plan

ning

.

To id

en-

tify

and

to

supp

ort t

hose

pe

rson

s with

di

sabi

litie

sw

ho n

eed

supp

ort a

ndto

pre

vent

fu

ture

diss

abi-

litie

s thr

ough

ap

prop

riate

ca

re a

nd

supp

ort

Dur

ing

asse

ssm

ent a

nd im

plem

enta

tion

it is

impo

rtan

t to

iden

tify

thos

e gr

oups

in th

e co

mm

unity

who

are

m

ost v

ulne

rabl

e be

caus

e of

imm

obili

ty, d

iseas

e an

d di

sabi

lity.

Furt

herm

ore,

follo

win

g di

saste

r and

con

fl ict

, the

re is

a

need

to re

fer p

atie

nts t

o ap

prop

riate

trea

tmen

t to

prev

ent f

utur

e di

sabi

lity

resu

lting

from

lack

of c

are

and

supp

ort.

Asse

ss in

jurie

s and

dise

ases

for p

oten

tial c

ause

of f

utur

e di

sabi

lity.

Asse

ssm

ent,

repo

rts

Peop

le e

xpos

ed

to tr

aum

atic

ev

ents

Peop

le e

xpos

ed to

di

saste

r are

not

dire

ctly

tr

aum

atise

d. Th

ere

is

a po

tent

ial t

o de

velo

p ch

roni

c str

ess d

isord

er

Mos

t in

the

com

mun

ity

deve

lop

acut

e str

ess r

eact

ion

and

can

cope

with

som

esu

ppor

t.

Disa

ster i

s exc

eedi

ng u

sual

cop

ing

capa

citie

s. Th

eref

ore

ther

e is

a ne

ed fo

r PSC

whi

ch su

ppor

ts th

e lo

cal c

opin

g ca

paci

ty.

Asse

ssm

ent

Trau

mat

ised

pers

onPT

SD –

pos

t tra

umat

ic

stres

s diso

rder

: psy

chia

t-ric

dia

gnos

is. Th

ose

who

ar

e at

risk

to d

evel

op

PTSD

nee

d re

ferr

al to

m

enta

l hea

lth se

rvic

es.

PTSD

– c

ases

sh

ould

be

prev

ente

d th

roug

h PS

C.

Th er

e ar

e a

few

cas

es w

ho m

ight

dev

elop

PT

SD a

nd

need

pro

fess

iona

l men

tal h

ealth

inte

rven

tion.

Mos

t co

mm

unity

mem

bers

get

alo

ng w

ith e

mot

iona

l sup

port

w

hich

can

be

prov

ided

by

trai

ned

lay

coun

sello

rs.

Asse

ssm

ent

64

11. P

ERFO

RM

AN

CE

BA

SED

IN

DIC

ATO

RS

(

Can

be

appl

ied

in a

ll se

tting

s)%

of s

ympt

oms

and

diag

nosti

c th

at a

re c

orre

ct

Doc

umen

ted

sym

ptom

s an

d cl

inic

al fi

ndin

gs

mat

ch w

ith d

iagn

oses

> 75

% a

re

corr

ect

Inte

nsiv

e tr

aini

ng p

rior t

o th

e in

trodu

ctio

n of

the

indi

-ca

tor i

s im

port

ant;

case

defi

niti

ons s

houl

d be

ava

ilabl

e as

wel

l as t

reat

men

t gui

delin

es.

Mon

thly

sa

mpl

e of

5-

10%

from

re

cord

s in

the

HF

% o

f dia

gnos

tic

and

pres

crip

tion

that

are

cor

rect

Pres

crip

tion

and

treat

men

t mat

ches

with

di

agno

sis

> 75

% a

re

corr

ect

Inte

nsiv

e tr

aini

ng p

rior t

o th

e in

trodu

ctio

n of

the

indi

-ca

tor i

s im

port

ant;

case

defi

niti

ons s

houl

d be

ava

ilabl

e as

wel

l as t

reat

men

t gui

delin

es.

