According to a 2021 health care systems ranking among selected high-income countries, the United States came last in the overall ranking of its health care system performance. The overall ranking was based on five performance categories, including access to care, care process, administrative efficiency, equity, and health care outcomes. For the category health care outcomes, which takes into account health outcomes most likely to be responsive to health care, the U.S. was ranked last, while Australia took first place. Outcomes such as infant mortality or preventable mortality were included. This statistic present the health care outcomes rankings of the United States' health care system compared to ten other high-income countries in 2021.

In 2023, Singapore ranked first with a health index score of ****, followed by Japan and South Korea. The health index measures the extent to which people are healthy and have access to the necessary services to maintain good health, including health outcomes, health systems, illness and risk factors, and mortality rates. The statistic shows the health and health systems ranking of countries worldwide in 2023, by their health index score.

IntroductionPrivate sector healthcare delivery in low- and middle-income countries is sometimes argued to be more efficient, accountable, and sustainable than public sector delivery. Conversely, the public sector is often regarded as providing more equitable and evidence-based care. We performed a systematic review of research studies investigating the performance of private and public sector delivery in low- and middle-income countries. Methods and FindingsPeer-reviewed studies including case studies, meta-analyses, reviews, and case-control analyses, as well as reports published by non-governmental organizations and international agencies, were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into six World Health Organization health system themes: accessibility and responsiveness; quality; outcomes; accountability, transparency, and regulation; fairness and equity; and efficiency. Of 1,178 potentially relevant unique citations, data were obtained from 102 articles describing studies conducted in low- and middle-income countries. Comparative cohort and cross-sectional studies suggested that providers in the private sector more frequently violated medical standards of practice and had poorer patient outcomes, but had greater reported timeliness and hospitality to patients. Reported efficiency tended to be lower in the private than in the public sector, resulting in part from perverse incentives for unnecessary testing and treatment. Public sector services experienced more limited availability of equipment, medications, and trained healthcare workers. When the definition of “private sector” included unlicensed and uncertified providers such as drug shop owners, most patients appeared to access care in the private sector; however, when unlicensed healthcare providers were excluded from the analysis, the majority of people accessed public sector care. “Competitive dynamics” for funding appeared between the two sectors, such that public funds and personnel were redirected to private sector development, followed by reductions in public sector service budgets and staff. ConclusionsStudies evaluated in this systematic review do not support the claim that the private sector is usually more efficient, accountable, or medically effective than the public sector; however, the public sector appears frequently to lack timeliness and hospitality towards patients. Please see later in the article for the Editors' Summary

This dataset provides comprehensive statistics on global health, focusing on various diseases, treatments, and outcomes. The data spans multiple countries and years, offering valuable insights for health research, epidemiology studies, and machine learning applications. The dataset includes information on the prevalence, incidence, and mortality rates of major diseases, as well as the effectiveness of treatments and healthcare infrastructure.

Dataset Use Cases:

This dataset can be used for:

• Healthcare Policy Analysis: Understanding which diseases are most prevalent and which countries require more investment in healthcare infrastructure.
• Epidemiological Studies: Studying the correlation between disease prevalence and socio-economic factors like income, education, and urbanization.
• Machine Learning Models: Training predictive models to forecast disease trends, mortality rates, and treatment effectiveness based on historical data.
• Global Health Research: Identifying regions that need targeted interventions or public health campaigns.

Global Health Outcomes Data

Impact on Mortality Rates and Malnutrition in Countries Around the World

By Humanitarian Data Exchange [source]

About this dataset

This dataset provides comprehensive insights into critical health conditions around the world, such as mortality rate, malnutrition levels, and frequency of preventable diseases. It documents the prevalence of life-threatening diseases like malaria and tuberculosis, and are tracked alongside key health indicators like adult mortality rates, HIV prevalence, physicians per 10,000 people ratio and public health expenditures. Such metrics provide us with an accurate picture of how developed healthcare systems are in certain countries which ultimately leads to improvements in public policy formation and awareness amongst decision-makers. With this data it is possible to observe disparities between different regions of the world which can help inform global strategies for providing equitable care globally. This dataset is a valuable source for researchers interested in understanding global health trends over time or seeking to evaluate regional differences within countries

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How to use the dataset

This dataset provides comprehensive global health outcome data for countries around the world. It includes vital information such as infant mortality rates, child malnutrition rates, adult mortality rates, deaths due to malaria and tuberculosis, HIV prevalence rates, life expectancy at age 60 and public health expenditure. This dataset can be used to gain valuable insight into the challenges faced by different countries in providing a good quality of life for their citizens.

To use this dataset, first identify what questions you need answered and what outcomes you are looking to measure. You may want to look at specific disease-based indicators (e.g. malaria or tuberculosis), health-related indicators (e.g., nutrition), or overall population markers (e.g., life expectancy).

Then decide which data points from the provided fields will help answer your questions and provide the results needed - e.g,. infant mortality rate or HIV prevalence rate - extracting these values from relevant columns like “Infants lacking immunization (% of one-year-olds) Measles 2013” or “HIV prevalence, adult (% ages 15Ð49) 2013” respectively

Next extract other columnwise relevant information - e.g., country name — that could also aid your analysis using tools like Excel or Python's Pandas library; sorting through them based on any metric desired — e..g,, physicians per 10k people — while being mindful that some data points are missing in some cases (denoted by NA).

Finally perform basic analyses with either your own scripting language, like R/Python libraries' numerical functions with accompanying visuals/graphs etc if elucidating trends is desired; drawing meaningful conclusions about overall state of global health outcomes accordingly before making informed decisions thereafter if needed too!

Research Ideas

• Create a world health map to visualize the differences in health outcomes across different countries and regions.
• Develop an AI-based decision support tool that identifies optimal public health policies or interventions based on these metrics for different countries.
• Design a dashboard or web app that displays and updates this data in real-time, to allow users to compare the current state of global health indicators and benchmark them against historical figures

Acknowledgements

If you use this dataset in your research, please credit the original authors. Data Source

License

License: CC0 1.0 Universal (CC0 1.0) - Public Domain Dedication No Copyright - You can copy, modify, distribute and perform the work, even for commercial purposes, all without asking permission. See Other Information.

Columns

File: health-outcomes-csv-1.csv | Column name | Description | |:-------------------------------------------------------------------------------|:--------------------------------------------------------------------------------------------------------------------| | Country | The name of the country. (String) ...

This dataset provides key performance indicators (KPIs) for healthcare systems across various countries or regions. It includes metrics such as hospital capacity, patient satisfaction, healthcare expenditures, mortality rates, life expectancy, and doctor-to-patient ratios.

The dataset is valuable for researchers, policymakers, and data analysts seeking insights into healthcare efficiency, access, and outcomes. It can be used for comparative analysis, healthcare policy evaluation, predictive modeling, and machine learning applications in the medical field.

