The purpose of the Regional Health Observatory (RHO) of the Pan American ... RHO can be found in the project profile âStrengthening PAHO Public Health ...
PAN AMERICAN HEALTH ORGANIZATION WORLD HEALTH ORGANIZATION
4th MEETING OF THE REGIONAL ADVISORY COMMITTEE ON HEALTH STATISTICS
Havana, Cuba, 26 to 28 March 2012
REGIONAL HEALTH OBSERVATORY Project of Health Information and Analysis (HSD/HSD), Area of Health Surveillance and Disease Prevention and Control (HSD) INTRODUCTION The purpose of the Regional Health Observatory (RHO) of the Pan American Health Organization (PAHO) is to generate and disseminate data, information, and the scientific evidence to support health planning, as well as monitoring and evaluation of public health interventions in the Region of the Americas. RHO covers the following functions: collection, standardization, integration, and processing of health data and statistics from the countries in the Americas and technical areas and programs across the Organization; application of epidemiological methods for documenting health situation and trends, measuring of population health status, inequalities and inequities; monitoring the progress of health indicators and the achievement of goals; generating the analytical evidence to support decisions in public health and guide public health policies; and evaluating the impact of health interventions at local, national and regional levels. The RHO is integrated by three main components: 1) a cross-organizational team of health professionals, working under the leadership of the Health Information and Analysis project (HSD/HA); 2) the PAHO Health Information and Intelligence Platform (PHIP) as a corporate resource for health data and information, provider of processes and tools to support health analysis and intelligence; and 3) the Portal of the Regional Health Observatory as a means for disseminating health information and knowledge [1]. The purpose of this working document is to summarize the progress in the development and implementation of the Regional Health Observatory to the Regional Advisory Committee of Health Statistics (CRAES). ADVANCES
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OBSERVATORY The main ideas, the conceptual framework for the development of the RHO, and a description of RHO’s components were presented to CRAES members during the meeting 1
held in Washington DC from 11 to 13 August 2009 [1]. More detailed information about RHO can be found in the project profile “Strengthening PAHO Public Health Information Systems” and progress reports presented to PAHO Governing Bodies [2-3]. After having formulated the project of the RHO at the beginning of the year 2009, HSD/HA has been working in: i) the development and implementation of RHO’s components; ii) the articulation and coordination of the work with technical areas and programs of the Organization to strengthen the health data collection and integration processes; and ii) the consolidation of health analysis, production of results and generation of evidence for supporting decision-making in public health. Progress and achievements The implementation and consolidation of the PAHO Health Information and Intelligence Platform (PHIP) based on the design and architecture is documented elsewhere [1]. Today, PHIP is fully operational and serving as the main health information and intelligence resource of the Organization. PHIP IT infrastructure was setup and configured and most of the architectural components of PHIP were procured, installed and configured in both staging and production environments. PHIP has the capacity to cover the institutional demand of information. PHIP services permit: i) managing health data and information; ii) accessing data, indicators and health statistics for analyses based on self-service principle, making the use of data and production of results more efficient; iii) effective tools for data analysis, including visual and exploratory analysis techniques and iv) provide reports, data visualizations, dashboards and analytical products; and v) data exchange and interoperability mechanisms with other information systems, facilitating the dissemination of data, information, evidence and knowledge. The PHIP health intelligence component is available at http://phip.paho.org. Design, development, and implementation of the Health Data Warehouse: The Health Data Warehouse is a data repository, which integrates health data and statistics from technical programs across the Organization. One of its main features is that data are clean, well structured, data and metadata are integrated. A data integration service allows automated data extraction, transformation, integration and loading processes from multiple data sources from technical programs of the Organization and from other health institutions and partners to the data warehouse. The Health Data Warehouse currently contains the following datasets:
Regional Mortality datasets. Registered and corrected deaths, aggregated by five dimensions: country, year of occurrence, sex, age group and underlying cause of death (underlying cause ICD-10 to 4th character)
Core Health Indicators and data from PAHO Technical Programs, such as: Tuberculosis, HIV/AIDS, Dengue, Malaria, Immunization
Estimates of World’s Population, World Population Prospects, 2011, United Nation Population Division.