Mon

thly

sa

mpl

e of

5-

10%

from

re

cord

s

% o

f NC

(new

ca

ses)

that

rece

i-ve

d no

t mor

eth

an 3

med

ica-

men

ts

No.

of

med

icam

ents

pres

crib

ed o

r giv

en to

on

e pa

tient

> 80

%

rece

ived

< 3

m

edic

amen

ts

Rat

iona

l use

of m

edic

ines

refl e

cted

in ta

rget

ed tr

eat-

men

t, i.e

. use

of a

ntib

iotic

s acc

ordi

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trea

tmen

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idel

ines

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thly

sa

mpl

e of

5-1

0%

draw

n fro

m

reco

rds

Refe

rral

rate

per

N

CN

o. o

f pat

ient

s ref

erre

d to

seco

ndar

y he

alth

se

rvic

e

> 5

/ 1,0

00 /

year

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rral

s are

from

prim

ary

care

to se

cond

ary

heal

th

serv

ice.

Dep

ends

on

the

size

of th

e he

alth

faci

lity

and

the

com

-pe

tenc

e an

d ca

paci

ties o

f pro

fess

iona

l sta

ff .

Mon

thly

he

alth

stat

i-sti

cs

Pric

e lis

t for

he

alth

car

e se

rvic

e is

tran

spar

ent a

nd

resp

ecte

d

Avai

labi

lity,

aff o

rdab

ility

, tr

ansp

aren

cy,

qual

ity o

f car

e

In so

me

setti

ngs p

eopl

e pa

y fe

es fo

r hea

lth se

rvic

e; it

is

impo

rtan

t tha

t pat

ient

s are

not

ove

r cha

rged

.Th

is ca

n be

ens

ured

by

havi

ng c

omm

unity

repr

esen

ta-

tives

par

ticip

atin

g in

hea

lth c

entre

man

agem

ent i

ssue

s an

d co

nsen

ting

on fe

es to

be

paid

.

Min

istry

of

Hea

lth o

r di

rect

hea

lth

serv

ice

pro-

vide

r

65

Indi

cato

rD

efi n

ition

/ Re

fere

nce

Aim

Rem

arks

and

com

men

tsD

ata

sour

ceFr

ee h

ealth

se

rvic

e fo

r mos

t vu

lner

able

No.

of t

hose

rece

ived

fre

e se

rvic

e ou

t of t

otal

po

pula

tion

100%

(vul

nera

bilit

y cr

iteria

ava

ila-

ble)

List

shou

ld b

e es

tabl

ished

of t

he n

eedi

est.

Crit

eria

sh

ould

be

set a

nd c

larif

yed

who

is e

ligib

le fo

r fre

e se

rvic

es. T

ry to

ver

ify if

thos

e ar

e re

ally

rece

ivin

g fre

e se

rvic

es.

HF,

Com

mun

ity

repr

esen

ta-

tives

Avai

labi

lity

of

esse

ntia

l dru

gsAv

aila

bilit

y of

ess

entia

l dr

ugs

No

stock

rup-

ture

OR

1-5

m

edic

amen

tsar

e no

tav

aila

ble

for

less

than

5

days

Stoc

k ru

ptur

e is

espe

cial

ly c

omm

on in

rem

ote

and

con-

fl ict

are

as. M

ay re

fl ect

poo

r pla

nnin

g an

d pr

ocur

emen

tpr

oced

ures

.

HF

Adm

inist

ratio

n fo

rms a

re u

pda-

ted

and

in u

se

All f

orm

s are

av

aila

ble

and

in

use

Refe

rs to

gen

eral

man

agem

ent a

nd re

port

ing,

fi na

ncia

l m

anag

emen

t. pr

ocur

emen

t and

inve

ntor

y, pe

rson

nel

man

agem

ent.

HF

Com

mun

ity

part

icip

atio

nN

o. o

f mee

tings

hel

d w

ith c

omm

uniti

es/

mon

th

1 / m

onth

Com

mun

ities

nee

d to

be

invo

lved

in H

F m

anan

ge-

men

t and

pla

nnin

g th

roug

h vi

llage

com

mitt

ees o

r vi

llage

hea

lth w

orke

r in

the

HF.