Potential Use Cases:

📉 Analyzing healthcare efficiency and resource allocation
🏥 Identifying disparities in healthcare access
📊 Predictive modeling for patient outcomes
💰 Studying the impact of healthcare expenditures on public health
📌 Comparing healthcare systems across countries

The association between healthcare expenditures and outcomes, mainly mortality and life expectancy, is complex. The real explanation for this association is not clear, especially in the Middle East and North Africa (MENA) region. This study assesses the impact of health expenditures on improving healthcare systems and health status and finds a relationship between health expenditures and health outcomes across different region. Annual time series data on healthcare spending and outcomes from 1995 to 2015 were used for MENA region in comparison to developed and developing countries. Health expenditure was adjusted by the consumer price index equation to the 2015 US dollar eliminate the impact of inflation on our results. For many countries, spending on healthcare continues to rise, Among MENA countries, we found that the United Arab Emirates and Kuwait spent more per capita on health, $1,711 and $1,420, respectively, than any other countries in the region. Although this study demonstrated a relationship between total healthcare expenditure and outcomes, some countries spend more on healthcare but have shorter life expectancy. In most countries, efficient and effective utilization of healthcare resources is the key strategy for improving health outcomes in any country. The lack of a positive correlation between healthcare spending and life expectancy may indicate that health resources are not allocated effectively. In those cases, increasing health spending does not guarantee that there is any kind of improvement in healthcare.

This dataset provides a comparative analysis of education and health indicators across top countries, including Poland, Finland, Italy, and the USA etc... The data covers a range of indicators related to education, such as literacy rates, enrollment rates, and education spending, as well as health indicators such as life expectancy, infant mortality rates, and healthcare spending. The data is sourced from various official and publicly available data sources, including the World Bank, the United Nations, and country-specific government websites. Researchers, analysts, and educators can use this dataset to gain insights into the education and health outcomes of different countries, as well as to identify areas for improvement and best practices. The dataset is ideal for cross-country comparative analysis and can be used to inform policy-making, research, and educational programs.

Abstract

Different countries have different health outcomes that are in part due to the way respective health systems perform. Regardless of the type of health system, individuals will have health and non-health expectations in terms of how the institution responds to their needs. In many countries, however, health systems do not perform effectively and this is in part due to lack of information on health system performance, and on the different service providers.

The aim of the WHO World Health Survey is to provide empirical data to the national health information systems so that there is a better monitoring of health of the people, responsiveness of health systems and measurement of health-related parameters.

The overall aims of the survey is to examine the way populations report their health, understand how people value health states, measure the performance of health systems in relation to responsiveness and gather information on modes and extents of payment for health encounters through a nationally representative population based community survey. In addition, it addresses various areas such as health care expenditures, adult mortality, birth history, various risk factors, assessment of main chronic health conditions and the coverage of health interventions, in specific additional modules.

The objectives of the survey programme are to: 1. develop a means of providing valid, reliable and comparable information, at low cost, to supplement the information provided by routine health information systems. 2. build the evidence base necessary for policy-makers to monitor if health systems are achieving the desired goals, and to assess if additional investment in health is achieving the desired outcomes. 3. provide policy-makers with the evidence they need to adjust their policies, strategies and programmes as necessary.

Geographic coverage

The survey sampling frame must cover 100% of the country's eligible population, meaning that the entire national territory must be included. This does not mean that every province or territory need be represented in the survey sample but, rather, that all must have a chance (known probability) of being included in the survey sample.

There may be exceptional circumstances that preclude 100% national coverage. Certain areas in certain countries may be impossible to include due to reasons such as accessibility or conflict. All such exceptions must be discussed with WHO sampling experts. If any region must be excluded, it must constitute a coherent area, such as a particular province or region. For example if ¾ of region D in country X is not accessible due to war, the entire region D will be excluded from analysis.

Analysis unit

Households and individuals

Universe

The WHS will include all male and female adults (18 years of age and older) who are not out of the country during the survey period. It should be noted that this includes the population who may be institutionalized for health reasons at the time of the survey: all persons who would have fit the definition of household member at the time of their institutionalisation are included in the eligible population.

If the randomly selected individual is institutionalized short-term (e.g. a 3-day stay at a hospital) the interviewer must return to the household when the individual will have come back to interview him/her. If the randomly selected individual is institutionalized long term (e.g. has been in a nursing home the last 8 years), the interviewer must travel to that institution to interview him/her.

The target population includes any adult, male or female age 18 or over living in private households. Populations in group quarters, on military reservations, or in other non-household living arrangements will not be eligible for the study. People who are in an institution due to a health condition (such as a hospital, hospice, nursing home, home for the aged, etc.) at the time of the visit to the household are interviewed either in the institution or upon their return to their household if this is within a period of two weeks from the first visit to the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

SAMPLING GUIDELINES FOR WHS

Surveys in the WHS program must employ a probability sampling design. This means that every single individual in the sampling frame has a known and non-zero chance of being selected into the survey sample. While a Single Stage Random Sample is ideal if feasible, it is recognized that most sites will carry out Multi-stage Cluster Sampling.

The WHS sampling frame should cover 100% of the eligible population in the surveyed country. This means that every eligible person in the country has a chance of being included in the survey sample. It also means that particular ethnic groups or geographical areas may not be excluded from the sampling frame.

The sample size of the WHS in each country is 5000 persons (exceptions considered on a by-country basis). An adequate number of persons must be drawn from the sampling frame to account for an estimated amount of non-response (refusal to participate, empty houses etc.). The highest estimate of potential non-response and empty households should be used to ensure that the desired sample size is reached at the end of the survey period. This is very important because if, at the end of data collection, the required sample size of 5000 has not been reached additional persons must be selected randomly into the survey sample from the sampling frame. This is both costly and technically complicated (if this situation is to occur, consult WHO sampling experts for assistance), and best avoided by proper planning before data collection begins.

All steps of sampling, including justification for stratification, cluster sizes, probabilities of selection, weights at each stage of selection, and the computer program used for randomization must be communicated to WHO

STRATIFICATION

Stratification is the process by which the population is divided into subgroups. Sampling will then be conducted separately in each subgroup. Strata or subgroups are chosen because evidence is available that they are related to the outcome (e.g. health, responsiveness, mortality, coverage etc.). The strata chosen will vary by country and reflect local conditions. Some examples of factors that can be stratified on are geography (e.g. North, Central, South), level of urbanization (e.g. urban, rural), socio-economic zones, provinces (especially if health administration is primarily under the jurisdiction of provincial authorities), or presence of health facility in area. Strata to be used must be identified by each country and the reasons for selection explicitly justified.

Stratification is strongly recommended at the first stage of sampling. Once the strata have been chosen and justified, all stages of selection will be conducted separately in each stratum. We recommend stratifying on 3-5 factors. It is optimum to have half as many strata (note the difference between stratifying variables, which may be such variables as gender, socio-economic status, province/region etc. and strata, which are the combination of variable categories, for example Male, High socio-economic status, Xingtao Province would be a stratum).

Strata should be as homogenous as possible within and as heterogeneous as possible between. This means that strata should be formulated in such a way that individuals belonging to a stratum should be as similar to each other with respect to key variables as possible and as different as possible from individuals belonging to a different stratum. This maximises the efficiency of stratification in reducing sampling variance.

MULTI-STAGE CLUSTER SELECTION

A cluster is a naturally occurring unit or grouping within the population (e.g. enumeration areas, cities, universities, provinces, hospitals etc.); it is a unit for which the administrative level has clear, nonoverlapping boundaries. Cluster sampling is useful because it avoids having to compile exhaustive lists of every single person in the population. Clusters should be as heterogeneous as possible within and as homogenous as possible between (note that this is the opposite criterion as that for strata). Clusters should be as small as possible (i.e. large administrative units such as Provinces or States are not good clusters) but not so small as to be homogenous.

