UNIT 3

INDICATORS OF
HEALTH
By: Prof. Rekha Sharma Sen
 OBJECTIVES
Enumerate some health indicators
Describe the health situation in India
Provide examples of morbidity and mortality from
India
Explain the important components of the National
Health Policy in India
Outline the health care delivery system in India
 INDICATORS OF HEALTH
Indicators of health are regarded as variables that
help to measure the changes in the health status.
Health is an end product of several variables and
hence needs to be measured multidimentionally.
Indicators of health:
• Mortality indicators
• Morbidity indicators
• Disability rates
• Nutritional status indicators
• Health care delivery indicators
• Utilization rates
• Indicators of social and mental health
• Environmental indicators
• Indicators of Quality of life
• Health policy indicators
• Socio-economic indicators
 CHARACTERISTICS OF
AN INDICATOR
An ideal indicator should be:
• Valid: It should actually measure what it is supposed to
measure
• Reliable: If measurement is taken by different people in
similar circumstances, the answers yielded should be the
same.
• Sensitive: Even if there is a minor change in the situation
concerned, the indicator should be sensitive enough to
detect and reflect the change
• Specific: It should reflect changes only in the situation
and parameters concerned, and not in any other.
 MORTALITY INDICATORS
CRUDE DEATH RATE: It indicates the rate at which
people are dying. It is defined as the number of deaths in a
year per 1,000 population, and is calculated using the
formula:
No. of deaths in a year/mid-year population x 1000

INFANT MORTALITY RATE (IMR): It refers to the

number of deaths of infants (below one year of age) in a
year per 1,000 live births. Formula:
No. of deaths of children less than 1 year of age in a
year/No. of live births in the same year/1,000
CHILD MORTALITY RATE: It tells us about the
number of children dying after the 1st birthday but
before their 5th birthday.
No. of deaths of children aged 1-4 years during a
year/Total no. of children aged 1- 4 years at the middle of
the year. X 1,000
UNDER- 5 MORTALITY RATE: Here we club all the
deaths taking place before 5 years of age.
No. of deaths of children before 5 years of age/No. of live
births X 1,000
MATERNAL MORTALITY RATE: Death of women due
to pregnancy, child birth etc.

No. of death of females due to [pregnancy, child birth or

within 42 days of delivery from related causes in an area
during a given year/Total no. of live births in the same
area and year X 1,000
DISEASE – SPECIFIC MORTALITY: it is the simplest
method of calculating the disease burden in a society.
Mortality rates can be computed for particular diseases.
The number of deaths due to a specific disease is
expressed in terms of 1,000 or 1,00,000 population
depending upon the number of deaths due to that disease.
Expectation of Life: Life expectancy at birth is the “the
average number of years that will be lived by those by
those born into a population if the current age-specific
mortality rates of the population persist”.
 MORBIDITY INDICATORS
Morbidity refers to ill health.
Incidence: It refers to the occurrence of new cases in a
specified population within a specified time frame.
Incidence rate: No. of new cases of specific disease during
a given time period/population at risk X 1,000
Prevalence: prevalence refers to the number of existing
cases of a particular disease at one point of time, in a
defined population.
Attendance rates at out-patient departments, health
centres etc.
 DISABILITY RATES
Bed disability days
Work–loss days
Sullivan’s index: This index is calculated by
subtracting from the life expectancy the probable
duration of bed disability and inability to perform
major activities.
NUTRITIONAL STATUS INDICATORS:
• PEM
• Vitamin A deficiency
• Prevalence of low birth weight (LBW): The cut-off
point for calling a baby a low birth weight baby in
2,500 gms.
 Prevalence of PEM in the under-fives
Prevalence of Vitamin A deficiency

HEALTH CARE DELIVERY INDICATORS

• Health manpower
• Health infrastructure
• Population

o Doctor-population ratio
o Doctor-nurse ratio
o Population per health centre
o Population per hospital bed
o Population per trained birth attendant etc.
 UTILIZATION RATES
Proportion of fully immunized children
Proportion of pregnant women who receive antenatal
care
Bed occupancy rate