HF,

com

mun

ity

repr

esen

ta-

tives

66

67

AN

C

Ant

enat

al C

are

ARV

A

ntire

trovi

ral

BEO

C

Bas

ic E

ssen

tial O

bste

tric

Car

eC

EOC

C

ompr

ehen

sive

Ess

entia

l Obs

tetri

c C

are

CH

W

Com

mun

ity H

ealth

Wor

ker

CM

R

Cru

de M

orta

lity

Rat

eC

SW

Com

mer

ial S

ex W

orke

rD

OTS

D

irect

Obs

erve

d Tr

eatm

ent S

trate

gyEP

I Ex

pand

ed P

rogr

amm

e of

Imm

unis

atio

nG

BV

G

ende

r Bas

ed V

iole

nce

HF

Hea

lth F

acili

tyH

HS

Hou

seho

ld su

rvey

HIS

H

ealth

Info

rmat

ion

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emH

W

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lth W

orke

rID

P In

tern

ally

Dis

plac

ed P

erso

nID

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Intra

veno

us D

rug

Use

rIE

C

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rmat

ion

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atio

n an

d C

omm

unic

atio

n

IPT

Inte

rmitt

ent P

roph

ylax

is T

reat

men

tIU

In

tern

atio

nal U

nits

LDC

Le

ss D

evel

oped

Cou

ntry

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C

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t Dev

elop

ed C

ount

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DR

M

ulti

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g R

esis

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eN

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patie

nts D

epar

tmen

tO

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rpha

ns a

nd V

ulne

rabl

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ren

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P Po

st-e

xpos

ure

prop

hyla

xis

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Pr

imar

y H

ealth

Car

ePL

WH

A P

eopl

e Li

ving

With

HIV

/AId

sPN

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Post

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l Car

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Post

-Tra

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tress

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I Se

xual

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rans

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fect

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Tr

aditi

onal

Birt

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ttend

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T Vo

lunt

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Cou

nsel

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and

Test

ing

Abb

revi

atio

ns

7. Annex

7.1 Case defi nitions1

Measles: generalised rash lasting > 3 days and temperature >38 C and one of the following: cough, runny nose, red eyesDysentery: three or more liquid stool per day and presence of visible blood in stoolsCommon Diarrhoea: severe, profuse, watery diarrhoea with or without vo-miting.Acute Respiratory Infection (ARI): cough or diffi cult breathing > 50/mi-nute for infant age 2 months to 1 year; breathing >40/minute children 1-4 years; and no chest indrawing, stridor or danger signs.Meningitis: sudden onset of fever > 38.9 C neck stiff ness or purpura.

7.2 Glossary of terms2

Th e following paragraph clarifi es common terms in the area of public health, humanitarian aid and development. Th e authors opted for the ones that may be most applicable to Malteser’s work while other sources may off er diff erent defi nitions.

Accountability: Th e ability to call state offi cials, public employees, or pri-vate actors to account, requiring that they be answerable for their policies, actions, and use of funds. Access to information and analysis about the per-formance of services and policies builds pressure for accountability.

Accuracy: Th e degree to which a measurement or an estimate based on mea-surements represents the true value of the attribute that is being measured.

1 Referenced from SPHERE handbook2 Defi nitions are drawn from various World Bank publications and websites as well as Abbot and Guijt’s Changing Views on Change: Participatory Approaches to Monitoring the Environment (1998) AND the European Commission handbook on AID Delivery Methods, March 2004

68

Benefi ciary Assessments: A qualitative method of information-gathering which assesses the value of an activity as it is perceived by its principal users. Th e approach is qualitative, systematic but fl exible, action-oriented, and tar-geted to decision makers. Benefi ciary Assessments are often used during the project preparation phase, but are also performed during M&E phases as well. Key techniques involve participant observation and semi-structured interviews with individuals and focus groups.

Bias: Inferences leading to inaccuracy of results (selection bias, information bias, interview bias and others)

Coverage: Th e proportion of people benefi ting from the intervention and usually expressed in percentage or proportions.

Cure Rate: Effi cacy of a treatment (or drug) regimen; it is not really a rate but a proportion (Source: F. Checci et al, 2007)

Effi cacy: Optimal administration of intervention (Source: F. Checci et al, 2007)

Empowerment: Th e expansion of assets and capabilities of poor people to participate in, negotiate with, infl uence, control, and hold accountable ins-titutions that aff ect their lives.

Endemic Disease: Diseases that occur during the whole year in the area/community (Source: F. Checci et al, 2007)

Epidemic: A sudden increase of a disease that is usually absent or present on a low level

Epidemiology: Th e study of the distribution of diseases in the community by looking at factors aff ecting health or illness i.e what disease, when did it occur, which persons are aff ected, how has it been transmitted. Logic inter-ventions and methodologies are applied.

Equity: Inputs and benefi ts reach the various stakeholders fairly.

