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Accountability in the Health Sector, Part 3: Indicator Essentials


In Part 2 of this blog series regarding accountability in the health sector, I spoke about the characteristics of a good indicator:

  • It should be clear and concise.

  • It should focus on a single issue that provides relevant information about 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.

Let’s explore indicators more fully to understand how to achieve the above characteristics.

Essential components of an indicator

Essential components to be clearly defined or identified for a high-quality indicator include:

  • Title and definition

  • Purpose and rationale

  • Method of measurement

  • Data collection methodology and data collection tools

  • Data collection frequency

  • Subgroups that collected data can be separated into to more precisely understand and analyze the findings

  • Guidelines for interpreting and using data from the indicator

  • Strengths and weaknesses of the indicator and the challenges in its use

  • Relevant sources of additional information on the indicator

Further, indicators should always have a proven track record (i.e., demonstrated performance in field testing or operational use) before they are broadly deployed. It is impossible to underestimate the value of this. A proven track record prevents the allocation of resources on indicators that will not provide useful data.

Indicators are important . . . but not magic

An important but often-overlooked fact about indicators is that they merely indicate.

  • They do not capture or convey the many dimensions of a given situation and / or activity.

  • They are directional, such that they provide basic information on the past, present and possible future course of an activity, program and / or behaviour.

  • They are also very context-specific. Higher values or lower values can be either good or bad, depending on the situation. The desired direction of the indicator (i.e., an increase or decrease) is usually determined when the indicator is selected and before data collection begins.

I have seen health organizations become so focused on the creation of measurable indicators that they forget to focus on why they exist: to provide quality and value-added patient care. So while we have seen that indicators are incredibly useful tools for health administrators, policy makers and providers, they are not magical. Regardless of how well an indicator system is set up, the hard work of transferring the knowledge gleaned from indicators into transformative changes to policies, procedures, structures or processes remains.

Further, indicators are not designed to replace more detailed investigations of specific issues, nor should they be used to do so. Information generated by indicators should always be interpreted within the broader context of the situation and supplemented where necessary by special studies, additional evaluation activities and other types of data.

Indicators are an essential part of effective monitoring and evaluation. They can provide vital information on performance, achievement and accountability. However, indicators are only one part of an accountability mindset. They are only one method for collecting and analyzing data, and it is imperative that they be used when and where they provide meaningful information and insight.