World Development Indicators, World Bank 2011
Official Development Assistance for Health, OECD, and IHME
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Data stored in the Data Warehouse are accessible and ready to be used for analysis by all PAHO staff, including Country Offices and Centers. This is important because it breaks with the tradition of data silos within the Organization. The availability of integrated health data allows performing comprehensive and timely health analysis improving the capacity to respond to current and new public health challenges. Data warehousing concepts, principles and practices were implemented to facilitate access to and use of health data. The integration of data of both structural and contextual metadata was one of the most important practices implemented in the Data Warehouse. Design and implementation of the Public Health Intelligence component, containing tools for exploratory data analysis, elaboration and dissemination of interactive data visualizations: This component incorporates innovative techniques for data analysis and efficient production of results. A new paradigm for data use, generation of results and dissemination of information was implemented. It is characterized by: i) easy connection of multiple data sources in a variety of formats; ii) no need of programming or IT support; iii) easy to use analytical tools; and iv) efficient tools for production, dissemination and sharing of data visualizations and results. Because of PHIP, health analysts are able to carry out analysis processes and obtain final results and insights in hours or days, instead of weeks or months as in the past. Analysts are able to share results with peers and end users in a collaborative environment without relying on information technology professionals. Design, development and implementation of the RHO Portal: The Portal of the RHO was launched in September 2010 during the 50th Directing Council of PAHO. The site is available at this link http://www.paho.org/rho The interoperability mechanisms among PHIP (http://phip.paho.org), the Portal of the RHO (http://www.paho.org/rho) and PAHO Web site (http://www.paho.org) has been implemented. Reports, data visualizations, and information products that are disseminated through the Portal of the RHO are being served and powered by PHIP. Analyses of several health themes have been prepared and published, such as:
Health situation and trends in the Region of the Americas
Mortality and causes of death
Maternal health
Child and infant health
Adolescent health
Aging and health
Non-Communicable diseases
Tobacco control
Portal of the Regional Health Observatory The Portal of the RHO is the means to facilitate access to health data and statistics and to disseminate analytical results, technical and methodological recommendations, briefings 3
of the health situation and trends generated by the RHO. The RHO Portal is envisioned as a point of entry to a comprehensive and authoritative set of data and information from PAHO and the Region of the Americas. The content published at the Portal is organized with the following structure:
Health themes: Devoted to relevant public health themes and subjects from the Region. Each subject includes topics of data, information and analytical results; key messages, interactive `visualizations`, and reports, as well as liaisons to additional information on the subject. (See Annex 2)
Health data: This section facilitates the access to databases and datasets collected and processed by the RHO. All datasets are documented and freely available for download.
Country statistics: This section aims to disseminate data and information by countries of the Americas, including those developed by the RHO and national institutions. For each country, a Health Indicator Profile and other information products are currently published.
Reports: This section disseminates and facilitates access to reports, as well as formal and informal publications prepared by the RHO, PAHO Programs and Projects, international and national institutions, and RHO collaborating groups.
Presentations: This section aims to disseminate and share talks, lectures and technical presentations made by members of the RHO at technical meetings, conferences, and scientific events.
The Portal of the RHO is integrated into the PAHO Internet site and articulated with the various sections of the areas and technical programs of the Organization. The RHO is using interactive data visualizations to share and communicate analytic results, data and statistics. Information products, reports, dashboards and data visualizations are being prepared following information design good practices with intensive use of graphic representations. The RHO through data visualizations is able to i) effectively explain and communicate analytical results; ii) communicate key messages to a diverse and heterogeneous audience; iii) promote audience interest for data and result exploration, pattern discovering, and finding responses to ad hoc analytical questions; iv) facilitate access and transparent data sharing; v) facilitate re-utilization of results in other contexts and needs; and vi) support decisionmaking in health in a more effective and efficient way. Plan for the elaboration of Health Themes: Establishing a sound plan for the development of health themes is key for the RHO. In this regards, the Health Information and Analysis Project (HSD/HA) has drafted a plan that includes a comprehensive set of public health themes and subjects. This plan will be executed during the current biennium 20122013 and a review and evaluation is envisioned. Themes and subjects included in the plan are detailed in Annex 1 of this document. The RHO portal will be presented during the CRAES meeting and detailed information about the RHO will be given. Some information products will be illustrated, emphasizing how the RHO is facilitating the access and use of data, how the RHO is communicating 4
analytical results and promoting the use of information and evidence to find answers to ad hoc questions of analysis and to support decision making in health. Challenges and prospects Success and sustainability of the RHO depends primarily on the systematic and cohesive work of the health professionals’ team of the Observatory, who is in charge of health analyses, addressing relevant health issues, the production of evidence and recommendations to support decision-making in the Organization and Member States. The consolidation of the health analyst community of the Observatory and the establishment of networking is the key challenge at this time. The RHO is a valuable resource to guide technical cooperation, to improve health information, to strengthen the decision-making processes and to account for actions to improve the population health in the Region of the Americas. PAHO and HSD/HA foresee the systematic consolidation of RHO and work to achieve the vision that the RHO is an authorized source of health data and information for the Region of the Americas. The establishments of working relationships between RHO and national divisions and departments of health information, health institutions and groups of health professionals is also envisioned as part of the RHO perspective. TO THE CONSIDERATION OF THE CRAES This working document presents achievements and main progress in the development and implementation of the PAHO Regional Health Observatory. It is submitted to the Regional Advisory Committee on Health Statistics in order to be evaluated and it is expected that the Committee gives specific recommendations for its improvement, consolidation and strengthening.