In cluster sampling, a number of clusters are randomly selected from a list of clusters. Then, either all members of the chosen cluster or a random selection from among them are included in the sample. Multistage sampling is an extension of cluster sampling where a hierarchy of clusters are chosen going from larger to smaller.

In order to carry out multi-stage sampling, one needs to know only the population sizes of the sampling units. For the smallest sampling unit above the elementary unit however, a complete list of all elementary units (households) is needed; in order to be able to randomly select among all households in the TSU, a list of all those households is required. This information may be available from the most recent population census. If the last census was >3 years ago or the information furnished by it was of poor quality or unreliable, the survey staff will have the task of enumerating all households in the smallest randomly selected sampling unit. It is very important to budget for this step if it is necessary and ensure that all households are properly enumerated in order that a representative sample is obtained.

It is always best to have as many clusters in the PSU as possible. The reason for this is that the fewer the number of respondents in each PSU, the lower will be the clustering effect which

Global Health Spending

Country Global Health Spending Over Time

By Eva Murray [source]

About this dataset

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How to use the dataset

To get started with this data, begin by exploring the location and time columns as these will provide a breakdown of which countries are represented in the dataset as well as when each observation was collected. To drill down further into the analysis, use indicators, subjects and measures fields for comparison between healthcare spending for different topics like drug access or acute care across countries over time. The values field contains actual values related to healthcare spending while flag codes tell you if there are any discrepancies in data quality so it is important look into those too if necessary.

This dataset is useful for research relatedto how global health expenditures have varied across different countries over time and difference sources of funding among a few other applications. Understanding what's included in this dataset will help you determine how best to use it when doing comparative country-level analyses or international studies on healthcare funding sources over time

Research Ideas

• Identify countries with high public health spending as a percentage of GDP and determine if their population has better health outcomes than those with lower spending.
• Compare public health investments across various countries during the same period to ascertain areas that need more attention, such as medical research, vaccinations, medication and healthcare staffing.
• Determine the trends in health expenditures over time for key indicators such as life expectancy to gain insights into how well a country is managing its healthcare sector

Acknowledgements

If you use this dataset in your research, please credit the original authors. Data Source

License

License: Dataset copyright by authors - You are free to: - Share - copy and redistribute the material in any medium or format for any purpose, even commercially. - Adapt - remix, transform, and build upon the material for any purpose, even commercially. - You must: - Give appropriate credit - Provide a link to the license, and indicate if changes were made. - ShareAlike - You must distribute your contributions under the same license as the original. - Keep intact - all notices that refer to this license, including copyright notices.

Columns

File: DP_LIVE_18102020154144776.csv | Column name | Description | |:---------------|:-----------------------------------------| | LOCATION | Country or region of the data. (String) | | INDICATOR | Health spending indicator. (String) | | SUBJECT | Health spending subject. (String) | | MEASURE | Measurement of health spending. (String) | | FREQUENCY | Frequency of data collection. (String) | | TIME | Year of data collection. (Integer) | | Value | Value of health spending. (Float) | | Flag Codes | Codes related to data quality. (String) |

Acknowledgements

If you use this dataset in your research, please credit the original authors. If you use this dataset in your research, please credit Eva Murray.

The aim of the article is to compare health system outcomes in the BRICS countries, assess the trends of their changes in 2000−2017, and verify whether they are in any way correlated with the economic context. The indicators considered were: nominal and per capita current health expenditure, government health expenditure, gross domestic product (GDP) per capita, GDP growth, unemployment, inflation, and composition of GDP. The study covered five countries of the BRICS group over a period of 18 years. We decided to characterize countries covered with a dataset of selected indicators describing population health status, namely: life expectancy at birth, level of immunization, infant mortality rate, maternal mortality ratio, and tuberculosis case detection rate. We constructed a unified synthetic measure depicting the performance of individual health systems in terms of their outcomes with a single numerical value. Descriptive statistical analysis of quantitative traits consisted of the arithmetic mean (xsr), standard deviation (SD), and, where needed, the median. The normality of the distribution of variables was tested with the Shapiro–Wilk test. Spearman's rho and Kendall tau rank coefficients were used for correlation analysis between measures. The correlation analyses have been supplemented with factor analysis. We found that the best results in terms of health care system performance were recorded in Russia, China, and Brazil. India and South Africa are noticeably worse. However, the entire group performs visibly worse than the developed countries. The health system outcomes appeared to correlate on a statistically significant scale with health expenditures per capita, governments involvement in health expenditures, GDP per capita, and industry share in GDP; however, these correlations are relatively weak, with the highest strength in the case of government's involvement in health expenditures and GDP per capita. Due to weak correlation with economic background, other factors may play a role in determining health system outcomes in BRICS countries. More research should be recommended to find them and determine to what extent and how exactly they affect health system outcomes.

Abstract

Different countries have different health outcomes that are in part due to the way respective health systems perform. Regardless of the type of health system, individuals will have health and non-health expectations in terms of how the institution responds to their needs. In many countries, however, health systems do not perform effectively and this is in part due to lack of information on health system performance, and on the different service providers.

The aim of the WHO World Health Survey is to provide empirical data to the national health information systems so that there is a better monitoring of health of the people, responsiveness of health systems and measurement of health-related parameters.

The overall aims of the survey is to examine the way populations report their health, understand how people value health states, measure the performance of health systems in relation to responsiveness and gather information on modes and extents of payment for health encounters through a nationally representative population based community survey. In addition, it addresses various areas such as health care expenditures, adult mortality, birth history, various risk factors, assessment of main chronic health conditions and the coverage of health interventions, in specific additional modules.

The objectives of the survey programme are to: 1. develop a means of providing valid, reliable and comparable information, at low cost, to supplement the information provided by routine health information systems. 2. build the evidence base necessary for policy-makers to monitor if health systems are achieving the desired goals, and to assess if additional investment in health is achieving the desired outcomes. 3. provide policy-makers with the evidence they need to adjust their policies, strategies and programmes as necessary.

Geographic coverage

The survey sampling frame must cover 100% of the country's eligible population, meaning that the entire national territory must be included. This does not mean that every province or territory need be represented in the survey sample but, rather, that all must have a chance (known probability) of being included in the survey sample.

There may be exceptional circumstances that preclude 100% national coverage. Certain areas in certain countries may be impossible to include due to reasons such as accessibility or conflict. All such exceptions must be discussed with WHO sampling experts. If any region must be excluded, it must constitute a coherent area, such as a particular province or region. For example if ¾ of region D in country X is not accessible due to war, the entire region D will be excluded from analysis.

Analysis unit

Households and individuals

Universe

The WHS will include all male and female adults (18 years of age and older) who are not out of the country during the survey period. It should be noted that this includes the population who may be institutionalized for health reasons at the time of the survey: all persons who would have fit the definition of household member at the time of their institutionalisation are included in the eligible population.

If the randomly selected individual is institutionalized short-term (e.g. a 3-day stay at a hospital) the interviewer must return to the household when the individual will have come back to interview him/her. If the randomly selected individual is institutionalized long term (e.g. has been in a nursing home the last 8 years), the interviewer must travel to that institution to interview him/her.

