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Indicators

In this section:

Input indicators

Process indicators

Output indicators

Outcome indicators

Characteristics of good indicators

Sample indicator reference sheet

An indicator is a variable that measures one aspect of a health program. The monitoring and evaluation (M&E) team uses indicators for:

monitoring health programs to show that program activities are being carried out as planned; and

evaluating health programs to show that a program activity has caused a change in a particular behavior or health outcome.

Monitoring and evaluation generally use five types of indicators to measure different aspects of program performance. Monitoring focuses primarily on the first three categories of indicators, while evaluation focuses largely on the last two categories.

Input indicators include indicators that measure the human and financial resources, physical facilities, equipment and supplies that enable implementation of a program. For example, data on an input indicator can tell whether supplies are coming in on time.

Process indicators reflect whether a program is being carried out as planned and how well program activities are being carried out. Such indicators could, for example, focus on training staff or counseling clients; for instance, they give program managers an explanation of why one clinic receives more clients than other clinics. Process indicators are often reported in the form of a number, for example, number of training sessions organized or number of educational materials developed.

Output indicators report on the results of program efforts (inputs and processes/activities) at the program level. They inform us about the direct products or deliverables of program activities and are usually reported as numbers, for example, number of providers trained or number of bed nets distributed.

Outcome indicators measure the program’s level of success in improving service accessibility, utilization or quality. These types of indicators are often reported as percentages or rates, such as the percentage of the population with knowledge of HIV/AIDS, Tuberculosis and long-acting contraception. Data for outcome indicators often come from censuses, surveys or surveillance systems. These data sources typically provide data on both numerators and denominators, needed to calculate the necessary percentages to measure outcome indicators.

Impact indicators measure the long-term, cumulative effects of programs over time on the larger social system or on a population’s health and well-being, such as changes in fertility rates, HIV infection and infant mortality rates. Such impacts are increasingly becoming difficult to attribute to a single program. Rather, a program may contribute to impacts at the population-level together with other programs.

Five characteristics define SMART Indicators:

Specific – focused and clear

Measurable - quantifiable and reflecting change

Attainable - reasonable in scope and achievable within set time-frame

Relevant - pertinent to the review of performance

Time-Bound/Trackable - progress can be charted chronologically

A health program should select at least one indicator for each significant aspect of the program, including each significant input, output or overarching program objective. The selected indicators should link to the program’s framework. Also, a program should consider resources needed to collect and analyze data for each indicator. A program can, and most likely will, use multiple sources of data to measure its selected indicators, such as censuses, surveys, service statistics, qualitative research and administrative records. Indicators can also be selected based on the requirements of other agencies, such as the government and donor agency.

Guidelines and examples of indicators exist for several health areas, for example, for family planning, and HIV/AIDS. These indicator lists are continually updated based on the latest evidence and knowledge in the field. Thus, it is important to review the latest list of relevant indicator lists when selecting the specific ones to monitor and evaluate a chosen program. These indicator guides also contain numerous indicator reference sheets.

Once specific indicators have been identified, it is helpful to choose and edit or develop an indicator reference sheet for each indicator. An indicator reference sheet gives a detailed account and definition of the selected indicator along with a brief justification for selecting that specific indicator. It outlines the numerator and denominator used to measure the indicator and explains the details relating to the data that will be used—the data source, frequency of collection and even the person(s) responsible for this process. Plans for data collection, analysis, reporting and review are all outlined in this reference sheet. It also includes an indicator table that consists of baseline values and targets. Data quality issues related to the collection of the specific indicator can also be included; this ensures that data of the highest quality possible are collected, recorded and analyzed. See sample indicator reference sheet.

Identifying appropriate indicators for each step of the M&E process, measuring them and reporting on them is an integral process of M&E, regardless of the program’s size.

General Health

Compendium of Gender Scales

No Date | C-Change

Website

In March 2010, C-Change convened a working group of researchers with expert knowledge of gender scales to review those scales in current use. The participants identified scales that measure adherence to gender norms and reviewed how they have been used to measure the success of interventions in changing these norms.

[read more >]

A Comprehensive Global Monitoring Framework (Noncommunicable Diseases)

2012 | WHO

Full Paper

Discussion paper that outlines a comprehensive global monitoring framework (including indicators and examples) for noncommunicable diseases.

[read more >]

Indicators

2012 | The World Bank

Website

This website includes 331 indicators from the World Development Indicators (WDI) covering 209 countries from 1960 to 2008. The indicators are available in Spanish, French and Arabic.