69

Eff ectiveness: Th e contribution made by results to achievement of the pro-ject purpose; and how assumptions have aff ected project achievements.

Effi ciency: Project results have been achieved at reasonable costs; this requi-res usually comparisons to alternative approaches.

Evaluation: Evaluation systematically judges the value of changes (planned and unplanned) resulting from project outputs and outcomes, in compa-rison against original plans. Evaluation provides an assessment of achieve-ment of project objectives, effi ciency, eff ectiveness, impact and sustainability. Evaluation should take into consideration the impact upon individuals and the community in terms of the development of new ideas and quality of life, resource mobilization, income distribution, self-reliance, and environ-mental and natural resource conservation. Evaluation helps to target project outcomes and qualify project benefi ts.

Evidence Based Public Health: “Evidence-based public health is defi ned as the development, implementation, and evaluation of eff ective programs and policies in public health through application of principles of scientifi c reasoning, including systematic uses of data and information systems, and appropriate use of behavioural science theory and program planning mo-dels” (Brownson et al., 2003).

Excess Mortality: Death that would not have occurred if the crisis had not taken place (Source: F. Checci et al, 2007).

Exposure: Th e event and degree of an individual getting in contact with an infectious pathogen or substance or other risk factors that increases the risk of a disease (Source: F. Checci et al, 2007).

Famine: A famine is a social and economic crisis that is commonly accom-panied by widespread malnutrition, starvation, epidemics and increased mortality

Household Survey: Type of epidemiological study in which representatives from household level are selected to provide health information (or others).

70

Analogue to cross-sectional surveys; and are often used for baseline data or monitoring/evaluation of an intervention program.

Incidence: Occurrence of new cases of infection/diseases in a specifi c po-pulation

Impact: Impact indicators measure the ultimate eff ect of an intervention on a key dimension of the living standards (mortality rates or prevalence of diseases) of individuals- such as freedom from hunger, literacy, good health, empowerment or security

Impact Evaluation: Th e systematic identifi cation of a development activity’s eff ects – positive or negative, intended or not – on individuals, households, institutions, and the environment. Impact evaluation helps explain the ex-tent to which activities reach poor people and the magnitude of their eff ects on people’s welfare.

Impact Monitoring: Th e regular assessment of changes over time in the status of project benefi ciaries.

Indicator: A variable to measure the progress of activities or changes resul-ting from the project activity, which assesses whether a change is in the desi-red direction and whether the objective will be achieved. A good indicator refl ects both quantitative and qualitative change. Quantitative indicators (numerical) can be displayed as a single factor or a cumulative fi gure. Qua-litative indicators measure either a behaviour or an indirect representation and often require open-ended responses.

Input: Input indicators track all the fi nancial and physical resources used for an intervention.

Local Capacity Building: Development of skills and capacity either through training or technical assistance to either civil society’s representa-tives (NGO’s, Red Cross, church groups etc.) or to government/adminis-tration structures. Local capacity building does not include budgetary or fi nancial support.

71

Local Organisational Capacity: Th e ability of people to work together, or-ganize themselves, and mobilize resources to solve problems of common interest. Local organisational capacity may take the form of informal associ-ations – lending circles or family groups – or formal associations – farmers’ groups or neighbourhood associations. Local organisational capacity ena-bles communities to collectively make decisions, manage funds, and solve problems.

Management: Th e act of controlling and directing an organisation

Methods: A regular systematic way of doing something

Monitoring: Monitoring is a continuous process to assess whether a project or policy is being implemented as planned, has made good progress, and faced any problems. It also considers how to solve such problems. Monito-ring plays an important role to ensure that activities are performed on sche-dule and within the allocated budget, that all concerned are satisfi ed, and that project outputs and outcomes correspond to stated objectives. It ena-bles a more responsive, accountable, and transparent system of operating.

Monitoring and Evaluation: Separate but interrelated activities to gather information and report fi ndings on project or policy performance and re-sults. Monitoring is a periodic, rather than a one-off , reassessment of indi-cators that are chosen to determine the eff ects of certain interventions or policies. Monitoring is almost always guided by pre-determined indicators, while evaluations are usually based on more general questions. Monitoring and evaluation yield the greatest benefi ts when they are performed in a par-ticipatory manner.

Outcome: Outcome indicators measure the level of access to public servi-ces (number of health facilities), use of these services (children vaccinated) and the level of satisfaction of users. Outcome typically depends on factors beyond the control of the implementing agency (such as behaviour of the individuals or other demand-side factors).

