Although EPHF 1 exhibited intermediate to high performance in the Region, a number of countries still need to improve the implementation of this function. Below is a frequency histogram detailing the performances of each country analyzed, with a median of 0.58 for the region and a distribution ranging from 0.24 to 0.97.
Within the performance of this function, the indicator with the greatest strength was indicator 3, referring to the institutional capacity of the NHA. Performing at intermediate levels were indicators 4 and 5: technologies for monitoring and evaluation, and technical support at the sub-national levels. The most critical areas were the availability of guidelines for monitoring and evaluating health status (indicator 1), and evaluation of the quality of information (indicator 2).
The distribution of indicators reveals that there is a high degree of variation among the countries in the region, especially with respect to the low performance of indicator 2 (evaluation of the quality of information). Despite the fact that weaknesses were found in most countries, there were a few that demonstrated adequate performance with respect to this indicator.
Similarly, indicator 5 exhibited high performance in most countries although it remained an area of weakness in others. The strong performance of indicator 3 also revealed low variability, demonstrating that institutional competencies and capacities for performing this function are strong in the Region.
Indicators 1 (guidelines for monitoring and evaluating health status) and 4 (technologies for monitoring and evaluating health status) should be carefully reviewed by each country since a number of countries revealed weaknesses in these areas.
The following graph presents the results related to the median, first standard deviation (representing sixty-six percent of the countries), and the maximum and minimum values for each indicator:
The primary factors determining this function’s performance are:
• Roughly 70% of the countries have guidelines for measuring health status at the national and intermediate levels, and a slightly higher percentage has guidelines at the local level.
• In most countries, the health status profile is updated every year to provide information on the use of individual and collective health services. It is also used to monitor trends and define national objectives and goals. However, deficiencies still exist with respect to the use of data to reveal inequalities in access to health services. Identifying these deficiencies helps to guide actions aimed at improving the efficacy of health services and provides information on the risk factors and determinants of health status.
• The main data used to measure health status include mortality rates, socioeconomic indicators, and health services utilization. In general, access barriers to health care are not monitored; fewer than 30% of the countries monitor risk factors for the most important pathologies; and data on morbidity is inconsistently registered.
• With respect to the quality of information, only 16% of the countries have a monitoring agency that is independent of the ministry of health. Thirty percent of the countries have implemented audits to evaluate the quality of the data. A common critical area is the lack of mechanisms to continuously improve the information systems. In addition, there are no procedures for disseminating information on the health status of the population to the media and to the general public (only half of the countries allow public access to the information). Finally, very few countries perform periodic evaluations of the utilization of the disseminated health information.
• Although there are institutions responsible for compiling health statistics at the national level, less than a third of these bodies gather at least once a year to analyze and evaluate their performance.
• With respect to human resources, 80% of the countries have qualified public health professionals at the intermediate level, and half of the countries have at least one professional with a doctoral degree at the central level.
• Most countries have trained personnel for the collection of general and specific health data. These professionals consolidate data from various sources, perform integrated data analysis, interpret results, formulate valid conclusions, and communicate pertinent information on the national health status trends to decision-makers.
• Seventy-six percent of the countries use computer resources to implement this function at the intermediate level, while only 27% use them at the local level. Forty-three percent of the countries have electronic communication systems to distribute data to sub-national entities. A common critical area is the lack of quick and easy access to specialized computer systems and equipment maintenance.
• In general, it was acknowledged that the NHA performs well with respect to advising the sub-national entities on data collection. However, the role of the NHA in supporting the interpretation of results was considered weaker.