The target population includes any adult, male or female age 18 or over living in private households. Populations in group quarters, on military reservations, or in other non-household living arrangements will not be eligible for the study. People who are in an institution due to a health condition (such as a hospital, hospice, nursing home, home for the aged, etc.) at the time of the visit to the household are interviewed either in the institution or upon their return to their household if this is within a period of two weeks from the first visit to the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

SAMPLING GUIDELINES FOR WHS

Surveys in the WHS program must employ a probability sampling design. This means that every single individual in the sampling frame has a known and non-zero chance of being selected into the survey sample. While a Single Stage Random Sample is ideal if feasible, it is recognized that most sites will carry out Multi-stage Cluster Sampling.

The WHS sampling frame should cover 100% of the eligible population in the surveyed country. This means that every eligible person in the country has a chance of being included in the survey sample. It also means that particular ethnic groups or geographical areas may not be excluded from the sampling frame.

The sample size of the WHS in each country is 5000 persons (exceptions considered on a by-country basis). An adequate number of persons must be drawn from the sampling frame to account for an estimated amount of non-response (refusal to participate, empty houses etc.). The highest estimate of potential non-response and empty households should be used to ensure that the desired sample size is reached at the end of the survey period. This is very important because if, at the end of data collection, the required sample size of 5000 has not been reached additional persons must be selected randomly into the survey sample from the sampling frame. This is both costly and technically complicated (if this situation is to occur, consult WHO sampling experts for assistance), and best avoided by proper planning before data collection begins.

All steps of sampling, including justification for stratification, cluster sizes, probabilities of selection, weights at each stage of selection, and the computer program used for randomization must be communicated to WHO

STRATIFICATION

Stratification is the process by which the population is divided into subgroups. Sampling will then be conducted separately in each subgroup. Strata or subgroups are chosen because evidence is available that they are related to the outcome (e.g. health, responsiveness, mortality, coverage etc.). The strata chosen will vary by country and reflect local conditions. Some examples of factors that can be stratified on are geography (e.g. North, Central, South), level of urbanization (e.g. urban, rural), socio-economic zones, provinces (especially if health administration is primarily under the jurisdiction of provincial authorities), or presence of health facility in area. Strata to be used must be identified by each country and the reasons for selection explicitly justified.

Stratification is strongly recommended at the first stage of sampling. Once the strata have been chosen and justified, all stages of selection will be conducted separately in each stratum. We recommend stratifying on 3-5 factors. It is optimum to have half as many strata (note the difference between stratifying variables, which may be such variables as gender, socio-economic status, province/region etc. and strata, which are the combination of variable categories, for example Male, High socio-economic status, Xingtao Province would be a stratum).

Strata should be as homogenous as possible within and as heterogeneous as possible between. This means that strata should be formulated in such a way that individuals belonging to a stratum should be as similar to each other with respect to key variables as possible and as different as possible from individuals belonging to a different stratum. This maximises the efficiency of stratification in reducing sampling variance.

MULTI-STAGE CLUSTER SELECTION

A cluster is a naturally occurring unit or grouping within the population (e.g. enumeration areas, cities, universities, provinces, hospitals etc.); it is a unit for which the administrative level has clear, nonoverlapping boundaries. Cluster sampling is useful because it avoids having to compile exhaustive lists of every single person in the population. Clusters should be as heterogeneous as possible within and as homogenous as possible between (note that this is the opposite criterion as that for strata). Clusters should be as small as possible (i.e. large administrative units such as Provinces or States are not good clusters) but not so small as to be homogenous.

In cluster sampling, a number of clusters are randomly selected from a list of clusters. Then, either all members of the chosen cluster or a random selection from among them are included in the sample. Multistage sampling is an extension of cluster sampling where a hierarchy of clusters are chosen going from larger to smaller.

In order to carry out multi-stage sampling, one needs to know only the population sizes of the sampling units. For the smallest sampling unit above the elementary unit however, a complete list of all elementary units (households) is needed; in order to be able to randomly select among all households in the TSU, a list of all those households is required. This information may be available from the most recent population census. If the last census was >3 years ago or the information furnished by it was of poor quality or unreliable, the survey staff will have the task of enumerating all households in the smallest randomly selected sampling unit. It is very important to budget for this step if it is necessary and ensure that all households are properly enumerated in order that a representative sample is obtained.

It is always best to have as many clusters in the PSU as possible. The reason for this is that the fewer the number of respondents in each PSU, the lower will be the clustering effect which

In 2023, Norway ranked first with a health index score of 83, followed by Iceland and Sweden. The health index score is calculated by evaluating various indicators that assess the health of the population, and access to the services required to sustain good health, including health outcomes, health systems, sickness and risk factors, and mortality rates. The statistic shows the health and health systems ranking of European countries in 2023, by their health index score.

United States US: Proportion of Population Spending More Than 25% of Household Consumption or Income on Out-of-Pocket Health Care Expenditure: % data was reported at 0.781 % in 2013. This records a decrease from the previous number of 0.856 % for 2012. United States US: Proportion of Population Spending More Than 25% of Household Consumption or Income on Out-of-Pocket Health Care Expenditure: % data is updated yearly, averaging 0.880 % from Dec 1995 (Median) to 2013, with 18 observations. The data reached an all-time high of 1.078 % in 2000 and a record low of 0.724 % in 2008. United States US: Proportion of Population Spending More Than 25% of Household Consumption or Income on Out-of-Pocket Health Care Expenditure: % data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s USA – Table US.World Bank: Poverty. Proportion of population spending more than 25% of household consumption or income on out-of-pocket health care expenditure, expressed as a percentage of a total population of a country; ; Wagstaff et al. Progress on catastrophic health spending: results for 133 countries. A retrospective observational study, Lancet Global Health 2017.; Weighted Average;

BackgroundIt is increasingly apparent that access to healthcare without adequate quality of care is insufficient to improve population health outcomes. We assess whether the most commonly measured attribute of health facilities in low- and middle-income countries (LMICs)—the structural inputs to care—predicts the clinical quality of care provided to patients.Methods and findingsService Provision Assessments are nationally representative health facility surveys conducted by the Demographic and Health Survey Program with support from the US Agency for International Development. These surveys assess health system capacity in LMICs. We drew data from assessments conducted in 8 countries between 2007 and 2015: Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania, and Uganda. The surveys included an audit of facility infrastructure and direct observation of family planning, antenatal care (ANC), sick-child care, and (in 2 countries) labor and delivery. To measure structural inputs, we constructed indices that measured World Health Organization-recommended amenities, equipment, and medications in each service. For clinical quality, we used data from direct observations of care to calculate providers’ adherence to evidence-based care guidelines. We assessed the correlation between these metrics and used spline models to test for the presence of a minimum input threshold associated with good clinical quality. Inclusion criteria were met by 32,531 observations of care in 4,354 facilities. Facilities demonstrated moderate levels of infrastructure, ranging from 0.63 of 1 in sick-child care to 0.75 of 1 for family planning on average. Adherence to evidence-based guidelines was low, with an average of 37% adherence in sick-child care, 46% in family planning, 60% in labor and delivery, and 61% in ANC. Correlation between infrastructure and evidence-based care was low (median 0.20, range from −0.03 for family planning in Senegal to 0.40 for ANC in Tanzania). Facilities with similar infrastructure scores delivered care of widely varying quality in each service. We did not detect a minimum level of infrastructure that was reliably associated with higher quality of care delivered in any service. These findings rely on cross-sectional data, preventing assessment of relationships between structural inputs and clinical quality over time; measurement error may attenuate the estimated associations.ConclusionInputs to care are poorly correlated with provision of evidence-based care in these 4 clinical services. Healthcare workers in well-equipped facilities often provided poor care and vice versa. While it is important to have strong infrastructure, it should not be used as a measure of quality. Insight into health system quality requires measurement of processes and outcomes of care.