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REFERENCES
1. Regional Health Observatory. Working document CRAES/09/06. 3rd Meeting of the Regional Advisory Committee on Health Statistics. Available at http:/craes.drupalgardens.com/sites/craes.drupalgardens.com/files/CRAES.09.06_ MARTINEZ_ENG.pdf 2. Report of progress. Project “Strengthening Public Health Information System of PAHO”. Subcommittee on Program, Budget and Administration, 2011. Available in http:/new.paho.org/hq/index.php?option=com_docman&task=doc_download& gi d=16882&Itemid= 3. Report of progress. Project “Strengthening Public Health Information System of PAHO”. Subcommittee on Program, Budget and Administration, 2010. Available in http:/new.paho.org/hq/dmdoc uments/2010/spba4-10-s.pdf, Annex, page 5.
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ANNEXES Annex 1. Health Themes to be developed and published in the RHO A proposal of health themes that should be addressed by the RHO is submitted in order to respond to its objective and purpose. •
Millennium Development Goals (MDG). Goal Monitoring o MDG 1–Nutrition (severe growth retardation) o MDG 4–Infant health and childhood; immunization o MDG 5–Maternal and reproductive health o ODM 6 – VIH/Sida, Tuberculosis, Malaria o MDG 7 – Water and sanitation o MDG 8–International Assistance for the development of the Health
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Health Situation and its trends in the `Region of the Americas` o Demographic features (demographic transition) o Socioeconomic characteristics o Health indicator trend o Health indicator atlas o Status index of health of the population
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Mortality and causes of death o Deaths by Chapters ICD-10 o Leading causes of death o Distribution and magnitude of mortality according to income brackets o Trends of broad groups of causes of death o Distribution and spatial mortality trend o Avoidable mortality
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Health systems: Performance of Health Systems and Services o Workforce in health o Health Financing and International Assistance National Accounts International Assistance in the development in health (bilateral and multilateral) o Essential drugs o Health technology o Health services o Governance and Leadership of the health
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Health according to groups of diseases o Non-communicable Diseases (NCD) Mortality/ Morbidity • Diabetes • Brain vascular • Cardiovascular/Ischemic • Cancer Risk factors • Tobacco control (already published) • Alcohol consumption • Hypertension Prevalence 7
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Obesity Prevalence
o
Communicable Diseases Mortality and morbidity • HIV/Aids • Malaria • Tuberculosis • Influenza • Cholera • Tropical Diseases (Neglected) • Vaccine-preventable diseases (immunization)
o
Injuries and External Causes Mortality Implementation of public policies to reduce the risk of injuries
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Population group health (Life-course) o Health in Infancy and childhood (< 1, 1-4 years, 5-9 years) o Maternal and reproductive health o Health of adolescents and young adults (10-19, 20-24 years) o Health of the adults (25-59 years)/ Workers’ health o Health of the older adults (60+ years) [Subject of World Health Day 2012]
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Health Determinants o Environmental, cultural, and socioeconomic conditions o Networks of the society and the community o Factors related to the lifestyle and individual behavior
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Risk Factors o Tobacco control (already published) o Alcohol consumption o Prevalence of Hypertension. o Prevalence of Obesity o Vaccination coverage
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Equity in health o Socioeconomic o Geographical o Gender
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Health and environment o Water and sanitation o Urban health o Poverty
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Natural disasters o Climate change o Reduction of risks of threats by Hurricanes/Earthquakes
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Annex 2. Health themes section, Portal of the RHO
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Annex 3. Information architecture of a health theme
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Annex 4. Information architecture for a health theme topic
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