INDICATORS OF SOCIAL AND MENTAL HEALTH

• The events indicating social and mental pathology are
suicide, homicide, juvenile delinquency, alcohol and
drug abuse, road traffic accidents, smoking, family
violence, battered – baby and battered – wife syndromes
etc.
 ENVIRONMENTAL INDICATORS
These refer to the physical and biological environment
in which people live and in which diseases occur.
Of these, the most useful indicators are measuring the
percentage of households with safe drinking water
facility, percentage of households with appropriate
sanitary facility etc.
INDICATORS OF QUALITY OF LIFE
Physical Quality of Life Index (PQLI): It takes three
factors into consideration i.e. infant mortality rate, life
expectancy at the age of one year, and literacy rate. It is
measured against a scale of 0 to 100.
 HEALTH POLICY INDICATORS
Resource allocation
Community Involvement
Degree of Equity of distribution of health services
Political Commitment

SOCIO- ECONOMIC INDICATORS

• Food availability, Housing

• Socio-economic status of the family, per capita income

• Adult literacy, Family literacy

• Rate of population increase

 HEALTH SITUATION IN INDIA

DEMOGRAPHIC PROFILE:

• Total population, Crude birth rate, Crude death rate,

Annual growth rate, rural population, literacy rate,
population density/sq.km., population below 15 years,
population above 60 years, average family size, female
age at marriage, sex ratio, annual per capita GNP.
MORTALITY PROFILE:
 HEALTH CARE SERVICES-BASIC
CONCEPTS
LEVELS OF HEALTH CARE:
• Primary Health Care: It is the first level of contact
between the individual and the health system where
essential services are provided. In India it is represented by
the sub-centre and the primary health centre.
• Secondary Health Care: Community health centres (CHC)
and district hospitals are included in this category.
• Tertiary Health Care: This level offers super-specialised
health services, provided by regional/central level
institutions. These centres also provide planning and
managerial skills and teaching to the specialized staff.
Medical colleges and institutions fall in this category.
 HEALTH TEAM CONCEPT
The practice of modern medicine has become a joint
effort of many groups of workers, both medical and
non-medical, i.e. physicians, nurses, social workers,
health assistants, village health guides, trained mid wives
etc. They all work as a team to achieve common goals.
WHO in 1977 gave “Health For All by 2000 AD” goal i.e.
“attainment by all the people of the world by the year
2000AD of a level of health that will permit them to lead a
socially and economically productive life”.
 PRIMARY HEALTH CARE
The Alma-Ata declaration visualised primary health care
as the nucleus of a country’s health system to make
essential health care universally accessible.
It stands on four pillars i.e. community participation,
intersectoral coordination, appropriate technology and
equitable distribution.
It includes providing:
• Education about prevailing health problems and
methods of preventing and controlling them.
• Promotion of food supply and proper nutrition.
• Adequate supply of safe water and basic sanitation.
Maternal and child health care, and family planning.
Immunization against the major infectious diseases
Prevention and control of endemic diseases
Appropriate treatment of common diseases and injuries;
and
Provision of essential drugs.
 NATIONAL HEALTH POLICY
Emphasis on preventive and promotive aspects of health
care.
Emphasis on availability of health care at doorstep.
Development of a National Medical and Health
Education Policy.
Formation of a Health Committee at every village to
project health needs of the community.
Involvement of non-government organizations in health
care delivery.
Integration of Indian system of medicine and
homeopathy in the health system.
Starting health insurance schemes on state wise basis.
Indigenous manufacture of essential bio-medical
equipment.
Organized services for school students.
Priority attention to be given to nutrition and distribution
of food to rural and slum population.
Prevention of food adulteration.
Strengthening of MCH services which includes training of
traditional birth attendants or dais and referral of all
complicated cases to experts.
Phasing out of private practice by doctors by providing
non-practicing allowance.
Formation of a separate national population policy.
HEALTH CARE DELIVERY SYSTEM
IN OUR COUNTRY
At the grassroots every village or a population of 1,000
has one community health volunteer (CHV) or Health
Guide who acts as a link between the health services and
the people. The CHV is expected to assist health
personnel in preventive and promotive services and in
providing simple curative care.
There is also a trained birth attendant.
On a population of 3,000-5,000, there is a sub-centre
staffed by one male and one female multi-purpose
worker (MPW). They form the backbone of the health
services.
Supervision and support to the staff of 4 sub-centres is
provided by one male and one female health assistant
(HA). The HA provides a link between the sub-centre and
the PHC.
The primary health centres provide composite health
services to a population of 20,000 to 30,000. Its staff
includes: 2-3 physicians, one male and one female health
assistant, a block extension educator, a laboratory
technician and a statistical assistant, MPWs and other
auxiliary staff.
There is one community health centre for 4 primary
health centres for a population of app. 1 lakh. There are
30 bedded hospitals with specialist services. The patients
can be referred to district level hospitals/Medical colleges
from these centres.
Thank You