Data set from the article Van Bulck L, Luyckx K, Goossens E, Apers S, Kovacs AH, Thomet C, Budts W, Sluman MA, Eriksen K, Dellborg M, Berghammer M, Johansson B, Caruana M, Soufi A, Callus E, Moons P. Patient-reported outcomes of adults with congenital heart disease from eight European countries: scrutinising the association with healthcare system performance. Eur J Cardiovasc Nurs. 2019 Aug;18(6):465-473. doi: 10.1177/1474515119834484. Epub 2019 Feb 26. PMID: 30808198.

This is the abstract:

Background: Inter-country variation in patient-reported outcomes of adults with congenital heart disease has been observed. Country-specific characteristics may play a role. A previous study found an association between healthcare system performance and patient-reported outcomes. However, it remains unknown which specific components of the countries' healthcare system performance are of importance for patient-reported outcomes.

Aims: The aim of this study was to investigate the relationship between components of healthcare system performance and patient-reported outcomes in a large sample of adults with congenital heart disease.

Methods: A total of 1591 adults with congenital heart disease (median age 34 years; 51% men; 32% simple, 48% moderate and 20% complex defects) from eight European countries were included in this cross-sectional study. The following patient-reported outcomes were measured: perceived physical and mental health, psychological distress, health behaviours and quality of life. The Euro Health Consumer Index 2015 and the Euro Heart Index 2016 were used as measures of healthcare system performance. General linear mixed models were conducted, adjusting for patient-specific variables and unmeasured country differences.

Results: Health risk behaviours were associated with the Euro Health Consumer Index subdomains about patient rights and information, health outcomes and financing and access to pharmaceuticals. Perceived physical health was associated with the Euro Health Consumer Index subdomain about prevention of chronic diseases. Subscales of the Euro Heart Index were not associated with patient-reported outcomes.

Conclusion: Several features of healthcare system performance are associated with perceived physical health and health risk behaviour in adults with congenital heart disease. Before recommendations for policy-makers and clinicians can be conducted, future research ought to investigate the impact of the healthcare system performance on outcomes further.

Abstract

Different countries have different health outcomes that are in part due to the way respective health systems perform. Regardless of the type of health system, individuals will have health and non-health expectations in terms of how the institution responds to their needs. In many countries, however, health systems do not perform effectively and this is in part due to lack of information on health system performance, and on the different service providers.

The aim of the WHO World Health Survey is to provide empirical data to the national health information systems so that there is a better monitoring of health of the people, responsiveness of health systems and measurement of health-related parameters.

The overall aims of the survey is to examine the way populations report their health, understand how people value health states, measure the performance of health systems in relation to responsiveness and gather information on modes and extents of payment for health encounters through a nationally representative population based community survey. In addition, it addresses various areas such as health care expenditures, adult mortality, birth history, various risk factors, assessment of main chronic health conditions and the coverage of health interventions, in specific additional modules.

The objectives of the survey programme are to: 1. develop a means of providing valid, reliable and comparable information, at low cost, to supplement the information provided by routine health information systems. 2. build the evidence base necessary for policy-makers to monitor if health systems are achieving the desired goals, and to assess if additional investment in health is achieving the desired outcomes. 3. provide policy-makers with the evidence they need to adjust their policies, strategies and programmes as necessary.

Geographic coverage

The survey sampling frame must cover 100% of the country's eligible population, meaning that the entire national territory must be included. This does not mean that every province or territory need be represented in the survey sample but, rather, that all must have a chance (known probability) of being included in the survey sample.

There may be exceptional circumstances that preclude 100% national coverage. Certain areas in certain countries may be impossible to include due to reasons such as accessibility or conflict. All such exceptions must be discussed with WHO sampling experts. If any region must be excluded, it must constitute a coherent area, such as a particular province or region. For example if ¾ of region D in country X is not accessible due to war, the entire region D will be excluded from analysis.

Analysis unit

Households and individuals

Universe

The WHS will include all male and female adults (18 years of age and older) who are not out of the country during the survey period. It should be noted that this includes the population who may be institutionalized for health reasons at the time of the survey: all persons who would have fit the definition of household member at the time of their institutionalisation are included in the eligible population.

If the randomly selected individual is institutionalized short-term (e.g. a 3-day stay at a hospital) the interviewer must return to the household when the individual will have come back to interview him/her. If the randomly selected individual is institutionalized long term (e.g. has been in a nursing home the last 8 years), the interviewer must travel to that institution to interview him/her.

The target population includes any adult, male or female age 18 or over living in private households. Populations in group quarters, on military reservations, or in other non-household living arrangements will not be eligible for the study. People who are in an institution due to a health condition (such as a hospital, hospice, nursing home, home for the aged, etc.) at the time of the visit to the household are interviewed either in the institution or upon their return to their household if this is within a period of two weeks from the first visit to the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

SAMPLING GUIDELINES FOR WHS

Surveys in the WHS program must employ a probability sampling design. This means that every single individual in the sampling frame has a known and non-zero chance of being selected into the survey sample. While a Single Stage Random Sample is ideal if feasible, it is recognized that most sites will carry out Multi-stage Cluster Sampling.

The WHS sampling frame should cover 100% of the eligible population in the surveyed country. This means that every eligible person in the country has a chance of being included in the survey sample. It also means that particular ethnic groups or geographical areas may not be excluded from the sampling frame.

The sample size of the WHS in each country is 5000 persons (exceptions considered on a by-country basis). An adequate number of persons must be drawn from the sampling frame to account for an estimated amount of non-response (refusal to participate, empty houses etc.). The highest estimate of potential non-response and empty households should be used to ensure that the desired sample size is reached at the end of the survey period. This is very important because if, at the end of data collection, the required sample size of 5000 has not been reached additional persons must be selected randomly into the survey sample from the sampling frame. This is both costly and technically complicated (if this situation is to occur, consult WHO sampling experts for assistance), and best avoided by proper planning before data collection begins.

All steps of sampling, including justification for stratification, cluster sizes, probabilities of selection, weights at each stage of selection, and the computer program used for randomization must be communicated to WHO

STRATIFICATION

Stratification is the process by which the population is divided into subgroups. Sampling will then be conducted separately in each subgroup. Strata or subgroups are chosen because evidence is available that they are related to the outcome (e.g. health, responsiveness, mortality, coverage etc.). The strata chosen will vary by country and reflect local conditions. Some examples of factors that can be stratified on are geography (e.g. North, Central, South), level of urbanization (e.g. urban, rural), socio-economic zones, provinces (especially if health administration is primarily under the jurisdiction of provincial authorities), or presence of health facility in area. Strata to be used must be identified by each country and the reasons for selection explicitly justified.

Stratification is strongly recommended at the first stage of sampling. Once the strata have been chosen and justified, all stages of selection will be conducted separately in each stratum. We recommend stratifying on 3-5 factors. It is optimum to have half as many strata (note the difference between stratifying variables, which may be such variables as gender, socio-economic status, province/region etc. and strata, which are the combination of variable categories, for example Male, High socio-economic status, Xingtao Province would be a stratum).

