—from Epidemiological Bulletin, Vol. 21 No. 2, June 2000—
Meeting of the Regional Advisory Committee on Health Statistics
The Regional Advisory Committee on Health Statistics (CRAES) met in Washington, DC, from 27 to 29 March 2000. Dr. George A. O. Alleyne, Director of the Pan American Sanitary Bureau, opened the meeting and welcomed the Committee members. He recalled that beginning in the 1960s, the previous Committee had guided the Organization in achieving an improvement in vital and health statistics in the countries of the Region and he expressed satisfaction that the Committee is being revitalized.
In addition, he pointed out the difference between an expert committee and an advisory committee. Expert committees meet to deliberate on a specific subject, prepare a report, and do not require monitoring of their recommendations. Advisory Committees such as the CRAES, however, are advisors to the Director. They are long-standing and responsible for providing advice and recommendations to the Director, who in turn has the responsibility of indicating what is accepted and what is not feasible, given the conditions of the health situation of the countries and the resources available in the Organization. The use of working subcommittees by this Advisory Committee will make it possible to delve further into the critical areas required to strengthen health statistics in the Americas.
The Pan American Health Organization (PAHO), added Dr. Alleyne, has placed emphasis on the strategic use of health information. The Organization needs good-quality information not only for its own internal purposes but also to know about the health status of the population. It will never be possible to serve all the needs and it is necessary to concentrate on what the countries are currently doing and what PAHO can do to assist them. As a result, it is necessary to establish priorities using the available scientific information and pertinent analyses.
Dr. Alleyne manifested his growing concern over the problems that arise from complex analytical formulations such as complex health measures or indices, many of which depend on the accuracy and validity of the underlying data. If the data used to carry out the calculations are of doubtful quality, the formulations will also be suspicious. As a result, it is necessary to pay much more attention to ensure that the basic data are of better quality.
The matter of vital statistics is not new. The word “statistics” is derived from “the needs of the state”, and this is important to keep in mind, not for the historical origin of the word but because the recommendations must be of importance to the population of the states. Equity cannot be achieved without information on the health status of the population, not only at the country level but also at other levels. The Director was pleased to observe the efforts of the countries to reach a geographical disaggregation of the basic indicators. There is still a need, however, to improve information transfer and to devote special attention to ensure that the basic data are of the best quality.
Dr. Carlos Castillo-Salgado, Chief of the Special Program for Health Analysis (SHA), expressed his satisfaction that the CRAES had been reinstated and was especially grateful that the three Collaborating Centers of the World Health Organization for the Classification of Diseases in Spanish, Portuguese and for North America, and the Division of Statistics of the United Nations were represented.
The basic points considered at this meeting of the Committee were: training of human resources, validation and consistency of information, dissemination of information and the International Classification of Diseases (ICD) and family of classifications.
During the meeting, each of the basic points was introduced with a brief presentation. Further, the results of a survey conducted between September 1999 and February 2000 to identify training programs for personnel in statistics in the Spanish-speaking countries of the Americas were presented. The following recommendations emerged from the active and fruitful discussion that followed.
Recommendations
As a result of the survey conducted in 1999-2000 and of the discussions
held during the meeting, the Committee recommended the adoption of a series
of measures. These recommendations are grouped by subject.
Human resources
- Training courses for technicians and professionals should be promoted and supported, tending towards professionalization. Courses for technicians should be transformed into degree programs, and complementary courses for technical personnel should be created to give them the opportunity to obtain a degree.
- PAHO should maintain and keep up-to-date a directory of the various courses and modalities offered by each country.
- An instrument should be defined to evaluate the use of the diverse training materials in health statistics, as a first step towards the possible creation of a clearinghouse for the review, recommendation, and dissemination of these materials.
- PAHO should strengthen horizontal cooperation between countries and institutions (both within and outside the country), taking advantage of previous successes in human resources training in health statistics.
- Cooperation should be encouraged between countries that have training programs for health statistics personnel and those that lack them (exchange of students and faculty).
- Courses to refresh and standardize knowledge should be conducted, especially in technology and scientific methodology, for statistical personnel that serve in health services.
Implementation of the ICD-10 in the Americas
- PAHO should obtain from WHO a clearer definition of the delegation of authority to translate (into Spanish and Portuguese), publish, print and distribute the family of classifications in the Region of the Americas.