[read more >]

Measuring Service Availability and Readiness: Core Questionnaire, Service Readiness Indicators and Service Availability Indicators

2012 | WHO

Core Questionnaire

Service Readiness Indicators

Service Availability Indicators

Provides the questionnaire, service availability indicators and service readiness indicators of the Survey Availability and Readiness Assessment (SARA).The questionnairewas  developed in order to collect data that can be compared within and across countries. The questionnaire is adaptable to country-specific elements.

[read more >]

Human Resources for Health (HRH) Indicator Compendium

2011 | CapacityPlus

PDF

HTML

This compendium provides a list of published indicators on human resources for health (HRH) organized according to the results framework of the CapacityPlus project. The objective of this compendium is to provide a tool for HRH systems strengthening practitioners interested in monitoring HRH projects and programs.

[read more >]

Monitoring the Building Blocks of Health Systems: A Handbook of Indicators and Their Measurement Strategies

2010 | World Health Organization [WHO] | 93 p

Full Text (PDF)

Increased attention to the strengthening of health systems would not be sustainable in the absence of a sound monitoring strategy that enables decision-makers to accurately track health progress and performance, evaluate impact, and ensure accountability at country and global levels. This handbook describes a set of indicators and related measurement strategies, structured around the WHO framework that describes health systems in terms of six “building blocks”: service delivery, health workforce, information, medicines, financing and governance.

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Selecting Programme Monitoring Indicators

2010 | Caribbean Health Research Council | 17 p

Full Text (PDF)

This resource provides a succinct summary of indicators, describing what an indicator is and outlining the criteria of a good indicator, to help one with selecting or developing appropriate indicators for monitoring their program.

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Tools: Key Indicators

2008 | USAID MCHIP Program | 10 p

Full Text (MS Word)

The Key Indicators are a group of 17 recommended indicators that provide important information to monitor and assess maternal and child health interventions. The table of indicators is organized by intervention area (e.g., maternal and newborn care, immunization, control of diarrhea, etc.), with the recommended indicators defined and their calculation described.

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Guidance for Selecting and Using Core Indicators for Cross-Country Comparisons of Health Facility Readiness to Provide Services

2007 | MEASURE Evaluation | 28 p

Full Text (PDF)

Using uniformly defined core indicators for health-service provision will facilitate the assessment of health service delivery at the national level and will encourage the production of nationally representative and comparable datasets. This document provides a list of recommended core indicators intended to assess the functionality of a health system.

[read more >]

Measuring Mortality, Nutritional Status, and Food Security in Crisis Situations: SMART Methodology

2006 | Standardized Monitoring & Assessment of Relief & Transitions [SMART] | 129 p

Full Text (PDF)

The basic indicators for assessing the severity of a crisis are mortality rate and the nutritional status of a population. The SMART Methodology provides a basic, integrated method for assessing nutritional status and mortality rate in emergency situations. This manual is designed to provide agencies with the basic tools to collect the data necessary for planning direct interventions in an emergency setting.

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SMART/SPICED Indicators

2005 | Toolkit Sport for Development | 10 p

Full Text (PDF)

"How do we know whether we are exactly on track in getting where we exactly want to be at the end?" This toolkit provides an introduction to indicators, explaining the concept and aspects of specific indicators, offering suggestions on how to formulate indicators, and providing several examples of indicators throughout the text.

[read more >]

HIV/AIDS and Tuberculosis

HIV/AIDS Survey Indicators Database

No Date | Measure DHS

Website

The HIV/AIDS Survey Indicators Database is a comprehensive source of information on HIV/AIDS indicators derived from sample surveys such as the Demographic Health Surveys and Reproductive Health Surveys. The Database is an easy to use resource that produces data tables for specific countries by criteria identified by the user (i.e., by select background characteristics). Country Reports can also be easily generated based on selected criteria.

[read more >]

Indicator Registry

No Date | USAID

Website

The Indicator Registry is a central repository of information on indicators used to track the AIDS epidemic and the national, regional and global response. The Registry can be searched by a variety of categories, by indicator, or by keywords.

[read more >]

Guidelines on Construction of Core Indicators

2010 | Joint United Nations Programme on HIV/AIDS (UNAIDS) | 140 p

Full Text (PDF)

This resource is intended to assist countries in reporting on their national HIV/AIDS response. A set of 25 core indicators are defined to facilitate standardized reporting, comparative analysis, and aggregate analysis of regional and global HIV/AIDS responses. The core indicators recommended are categorized as follows:

National Commitment and Action
National Knowledge and Behavior
National-Level Program Impact

[read more >]

Multidrug-Resistant Tuberculosis (MDR-TB) Indicators

2010 | World Health Organization [WHO] | 9 p

Full Text (PDF)

This resource highlights the minimum set of indicators for the programmatic management of multidrug-resistant tuberculosis (MDR-TB) in national tuberculosis control programmes.