Strata should be as homogenous as possible within and as heterogeneous as possible between. This means that strata should be formulated in such a way that individuals belonging to a stratum should be as similar to each other with respect to key variables as possible and as different as possible from individuals belonging to a different stratum. This maximises the efficiency of stratification in reducing sampling variance.

MULTI-STAGE CLUSTER SELECTION

A cluster is a naturally occurring unit or grouping within the population (e.g. enumeration areas, cities, universities, provinces, hospitals etc.); it is a unit for which the administrative level has clear, nonoverlapping boundaries. Cluster sampling is useful because it avoids having to compile exhaustive lists of every single person in the population. Clusters should be as heterogeneous as possible within and as homogenous as possible between (note that this is the opposite criterion as that for strata). Clusters should be as small as possible (i.e. large administrative units such as Provinces or States are not good clusters) but not so small as to be homogenous.

In cluster sampling, a number of clusters are randomly selected from a list of clusters. Then, either all members of the chosen cluster or a random selection from among them are included in the sample. Multistage sampling is an extension of cluster sampling where a hierarchy of clusters are chosen going from larger to smaller.

In order to carry out multi-stage sampling, one needs to know only the population sizes of the sampling units. For the smallest sampling unit above the elementary unit however, a complete list of all elementary units (households) is needed; in order to be able to randomly select among all households in the TSU, a list of all those households is required. This information may be available from the most recent population census. If the last census was >3 years ago or the information furnished by it was of poor quality or unreliable, the survey staff will have the task of enumerating all households in the smallest randomly selected sampling unit. It is very important to budget for this step if it is necessary and ensure that all households are properly enumerated in order that a representative sample is obtained.

It is always best to have as many clusters in the PSU as possible. The reason for this is that the fewer the number of respondents in each PSU, the lower will be the clustering effect which

Abstract

Different countries have different health outcomes that are in part due to the way respective health systems perform. Regardless of the type of health system, individuals will have health and non-health expectations in terms of how the institution responds to their needs. In many countries, however, health systems do not perform effectively and this is in part due to lack of information on health system performance, and on the different service providers.

The aim of the WHO World Health Survey is to provide empirical data to the national health information systems so that there is a better monitoring of health of the people, responsiveness of health systems and measurement of health-related parameters.

The overall aims of the survey is to examine the way populations report their health, understand how people value health states, measure the performance of health systems in relation to responsiveness and gather information on modes and extents of payment for health encounters through a nationally representative population based community survey. In addition, it addresses various areas such as health care expenditures, adult mortality, birth history, various risk factors, assessment of main chronic health conditions and the coverage of health interventions, in specific additional modules.

The objectives of the survey programme are to: 1. develop a means of providing valid, reliable and comparable information, at low cost, to supplement the information provided by routine health information systems. 2. build the evidence base necessary for policy-makers to monitor if health systems are achieving the desired goals, and to assess if additional investment in health is achieving the desired outcomes. 3. provide policy-makers with the evidence they need to adjust their policies, strategies and programmes as necessary.

Geographic coverage

The survey sampling frame must cover 100% of the country's eligible population, meaning that the entire national territory must be included. This does not mean that every province or territory need be represented in the survey sample but, rather, that all must have a chance (known probability) of being included in the survey sample.

There may be exceptional circumstances that preclude 100% national coverage. Certain areas in certain countries may be impossible to include due to reasons such as accessibility or conflict. All such exceptions must be discussed with WHO sampling experts. If any region must be excluded, it must constitute a coherent area, such as a particular province or region. For example if ¾ of region D in country X is not accessible due to war, the entire region D will be excluded from analysis.

Analysis unit

Households and individuals

Universe

The WHS will include all male and female adults (18 years of age and older) who are not out of the country during the survey period. It should be noted that this includes the population who may be institutionalized for health reasons at the time of the survey: all persons who would have fit the definition of household member at the time of their institutionalisation are included in the eligible population.

If the randomly selected individual is institutionalized short-term (e.g. a 3-day stay at a hospital) the interviewer must return to the household when the individual will have come back to interview him/her. If the randomly selected individual is institutionalized long term (e.g. has been in a nursing home the last 8 years), the interviewer must travel to that institution to interview him/her.

The target population includes any adult, male or female age 18 or over living in private households. Populations in group quarters, on military reservations, or in other non-household living arrangements will not be eligible for the study. People who are in an institution due to a health condition (such as a hospital, hospice, nursing home, home for the aged, etc.) at the time of the visit to the household are interviewed either in the institution or upon their return to their household if this is within a period of two weeks from the first visit to the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

SAMPLING GUIDELINES FOR WHS

Surveys in the WHS program must employ a probability sampling design. This means that every single individual in the sampling frame has a known and non-zero chance of being selected into the survey sample. While a Single Stage Random Sample is ideal if feasible, it is recognized that most sites will carry out Multi-stage Cluster Sampling.

The WHS sampling frame should cover 100% of the eligible population in the surveyed country. This means that every eligible person in the country has a chance of being included in the survey sample. It also means that particular ethnic groups or geographical areas may not be excluded from the sampling frame.

The sample size of the WHS in each country is 5000 persons (exceptions considered on a by-country basis). An adequate number of persons must be drawn from the sampling frame to account for an estimated amount of non-response (refusal to participate, empty houses etc.). The highest estimate of potential non-response and empty households should be used to ensure that the desired sample size is reached at the end of the survey period. This is very important because if, at the end of data collection, the required sample size of 5000 has not been reached additional persons must be selected randomly into the survey sample from the sampling frame. This is both costly and technically complicated (if this situation is to occur, consult WHO sampling experts for assistance), and best avoided by proper planning before data collection begins.

All steps of sampling, including justification for stratification, cluster sizes, probabilities of selection, weights at each stage of selection, and the computer program used for randomization must be communicated to WHO

STRATIFICATION

Stratification is the process by which the population is divided into subgroups. Sampling will then be conducted separately in each subgroup. Strata or subgroups are chosen because evidence is available that they are related to the outcome (e.g. health, responsiveness, mortality, coverage etc.). The strata chosen will vary by country and reflect local conditions. Some examples of factors that can be stratified on are geography (e.g. North, Central, South), level of urbanization (e.g. urban, rural), socio-economic zones, provinces (especially if health administration is primarily under the jurisdiction of provincial authorities), or presence of health facility in area. Strata to be used must be identified by each country and the reasons for selection explicitly justified.

Stratification is strongly recommended at the first stage of sampling. Once the strata have been chosen and justified, all stages of selection will be conducted separately in each stratum. We recommend stratifying on 3-5 factors. It is optimum to have half as many strata (note the difference between stratifying variables, which may be such variables as gender, socio-economic status, province/region etc. and strata, which are the combination of variable categories, for example Male, High socio-economic status, Xingtao Province would be a stratum).

Strata should be as homogenous as possible within and as heterogeneous as possible between. This means that strata should be formulated in such a way that individuals belonging to a stratum should be as similar to each other with respect to key variables as possible and as different as possible from individuals belonging to a different stratum. This maximises the efficiency of stratification in reducing sampling variance.

MULTI-STAGE CLUSTER SELECTION

A cluster is a naturally occurring unit or grouping within the population (e.g. enumeration areas, cities, universities, provinces, hospitals etc.); it is a unit for which the administrative level has clear, nonoverlapping boundaries. Cluster sampling is useful because it avoids having to compile exhaustive lists of every single person in the population. Clusters should be as heterogeneous as possible within and as homogenous as possible between (note that this is the opposite criterion as that for strata). Clusters should be as small as possible (i.e. large administrative units such as Provinces or States are not good clusters) but not so small as to be homogenous.