- PAHO should encourage and support the creation of national reference groups for the International Classification of Diseases and the family of classifications in the countries of the Region. Their function would include providing advisory services and recommendations to the users of the ICD and clarifying both mortality and morbidity coding questions.
- PAHO should keep and expand the Latin American Forum of discussions on the ICD and family of classifications and, in addition, promote the creation of similar national groups using e-mail.
- The ICD subcommittee should develop a plan to obtain information on the use of the ICD and the family of classifications, and their adaptations in all the countries of the Americas. This plan should include its opinion on the action that should be taken regarding the classification of procedures in medicine.
- The ICD subcommittee should analyze the proposed list for tabulation of the leading causes of death and the tables of consistency for mortality coding, and specify the form of dissemination to be used in all the countries.
Processes of data review and validation
- PAHO should promote the preparation and dissemination of documents on the principle of obtaining good quality information, and support the visit of experts, horizontal cooperation between countries and within regions of each country.
- In each country and in a joint effort with other institutions, the improvement in vital statistics should be strengthened through joint efforts at the local levels.
- In addition to promoting the use of established validation processes in the countries of the Region, PAHO should support and promote the implementation of specific field studies for data collection.
- PAHO should promote the exchange of the methodology for the study of the quality of medical death certification between countries.
- PAHO should give priority to the implementation of specific studies on the registry of fetal deaths to describe this event with greater precision.
Dissemination of information
- A subcommittee of the CRAES, with the possible help of experts in the subject, should review the International Standards Organization (ISO) standards in order to evaluate their adequacy to health metadata.
- PAHO should prepare a directory of the various existing sources of health information in the countries’ Web pages.
- PAHO should support the preparation of a guide or manual on the methodology for the analysis of mortality data based on years of life lost and widely disseminate it.
- On the occasion of the approaching celebration of PAHO’s 100th anniversary, topics should be suggested for a regional study on health statistics.
- A subcommittee of the CRAES should study the feasibility and methods of including, in all Web pages of public institutions containing information on health, details related to coverage and quality that should be taken into account when using the data.
The members of the Regional Advisory Committee on Health Statistics are:
- Ms. Yolanda Bodnar Contreras (Departamento Administrativo Nacional de Estadísticas, Colombia)
- Dr. J. Peter Figueroa (Ministry of Health, Jamaica)
- Mr. Alejandro Esteban Giusti (Instituto nacional de Estadísticas y Censos, Argentina)
- Ms. Marjorie S. Greenberg (WHO Collaborating Center for the Classification of Diseases for North America, USA)
- Prof. Ruy Laurenti (Centro Colaborador da OMS Para a Classificação de Doenças em Português, Brasil)
- Dr. Miguel Angel Lezana Fernández (Secretaría de Salud, Mexico)
- Ms. Elida Hilda Marconi (Ministerio de Salud y Acción Social, Argentina)
- Dr. José Miguel Mata de la Torre (Instituto de Salud Carlos III del Ministerio de Salud y Consumo, Spain)
- Dr. Carlos Felipe Muñoz Rojas (Centro Colaborador de la OMS para la Clasificación de Enfermedades en Español, Venezuela)
- Dr. Danuta Rajs Grzebien (Instituto de Salud Pública, Chile).
Other participants to this meeting were:
- Dr. Eduardo Arriaga (University of Córdoba, Argentina)
- Dr. Sonia B. Fernández Cantón (Secretaría de Salud, Mexico)
- Dr. F. Sam Notzon (Office of International Statistics, National Center for Health Statistics, USA)
- Ms. Gladys Rojas (Ministry of Health, Venezuela)
- Ms. Susana Schkolnik (Centro Latinoamericano de Demografía, Comisión Económica para América Latina y el Caribe, Chile)
- Dr. Eduardo Zacca (Ministerio de Salud Pública, Cuba)
- and Ms. Violeta Gonzales-Diaz (Demographic and Social Statistics Branch, Statistics Division of the United Nations).
For additional information and previous articles on this subject, click here .
Source: PAHO. Special Program for Health Analysis
Return to Index
Epidemiological Bulletin, Vol. 21 No. 2, June
2000