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National AIDS Programmes: A Guide to Indicators for Monitoring and Evaluating National Antiretroviral Programmes

2005 | World Health Organization (WHO) | 36 p

Full Text (PDF)

As antiretroviral therapy (ART) programs scale-up to meet demand, monitoring and evaluation will assist with monitoring progress and refining approaches. This document describes an approach to monitoring and evaluating the scaling up of ART, including the provision of a list of core indicators.  Each core indicator is defined and includes the rationale for its use and what it measures; how to measure it and the tools used for measurement; the frequency of measurement; and the strengths and limitations of each indicator.

[read more >]

Compendium of Indicators for Monitoring and Evaluating National Tuberculosis Programs

2004 | World Health Organization [WHO] | 227 p

Full Text (PDF)

To improve the quality and effectiveness of TB control programs, this compendium was developed to assist programs with monitoring and evaluating TB control activities. The compendium provides a comprehensive listing of the most widely used TB indicators relevant to developing countries and uses standardized terminology to facilitate consistent use of indicators across programs.

[read more >]

National AIDS Programmes: A Guide to Indicators for Monitoring and Evaluating National HIV/AIDS Prevention Programmes for Young People

2004 | World Health Organization [WHO] | 83 p

Full Text (PDF)

This guide is intended for use by programme managers at the national level, particularly managers of national AIDS programmes. It may also be useful for programme managers and planners at subnational levels who seek to align their measurement efforts with national ones.

[read more >]

National AIDS Programmes: A Guide to Monitoring and Evaluation

2000 | UNAIDS | 133 p

Full Text (PDF)

This guide provides an overview of monitoring and evaluation of HIV/AIDS programs. The guide describes the use of indicators at different levels (international, national, district, and project level); the different functions of surveillance, monitoring, and evaluation; and the features of a good monitoring and evaluation system. Lastly, a series of key HIV/AIDS indicators for various areas are proposed and described.

[read more >]

Malaria

Monitoring and Evaluation Indicators to be used within The President’s Malaria Initiative

2009 | President’s Malaria Initiative | 14 p

Full Text (PDF)

This resource includes a table with the full set of indicators to be used for monitoring and evaluation of the President's Malaria Initiative.

[read more >]

Zambia National Malaria Indicator Survey

2009 | Government of the Republic of Zambia Ministry of Health | 98 p

Full Text (PDF)

This report presents the results of the Zambia National Malaria Indicator Survey 2008, a comprehensive, nationally representative household survey designed to measure progress toward achieving the goals and targets set forth in the National Malaria Strategic Plan 2006–2010.

[read more >]

Maternal and Child Health

Child Status Index : A Tool for Assessing the Well-Being of Orphans and Vulnerable Children- Manual

2009 | MEASURE Evaluation | 45 p

Full Text (PDF)

In an effort to better assess the needs of orphans and vulnerable children (OVC) and their household and to understand whether programs are making an impact in addressing the needs of OVC, the Child Status Index (CSI) was developed. The CSI is an easy-to-use tool to assess the current needs of a child, monitor improvements in specific areas of child well-being, and identify areas of concern that can be served by program interventions. The index gathers information in the following areas:

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Monitoring Emergency Obstetric Care: A Handbook

2009 | World Health Oganization [WHO] | 164 p

Full Text (PDF)

Emergency Obstetric Care (EmOC) is the timely access to care for women experiencing complications during pregnancy, birth, or postpartum. This handbook presents a series of indicators designed to monitor EmOC interventions intended to reduce maternal mortality. The handbook is designed for practical use within health care facilities. A set of eight EmOC-related indicators are listed and the type of data and data collection processes are described. Forms and worksheets to assist with data collection and calculation are also included.

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Reproductive Health/Family Planning

Health and Family Planning Indicators: Measuring Sustainability

No Date | USAID | 49 p

Full Text (PDF)

Sustainability is often the ultimate goal of a program. This document provides a list of potential sustainability indicators for health and family planning programs. It is intended to guide program managers in selecting appropriate sustainability indicators during program design and program assessment activities. Each of the indicators in this document includes a detailed definition, narrative on its use and relationship to sustainability, and a proposed data source.

[read more >]

Family Planning and Reproductive Health Indicators Database

2011 | MEASURE Evaluation PRH

Website

The Family Planning and Reproductive Health Indicators Database provides a comprehensive listing of the most widely used indicators for evaluating family planning and reproductive health programs in developing countries. For each indicator the Database includes: a definition, data requirements, data sources, the purpose, and any issues with the indicator.