In cluster sampling, a number of clusters are randomly selected from a list of clusters. Then, either all members of the chosen cluster or a random selection from among them are included in the sample. Multistage sampling is an extension of cluster sampling where a hierarchy of clusters are chosen going from larger to smaller.

In order to carry out multi-stage sampling, one needs to know only the population sizes of the sampling units. For the smallest sampling unit above the elementary unit however, a complete list of all elementary units (households) is needed; in order to be able to randomly select among all households in the TSU, a list of all those households is required. This information may be available from the most recent population census. If the last census was >3 years ago or the information furnished by it was of poor quality or unreliable, the survey staff will have the task of enumerating all households in the smallest randomly selected sampling unit. It is very important to budget for this step if it is necessary and ensure that all households are properly enumerated in order that a representative sample is obtained.

It is always best to have as many clusters in the PSU as possible. The reason for this is that the fewer the number of respondents in each PSU, the lower will be the clustering effect which

Abstract

Different countries have different health outcomes that are in part due to the way respective health systems perform. Regardless of the type of health system, individuals will have health and non-health expectations in terms of how the institution responds to their needs. In many countries, however, health systems do not perform effectively and this is in part due to lack of information on health system performance, and on the different service providers.

The aim of the WHO World Health Survey is to provide empirical data to the national health information systems so that there is a better monitoring of health of the people, responsiveness of health systems and measurement of health-related parameters.

The overall aims of the survey is to examine the way populations report their health, understand how people value health states, measure the performance of health systems in relation to responsiveness and gather information on modes and extents of payment for health encounters through a nationally representative population based community survey. In addition, it addresses various areas such as health care expenditures, adult mortality, birth history, various risk factors, assessment of main chronic health conditions and the coverage of health interventions, in specific additional modules.

The objectives of the survey programme are to: 1. develop a means of providing valid, reliable and comparable information, at low cost, to supplement the information provided by routine health information systems. 2. build the evidence base necessary for policy-makers to monitor if health systems are achieving the desired goals, and to assess if additional investment in health is achieving the desired outcomes. 3. provide policy-makers with the evidence they need to adjust their policies, strategies and programmes as necessary.

Geographic coverage

The survey sampling frame must cover 100% of the country's eligible population, meaning that the entire national territory must be included. This does not mean that every province or territory need be represented in the survey sample but, rather, that all must have a chance (known probability) of being included in the survey sample.

There may be exceptional circumstances that preclude 100% national coverage. Certain areas in certain countries may be impossible to include due to reasons such as accessibility or conflict. All such exceptions must be discussed with WHO sampling experts. If any region must be excluded, it must constitute a coherent area, such as a particular province or region. For example if ¾ of region D in country X is not accessible due to war, the entire region D will be excluded from analysis.

Analysis unit

Households and individuals

Universe

The WHS will include all male and female adults (18 years of age and older) who are not out of the country during the survey period. It should be noted that this includes the population who may be institutionalized for health reasons at the time of the survey: all persons who would have fit the definition of household member at the time of their institutionalisation are included in the eligible population.

If the randomly selected individual is institutionalized short-term (e.g. a 3-day stay at a hospital) the interviewer must return to the household when the individual will have come back to interview him/her. If the randomly selected individual is institutionalized long term (e.g. has been in a nursing home the last 8 years), the interviewer must travel to that institution to interview him/her.

The target population includes any adult, male or female age 18 or over living in private households. Populations in group quarters, on military reservations, or in other non-household living arrangements will not be eligible for the study. People who are in an institution due to a health condition (such as a hospital, hospice, nursing home, home for the aged, etc.) at the time of the visit to the household are interviewed either in the institution or upon their return to their household if this is within a period of two weeks from the first visit to the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

SAMPLING GUIDELINES FOR WHS

Surveys in the WHS program must employ a probability sampling design. This means that every single individual in the sampling frame has a known and non-zero chance of being selected into the survey sample. While a Single Stage Random Sample is ideal if feasible, it is recognized that most sites will carry out Multi-stage Cluster Sampling.

The WHS sampling frame should cover 100% of the eligible population in the surveyed country. This means that every eligible person in the country has a chance of being included in the survey sample. It also means that particular ethnic groups or geographical areas may not be excluded from the sampling frame.

The sample size of the WHS in each country is 5000 persons (exceptions considered on a by-country basis). An adequate number of persons must be drawn from the sampling frame to account for an estimated amount of non-response (refusal to participate, empty houses etc.). The highest estimate of potential non-response and empty households should be used to ensure that the desired sample size is reached at the end of the survey period. This is very important because if, at the end of data collection, the required sample size of 5000 has not been reached additional persons must be selected randomly into the survey sample from the sampling frame. This is both costly and technically complicated (if this situation is to occur, consult WHO sampling experts for assistance), and best avoided by proper planning before data collection begins.

All steps of sampling, including justification for stratification, cluster sizes, probabilities of selection, weights at each stage of selection, and the computer program used for randomization must be communicated to WHO

STRATIFICATION

Stratification is the process by which the population is divided into subgroups. Sampling will then be conducted separately in each subgroup. Strata or subgroups are chosen because evidence is available that they are related to the outcome (e.g. health, responsiveness, mortality, coverage etc.). The strata chosen will vary by country and reflect local conditions. Some examples of factors that can be stratified on are geography (e.g. North, Central, South), level of urbanization (e.g. urban, rural), socio-economic zones, provinces (especially if health administration is primarily under the jurisdiction of provincial authorities), or presence of health facility in area. Strata to be used must be identified by each country and the reasons for selection explicitly justified.

Stratification is strongly recommended at the first stage of sampling. Once the strata have been chosen and justified, all stages of selection will be conducted separately in each stratum. We recommend stratifying on 3-5 factors. It is optimum to have half as many strata (note the difference between stratifying variables, which may be such variables as gender, socio-economic status, province/region etc. and strata, which are the combination of variable categories, for example Male, High socio-economic status, Xingtao Province would be a stratum).

Strata should be as homogenous as possible within and as heterogeneous as possible between. This means that strata should be formulated in such a way that individuals belonging to a stratum should be as similar to each other with respect to key variables as possible and as different as possible from individuals belonging to a different stratum. This maximises the efficiency of stratification in reducing sampling variance.

MULTI-STAGE CLUSTER SELECTION

A cluster is a naturally occurring unit or grouping within the population (e.g. enumeration areas, cities, universities, provinces, hospitals etc.); it is a unit for which the administrative level has clear, nonoverlapping boundaries. Cluster sampling is useful because it avoids having to compile exhaustive lists of every single person in the population. Clusters should be as heterogeneous as possible within and as homogenous as possible between (note that this is the opposite criterion as that for strata). Clusters should be as small as possible (i.e. large administrative units such as Provinces or States are not good clusters) but not so small as to be homogenous.

In cluster sampling, a number of clusters are randomly selected from a list of clusters. Then, either all members of the chosen cluster or a random selection from among them are included in the sample. Multistage sampling is an extension of cluster sampling where a hierarchy of clusters are chosen going from larger to smaller.