72

Outbreak: Equivalent to epidemic but usually refers to the very fi rst group of epidemic cases (Source: F. Checci et al, 2007).

Output: Output indicators cover all the goods and services generated (staf-fi ng, availability of medicine) by the use of the inputs. Th ese measure the supply of goods and services provided to individuals. Outputs typically are fully under the control of the agency that provides them.

Participation: A process through which stakeholder’s infl uence and share control over development initiatives and the decisions and resources that af-fects them. Th ere are diff erent levels of stakeholder involvement, including information dissemination (one-way fl ow of information), consultation (two-way fl ow of information), collaboration (shared control over decision making), and empowerment (the transfer of control over decisions and re-sources). Diff erent levels of participation ensure varying degrees of responsi-veness, transparency, accountability, and equity.Participation eff ects monitoring and evaluation in the following ways:

• Purpose of the evaluation• Criteria and indicators identifi ed• Design and implementation of the evaluation• Who participates in the monitoring and analysis• How the information is used

Participatory Monitoring and Evaluation (PME): A systematic manage-ment tool designed to reveal the degree of eff ectiveness and effi ciency in the achievement of objectives according to the perspectives of stakeholders. PME brings together diverse stakeholders, giving them an opportunity to negotiate regarding what success should look like and what indicators should be used to evaluate success. In this process, all stakeholders discuss and plan the project together from the outset, jointly setting the objectives, targets, indicators, and work process. It is a process that leads to knowledge generation, collaborative problem solving, and corrective action by invol-ving all levels of stakeholders in shared decision-making.

Participatory Rural Appraisal (PRA)A growing family of participatory approaches and methods that emphasize

73

local knowledge and enable local people to do their own appraisal, analysis and planning. Th e approach also enables shared learning and planning of appropriate interventions among local people and outsiders (development practitioners and government offi cials). PRA techniques have mainly been used early in the project cycle, but can also be applied during other phases. Visual techniques such as mapping, seasonal calendars or cause-impact dia-grams are often featured so that non-literate people can participate. Other common methods include semi-structured interviewing with individuals and focus groups. Although originally developed for use in rural areas, PRA has been used successfully in a variety of settings.

Performance Monitoring: Continual assessment of actual results to de-monstrate whether project, program, or policy is achieving its stated goals. Performance monitoring promotes effi ciency, transparency, and targeting.

Point Prevalence: Proportion or percentage of the population (or sub-group) that has the infection/disease at a specifi c point in time i.e. yesterday. It is the most expressed type of prevalence (Source: F. Checci et al, 2007).

Prevalence: Number of cases of infection or diseases present in a popu-lation or sub-group; this includes incident (new cases) as well as existing cases(Source: F. Checci et al, 2007).

Process Monitoring: Continual assessment of how the processes, procedu-res and criteria of a project are working.

Proportion: Quantity A over quantity N; or A is a fraction of N (e.g. 15% of the population [=A] of 12.000 people [=N] got malaria); (Source: F. Checci et al, 2007).Proxy: Indicator of something which is, by its complex nature, not measu-rable.

Primary Health Care (Alma Ata, 1978): WHO’s holistic concept for pro-viding equal access to health care for all, which include eight elements such as curative care, provision of essential drugs, health promotion, mother and child health, immunization, water and sanitation facilities, control of en-

74

demic diseases and capacity building. Participation of communities, decen-tralisation and sustainability are the key strategies or principals. Although there have been rapid changes in the last 30 years PHC is still valid and will play an important part to tackle diseases such as HIV/AIDS, TB, maternal health, mental health among others.

Public Health: It’s a science and art of preventing diseases, prolonging life and promoting health. Health systems, epidemiology, health services, health economics, environmental and social behaviour are some of the important sub-fi elds.

Quality: Degree to which of the stated results of a project or programme at the outputs, outcome and impact levels, are being or have been achieved.

Quantitative and Qualitative Approaches: Quantitative and qualitative research methods are complementary techniques. Th e choice of methods will depend on the availability of time, skills, technology, and resources. Quantitative methods refer to random sampling for survey research, struc-tured individual interviews for data collection and subsequent statistical analyses that allow the results to be considered representative, comparab-le and generalizable to a wider population. Qualitative methods refer to a spectrum of data collection and analysis techniques where sampling is not necessarily random and more in-depth, unstructured, open-ended eff orts are incorporated. Th is allows for in-depth analysis of social, political, and economic issues.

