—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
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Epidemiological Bulletin, Vol. 21 No. 2, June
2000