In order to carry out multi-stage sampling, one needs to know only the population sizes of the sampling units. For the smallest sampling unit above the elementary unit however, a complete list of all elementary units (households) is needed; in order to be able to randomly select among all households in the TSU, a list of all those households is required. This information may be available from the most recent population census. If the last census was >3 years ago or the information furnished by it was of poor quality or unreliable, the survey staff will have the task of enumerating all households in the smallest randomly selected sampling unit. It is very important to budget for this step if it is necessary and ensure that all households are properly enumerated in order that a representative sample is obtained.

It is always best to have as many clusters in the PSU as possible. The reason for this is that the fewer the number of respondents in each PSU, the lower will be the clustering effect which

Abstract

Different countries have different health outcomes that are in part due to the way respective health systems perform. Regardless of the type of health system, individuals will have health and non-health expectations in terms of how the institution responds to their needs. In many countries, however, health systems do not perform effectively and this is in part due to lack of information on health system performance, and on the different service providers.

The aim of the WHO World Health Survey is to provide empirical data to the national health information systems so that there is a better monitoring of health of the people, responsiveness of health systems and measurement of health-related parameters.

The overall aims of the survey is to examine the way populations report their health, understand how people value health states, measure the performance of health systems in relation to responsiveness and gather information on modes and extents of payment for health encounters through a nationally representative population based community survey. In addition, it addresses various areas such as health care expenditures, adult mortality, birth history, various risk factors, assessment of main chronic health conditions and the coverage of health interventions, in specific additional modules.

The objectives of the survey programme are to: 1. develop a means of providing valid, reliable and comparable information, at low cost, to supplement the information provided by routine health information systems. 2. build the evidence base necessary for policy-makers to monitor if health systems are achieving the desired goals, and to assess if additional investment in health is achieving the desired outcomes. 3. provide policy-makers with the evidence they need to adjust their policies, strategies and programmes as necessary.

Geographic coverage

The survey sampling frame must cover 100% of the country's eligible population, meaning that the entire national territory must be included. This does not mean that every province or territory need be represented in the survey sample but, rather, that all must have a chance (known probability) of being included in the survey sample.

There may be exceptional circumstances that preclude 100% national coverage. Certain areas in certain countries may be impossible to include due to reasons such as accessibility or conflict. All such exceptions must be discussed with WHO sampling experts. If any region must be excluded, it must constitute a coherent area, such as a particular province or region. For example if ¾ of region D in country X is not accessible due to war, the entire region D will be excluded from analysis.

Analysis unit

Households and individuals

Universe

The WHS will include all male and female adults (18 years of age and older) who are not out of the country during the survey period. It should be noted that this includes the population who may be institutionalized for health reasons at the time of the survey: all persons who would have fit the definition of household member at the time of their institutionalisation are included in the eligible population.

If the randomly selected individual is institutionalized short-term (e.g. a 3-day stay at a hospital) the interviewer must return to the household when the individual will have come back to interview him/her. If the randomly selected individual is institutionalized long term (e.g. has been in a nursing home the last 8 years), the interviewer must travel to that institution to interview him/her.

The target population includes any adult, male or female age 18 or over living in private households. Populations in group quarters, on military reservations, or in other non-household living arrangements will not be eligible for the study. People who are in an institution due to a health condition (such as a hospital, hospice, nursing home, home for the aged, etc.) at the time of the visit to the household are interviewed either in the institution or upon their return to their household if this is within a period of two weeks from the first visit to the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

SAMPLING GUIDELINES FOR WHS

Surveys in the WHS program must employ a probability sampling design. This means that every single individual in the sampling frame has a known and non-zero chance of being selected into the survey sample. While a Single Stage Random Sample is ideal if feasible, it is recognized that most sites will carry out Multi-stage Cluster Sampling.

The WHS sampling frame should cover 100% of the eligible population in the surveyed country. This means that every eligible person in the country has a chance of being included in the survey sample. It also means that particular ethnic groups or geographical areas may not be excluded from the sampling frame.

The sample size of the WHS in each country is 5000 persons (exceptions considered on a by-country basis). An adequate number of persons must be drawn from the sampling frame to account for an estimated amount of non-response (refusal to participate, empty houses etc.). The highest estimate of potential non-response and empty households should be used to ensure that the desired sample size is reached at the end of the survey period. This is very important because if, at the end of data collection, the required sample size of 5000 has not been reached additional persons must be selected randomly into the survey sample from the sampling frame. This is both costly and technically complicated (if this situation is to occur, consult WHO sampling experts for assistance), and best avoided by proper planning before data collection begins.

All steps of sampling, including justification for stratification, cluster sizes, probabilities of selection, weights at each stage of selection, and the computer program used for randomization must be communicated to WHO

STRATIFICATION

Stratification is the process by which the population is divided into subgroups. Sampling will then be conducted separately in each subgroup. Strata or subgroups are chosen because evidence is available that they are related to the outcome (e.g. health, responsiveness, mortality, coverage etc.). The strata chosen will vary by country and reflect local conditions. Some examples of factors that can be stratified on are geography (e.g. North, Central, South), level of urbanization (e.g. urban, rural), socio-economic zones, provinces (especially if health administration is primarily under the jurisdiction of provincial authorities), or presence of health facility in area. Strata to be used must be identified by each country and the reasons for selection explicitly justified.

Stratification is strongly recommended at the first stage of sampling. Once the strata have been chosen and justified, all stages of selection will be conducted separately in each stratum. We recommend stratifying on 3-5 factors. It is optimum to have half as many strata (note the difference between stratifying variables, which may be such variables as gender, socio-economic status, province/region etc. and strata, which are the combination of variable categories, for example Male, High socio-economic status, Xingtao Province would be a stratum).

Strata should be as homogenous as possible within and as heterogeneous as possible between. This means that strata should be formulated in such a way that individuals belonging to a stratum should be as similar to each other with respect to key variables as possible and as different as possible from individuals belonging to a different stratum. This maximises the efficiency of stratification in reducing sampling variance.

MULTI-STAGE CLUSTER SELECTION

A cluster is a naturally occurring unit or grouping within the population (e.g. enumeration areas, cities, universities, provinces, hospitals etc.); it is a unit for which the administrative level has clear, nonoverlapping boundaries. Cluster sampling is useful because it avoids having to compile exhaustive lists of every single person in the population. Clusters should be as heterogeneous as possible within and as homogenous as possible between (note that this is the opposite criterion as that for strata). Clusters should be as small as possible (i.e. large administrative units such as Provinces or States are not good clusters) but not so small as to be homogenous.

In cluster sampling, a number of clusters are randomly selected from a list of clusters. Then, either all members of the chosen cluster or a random selection from among them are included in the sample. Multistage sampling is an extension of cluster sampling where a hierarchy of clusters are chosen going from larger to smaller.

In order to carry out multi-stage sampling, one needs to know only the population sizes of the sampling units. For the smallest sampling unit above the elementary unit however, a complete list of all elementary units (households) is needed; in order to be able to randomly select among all households in the TSU, a list of all those households is required. This information may be available from the most recent population census. If the last census was >3 years ago or the information furnished by it was of poor quality or unreliable, the survey staff will have the task of enumerating all households in the smallest randomly selected sampling unit. It is very important to budget for this step if it is necessary and ensure that all households are properly enumerated in order that a representative sample is obtained.

It is always best to have as many clusters in the PSU as possible. The reason for this is that the fewer the number of respondents in each PSU, the lower will be the clustering effect which