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Counting Abortions so that Abortion Counts: Indicators for Monitoring the Availability and Use of Abortion Care Services

2006 | International Journal of Gynecology and Obstetrics | 12 p

Full Text (PDF)

This article describes Safe Abortion Care (SAC) services – contraception and safe abortion to prevent and manage unwanted pregnancies, and prompt and proper treatment of complications. The article also includes a proposed model for monitoring the implementation of SAC services.

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Monitoring Quality of Care in Family Planning Programs: A Comparison of Observations and Client Exit Interviews

2001 | International Family Planning Perspectives

Full Text (PDF)

Monitoring quality of care in family planning programs is important, but can be challenging and complicated. The Quick Investigation of Quality (QIQ) was developed to monitor quality of care by using observations of client-provider interactions, exit interviews with clients, and facility audits.  This article describes an analysis examining the comparability of results of the QIQ from observations and exit interviews of program clients in Ecuador, Uganda and Zimbabwe.

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Quick Investigation of Quality: A User's Guide for Monitoring Quality of Care in Family Planning

2001 | MEASURE Evaluation | 205 p

Full Text (PDF)

The Quick Investigation of Quality (QIQ) was developed as a low-cost and practical way to assist programs in routinely monitoring the quality of care (QC) in family planning programs. The QIQ includes a list of 25 indicators that programs can use to assess (QC). The indicators can be measured by facility audit, observation or exit interviews. The 25 indicators together provide a comprehensive picture of QC within a facility.

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Indicators for Reproductive Health Program Evaluation

1995 | Carolina Population Center, UNC | 42 p

Full Text (PDF)

This resource includes a collection of key indicators identified for monitoring and evaluating reproductive health interventions within the areas of: 1) Safe Pregnancy, 2) STD/HIV, 3) Women's Nutrition, 4) Breastfeeding, and 5) Adolescent Reproductive Health Services.  A review of the conceptual framework used for developing the list of indicators as well as a review of the issues with measurement and types of data sources for the indicators are included.

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Handbook of Indicators for Family Planning Program Evaluation

1994 | MEASURE Evaluation | 222 p

Full Text (PDF) - English

Manuel d'indicateurs pour l'evaluation des programmes de planification familiale

This Handbook provides a comprehensive collection of indicators for evaluating
family planning programs in developing countries. The indicators are organized according
to the components of the Conceptual Framework of Family Planning Demand and Program Impact on Fertility developed by The EVALUATION Project. The components include:

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Water and Sanitation

Health-Care Waste Management Rapid Assessment Tool

No Date | World Health Organization [WHO]

Tool (MS Excel; English)

Tool (MS Excel; French)

This rapid assessment tool is a part of an overall strategy developed by the World Health Organization that aims to reduce the disease burden caused by poor health care waste management through the promotion of best practices and the development of safety standards. This tool can be used to gather information to provide decision-makers, experts, and others with the necessary data to help develop a national action plan to manage health care waste.

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Background Paper on Measuring WASH and Food Hygiene Practices – Definition of Goals to be Tackled Post 2015 by the Joint Monitoring Programme

2012 | The London School of Hygiene and Tropical Medicine

PDF

Guide intended to help trainers teach program managers, staff and other decision makers the fundamental elements and techniquest of M&E, with a focus on population and health programs. The document is divided into three modules: introduction to M&E, developing plans for M&E: frameworks, and developing plans for M&E: indicators and data systems.

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Access and Behavioral Outcome Indicators for Water, Sanitation, and Hygiene

2010 | U.S. Agency for International Development [USAID] | 89 p

Full Text (PDF)

The content of this document reflects the evidence that has accumulated to date on how to measure in a reliable and valid way hygiene practices that are critical for the prevention of diarrheal disease and the reduction of child morbidity and mortality.

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Water and Sanitation Indicators Measurement Guide

1999 | Food and Nutrition Technical Assistance Project | 25 p

Full Text (PDF)

This Guide is intended to facilitate consistent measurement of a set of generic water and sanitation-related monitoring and evaluation performance indicators. For each indicator presented in this Guide, a definition is included along with a description on how to calculate the indicator, sources of data for the indicator, issues with the indicator, and target values for the indicator.

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Resources by Health Topics

General Health

HIV/AIDS and Tuberculosis

Malaria

Maternal and Child Health

Neglected Tropical Diseases

Reproductive Health/Family Planning

Water and Sanitation

Toolkit last updated: 20 December 2013