Rate: Th e number of events occurring per unit (e.g. number of births per year). In epidemiology rates are expressed as events per unit people and unit time e.g. fertility rate: number of children per woman per lifetime. Note that incidence rates refl ecting only new cases of a disease per unit people per unit time e.g. new HIV positive cases in pregnant women during the last 12 month.

Relevance: Th e appropriateness of project objectives to the problems that it was supposed to address, and to the physical and policy environment within which it operated.

75

Responsiveness: Project objectives are met according to the priorities of all stakeholders.

Sampling: Th e number of people, households, communities or other units of a population that have been selected in a systematic way.

Sensitivity: Often used for diagnostic quality control i.e. for the laboratory: the test are capturing the positive diagnosed cases (e.g. malaria or TB) as true positive.

Specifi city: Often used for diagnostic quality control i.e. for the laboratory: the test are capturing the negative diagnosed cases (e.g. malaria or TB) as true negative.

Stakeholder: People, groups, or institutions those are likely to be aff ected by a proposed Intervention (either negatively or positively), or those which can aff ect the outcome of the intervention. Examples of stakeholders inclu-de: client governments, the poor and other vulnerable groups (e.g. landless, women, children, indigenous people, and minority groups), other individu-als, families, communities or groups aff ected by the project or policy, and interested groups (donors, NGOs, religious and community organisations, local authorities, and private fi rms).

Stakeholder Analysis: Th e starting point of most participatory work and social assessments. It is used to develop an understanding of the power rela-tionships, infl uence and interests of the various people involved in an activi-ty, and to develop an appropriate plan for their participation.Strategic Monitoring: Analysis of monitoring and evaluation data or spe-cial studies to help assess lessons learned in terms of needed policy changes or larger scale adjustments of programming strategies.

Surveillance: Systematic collection, analysis and interpretation of health data; used for regular monitoring, early detection of outbreaks and outbreak control.

76

Sustainability: An attempt to ensure that the best or desirable outcomes will be maintained and continue into the future.

Transparency: Clarity and openness regarding activities and relationships.

Vector: Pathogens, organism, parasite, insects or others that is involved in the transmission of diseases (e.g. aedes aegypti, anopheles etc.).

8. References and web addresses

8.1 Health

Brownson, Ross C., Elizabeth A. Baker, Terry L. Leet, and Kathleen N. Gillespie, Editors. Evidence-Based Public Health. New York: Oxford Uni-versity Press, 2003.

Checci F and Roberts L. Interpreting and using mortality data in humani-tarian emergencies. London: Overseas Development Institute. 2005.

Connolly MA. Communicable disease control in emergencies. A fi eldma-nual. Geneva: World Health Organization, 2005.

Demographic and Health Surveys. Available at: http://www.measuredhs.com. Accessed 29.10.2007. Centre for Disease Control and Prevention (CDC) Atlanta. Famine-Aff ected, Refugee, and Displaced.

Populations: Recommendations for Public Health Issues. MMWR - Vol. 41, No. RR-13. Publication date: 07/24/1992. Available at: http://wonder.cdc.gov/wonder/prevguid/p0000113/p0000113.asp#head01200600000000. Accessed 05.09.2007.

European Commission. Aid Delivery Methods. Project Cycle Manage-ment. March 2004.

77

F. Checci, M. Gayer, R. Freeman Grais and E.J. Mills. Public Health incrisis aff ected populations. London: Overseas Development Institute, 2007.

Handbook for Emergencies (2nd edition). Geneva: UNHCR, 1999.

Harries AD, Maher D, Raviglione MC, Chaulet P, Nunn PP, Praag vanE. TB/HIV, A clinical manual. Geneva: WHO, 1996.

http://www.worldbank.org

Malaria control in complex emergencies: An Inter-Agency Field Hand-book. Geneva: WHO and the RBM Technical Support network, 2005.

Murray CJL. Towards good practice for health statistics: lessons from the Millenium Development Goal health indicators. Lancet 2007; 369:862-73.

Report on the analysis of “Quality Management” tools in the humanitar-ian sector and their application by NGO’s. Brussels: ECHO, 2002.

