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Accountability in the Health Sector, Part 2: The Value of a Good Indicator


How many times have you heard or said the words, “If we only had accurate information about that, we could do something about it?” Take some comfort in the fact that you are not alone. Health system administrators, managers and caregivers, not to mention provincial / territorial departments of health and social services, all struggle with this reality every day.

While getting the information or the answer you seek is not easy, it is perhaps one of the most worthwhile endeavours you can undertake to improve your health system, facility or department.

Indicators are key to accountability

In Part 1 of this blog series regarding accountability in the health sector, I spoke about the three elements that must be present for there to be genuine accountability:

  • Clearly defined responsibilities and performance targets,
  • Accurate and timely reporting of performance measures, and;
  • The power and authority for an overseeing actor to impose consequences for achieving or not achieving performance targets. Accountability with no sanctions is typically considered to be weak accountability.

Performance measures can provide you with the elusive ‘accurate information’ that will allow you to make real changes in your system, facility, program or department. And to measure performance, you need good indicators.

Characteristics of a good performance indicator

Fundamentally, an indicator provides a sign or a signal that something exists or is true. It is used to show the presence or state of a situation or condition. In the context of monitoring and evaluation, an indicator is a quantitative metric that provides information to monitor performance, measure achievement and determine accountability. A quantitative metric can be used to provide data on the quality of an activity, project or program.

A good indicator has several characteristics:

  • It is clear and concise.
  • It focuses on a single issue that provides relevant information on a situation — particularly information that provides the strategic insight required for effective planning and sound decision making.
  • It is feasible to collect meaningful and credible data to measure it. If it is not feasible to collect data for an indicator, or if the data that can be collected is invalid, unreliable or biased, the indicator will have little or no utility.
  • It actually and accurately measures what it claims to measure.

I cannot stress these points enough. Unfortunately, I have seen too many situations where a health facility, program or department embarks on an indicator development initiative and gets very excited about it, but then spends too little time determining the feasibility of collecting the data, or whether in fact the indicator is simply a ‘nice to have’ versus something that will actually provide valuable information about their facility, program or department in order to make improvements or enhancements.

To avoid this pitfall and learn what the essential components of an indicator are, please tune in next month for Part 3 of my Accountability in the Health Sector blog series, where we will explore health indicators in more detail.