Salma P, Spiegel P, Talley L and Waldman R. Lessons learned fromcomplex emergencies over past decade. Th e Lancet, Vol 364, November 13. 2004.

Technical Guidelines for Humanitarian Assistance. Geneva: WHO, 2001. Available at www.who.int/hac/techguidance/tools/disrupted_sectors/mod-ule_01/en/print.html. Accessed 25.02.2008.

Th e SPHERE Project. Humanitarian Charter and Minimum Standards in Disaster Response. Geneva: 2004 Edition.

United Nations. World Mortality Report 2005. Department of Economic and Social Aff airs; Population Division. 2006.

78

WHO Bulletin online. Available at: http://www.who.int/bulletin/en/. Ac-cessed 15.03.2008.

WHO Health Action in Crisis Technical Guidelines. Available at http://www.who.int/hac/techguidance/en/. Accessed 15.03.2008.

WHO. Reproductive Health Indicators: guidelines for their generation, interpretation and analysis for global monitoring. 2006.

Yip R and Sharp TW. Acute malnutrition and high childhood mortality related to diarrhoea: lessons learned from the Kurdish refugee crisis. JAMA 1993; 270: 587-90.

Young H and Haspers S. Nutrition disease and death in times of famine. Disasters 1995; 19:94-109.

8.2 Reproductive Health

Minimum Initial Service package (MISP) for Reproductive health in Crisis Situations: A distance learning Module. Women’s Commission for Refugee Women and Children. Available at: http://misp.rhrc.org/.

ICW and Young Positives. 2008. Available at:http://www.unfpa.org/upload/lib_pub_fi le/815_fi lename_lnkages_rapid_tool.pdf.

Rapid Assessment Tool for Sexual &Reproductive Health and HIV linkages. A Generic Guide. Prepared and published by IPPF, UNFPA, WHO, UN-AIDS, GNP and ICW and Young Positives. 2008. Available at: http://www.unfpa.org/upload/lib_pub_fi le/815_fi lename_lnkages_rapid_tool.pdf.

79

Reproductive Health in Refugee Situations: An Inter-Agency Field Manual UNHCR/UNFPA/WHO, 1999. Available at:http://www.unfpa.org/emer-gencies/manual/.

Reproductive Health Kits for Crisis Situations, 3rd edition. New York: UN-FPA, 2004.

8.3 Sexual gender based violence (SGBV) and Mental Health

C. Lindsey-Curtet, F.T. Holst-Roness, L. Anderson. Addressing the Needs of Women Aff ected by Armed Confl ict: an ICRC Guidance. Geneva: ICRC, 2004. Available at: http://www.icrc.org/Web/Eng/siteeng0.nsf/htmlall/p0840/$File/ICRC_002_0840_WOMEN_GUIDANCE.PDF!Open.

Clinical management of survivors of rape. Geneva: WHO, UNHCR, 2004. Available at: http://www.unfpa.org/upload/lib_pub_fi le/373_fi lename_cli-nical-mgt-2005rev1.pdf.

Guidelines for Gender-based Violence Interventions in Humanitarian Set-tings. Inter Agency Standing Committee, Geneva, 2005.

Mental Health in Emergencies: Psychological and Social Aspects of Health of Populations exposed to extreme stressors. Geneva: WHO, 2003. http://www.who.int/mental_health/media/en/640.pdf.

Mental Health of Refugees. Geneva: WHO & UNHCR, 1996.

Sexual and Gender based Violence against Refugees, Returnees, and Inter-nally Displaced Persons. Geneva: UNHCR, 2003. Available at: http://www.rhrc.org/pdf/gl_sgbv03.pdf.

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8.4 Nutrition

Food and Nutrition Needs in Emergencies. Geneva, New York, Rome: UNHCR, UNICEF, WFP, WHO, 2004. Available at: http://whqlibdoc.who.int/hq/2004/a83743.pdf

H.Young and S. Jaspers. Th e meaning and measurement of acute malnu-trition in emergencies. A primer for decision-makers. London: Overseas Development Institute, 2006.

Management of severe malnutrition: a manual for physicians and other senior health workers. Geneva: WHO, 1999.

81

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82

Imprint:2009

Authors: Marie T. Benner, K. Peter SchmitzLayout: Esther Suchanek

Druck: LUTHE Druck und Medienservice KGPhotos: M.T. Benner, K.P. Schmitz, E. Suchanek,

Malteser International Published by Malteser International 2009

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