Indicators and Reference Data: A Practical Tool for ... · This manual is intended to help project...
Transcript of Indicators and Reference Data: A Practical Tool for ... · This manual is intended to help project...
Indicators and Reference Data: A Practical Tool for Project
Managers in Humanitarian Aid
Malteser InternationalOperational Guideline
www.malteser-international.org
AuthorsMarie Theres Benner
K. Peter Schmitz
Design and LayoutEsther Suchanek
Published by Malteser International,Cologne, Germany
2009
Disclaimer The idea, design and contents of this guideline have been purely driven by the context Malteser International is working in. Many of the indicators and standards in this booklet have been used from the World Health Organization (WHO), the SPHERE project, the World Bank, Centre for Disease Control and Prevention, Atlanta (CDC), the United Nations High Commissioner for Refugees (UNHCR) and others, but also from own practical experience in the field of humanitarian aid.
The tool is aimed to support project managers and health personnel in effective planning and result oriented managing of programmes by selecting appropriate and practical indicators. It covers the sector of health, nutrition, immunisation, psycho-social care, mental health and water, sanitation and hygiene. Malteser International fully endorses the international standards already produced and considers them as important references; nevertheless, this guideline is aimed to be as practical as possible and should be used as a flexible tool and adapted to the local context.
Acknowledgements We gratefully acknowledge the support of all Malteser health staff who provided their contribution and invaluable input for this tool. We specifically show our appreciation towards our colleagues who participated in the regional health workshops where much of their invaluable input was given.
Finally, the editors would like to thank Prof. François Nosten from the Shoklo Malaria Research Unit (Mae Sot, Thailand) for his contribution on the malaria indicators and Dr. Osman Eltayeb (former Malteser Country Health Coordinator for Myanmar) for his contribution on the TB indicators.
Copyright Copyright for this document is held by Malteser International. Copying of all parts is permitted provided that the source is acknowledged.
3
Foreword
This manual is intended to help project managers alike to assess and plan hu-manitarian aid projects throughout all phases, from the emergency situation up to the developmental phase. The manual provides a set of compiled stan-dards and key indicators, which have been developed by many people for va-rious sectors and have reached a remarkable consensus in the humanitarian world. It gives practical advice for on-the-ground interventions. Additional some references have been made on further information sources.
Although this manual is a technical toolkit with a focus on standards and indicators, it does not neglect the importance of the human rights approach and the principles addressed in the Humanitarian Charter and the Code of Coduct, which has been signed by Malteser International. It rather con-fesses the strong commitment for quality, accountability and the respect of those affected by disaster or conflict.
I hope that this manual will support Malteser International staff and en-courage other humanitarian aid organisations to increasingly use standards and indicators to show their effectiveness of work and to be accountable for those in need. It is a shared responsibility.
Ingo RadtkeSecretary GeneralMalteser International
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Table of contents
1. Introduction 6
2. How to give meaning to data in a complex situation 62.1 Possible information sources to obtain health relevant data 7
3. Population estimations 7
4. Planning a programme with limited available information 94.1 Reproductive Health 114.2 Nutrition 134.3 Immunisation 16
5. Indicators 185.1 Indicators should be 19
6. Indicator Matrix 19
7. Annex 687.1 Case definition 687.2 Glossary of terms 68
8. References and web addresses 778.1 Health 778.2 Reproductive Health 798.3 Sexual gender based violence (SGBV) and Mental Health 808.4 Nutrition 81
Weekly morbidity/mortality surveillance form 82
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1. Introduction
Health Indicators are an important tool of project management, monitoring and evaluation in humanitarian aid and development. Measuring outcomes, results and effectiveness of interventions helps not only the programme manager to identify the most appropriate response according to the affected population, context and culture; it is also an increasing requirement of donors to reflect the agency’s work and the overall quality and to show accountability towards the beneficiaries.
However, before planning and designing a project, it is imminent to get some information on the situation. The following section describes some approaches.
2. How to give meaning to data in a complex situation
Especially in complex emergencies, information systems are often interrupted, data are invalid and deficient, standards are not available and therefore health information are often not used even when large amounts of data are available. Even in extreme situations such as in Afghanistan, Sudan or the D.R. Congo, health data, although incomplete, of variable quality and collected with different stakeholders, are available. However, the capacity and the coordination to make meaning out of those scattered information is a challenge and often not practiced (Pavignani E and Colombo A, 2001).
The registration of absolute numbers of deaths or patients with specific diseases during a disaster or emergency is not very informative, unless they are reported in relation to the relevant population and reported in rates or ratios. This helps to make the death and disease pattern clearer. Data, which are collected over time, may even show change and may provide useful information for the respective aid programmes. Further dividing data by sex, age groups, ethnic or social groups (i.e. migrants or non-migrants) or working activities, may suggest factors behind the vulnerability of the affected population. However, collecting and manipulating data in the hope that something ‘appealing’ comes up is not giving the real evidence to make decisions and therefore not very useful (Pavignani E and Colombo A, 2001).
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The following section will provide some ideas on where to collect information and how to make use of available data for decision making.
2.1 Possible information sources to obtain health relevant data
Ministry of Health: collects routinely data; availability has to be assessed
Ministry of Foreign Affairs: may collect information on specific social groups such as refugees or foreign migrants
WHO in respective country: collects routine country specific data and may support the country health information system
Standardised national surveys: such as Demographic and Health Surveys (DHS); sometimes published in relevant journals
Survey data: assess if surveys have been conducted in the country; they may be relevant for the programme planning and do not necessarily require another survey
Surveillance system: sometimes implemented by the health authorities and WHO and part of the national surveillance system
3. Population estimations
To find out the total number of the target population and the breakdown by age and sex is always a challenge in emergencies and post-conflict situations. Rarely, exact figures can be attained. On the other hand, it is of utmost importance to decide on the number of people to be served – i.e. the target
Key Message 1: Assess if and what information is already available through the relevant ministries, WHO or other NGOs. Take into account available information before planning your own survey or assessment.
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population. The population is the basis to decide on the denominator, which gives an idea on quantities of commodities and services to be organised in a given timeframe. A helpful tool is to find out the number of health facilities and the estimated total population number in a specific area such as a district or province. If one has to plan just for a small population group within the province, look at the number of health facilities in this specific area and divide those by the total number of health facilities to get the percentage out of the total; this is also your estimated percentage of population to use as a denominator. Look at the following example:
EXAMPLE: the province in this example provides the baseline in- formation while the district estimated population has been calculated out of the province data
Province No. of total health facilities Estimated Population A 56 850,000
District A 24 (43%) out of 56 484,500 (43% of total 850,000)
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The following table gives some indications for a more or less normal distributed population.
Table 1: Estimated population figures in a “normal” distributed society
Group % of population Remarks by the authors0-4 years 12 Might be higher in societies with high
birth rates --> 12 – 20 %5-9 years 12 Might be higher in societies with high
birth rates10-14 years 11 Might be higher in societies with high
birth rates15-19 years 10 Might be higher in societies with high
birth rates20-59 4960 + 7Pregnant Women 2.5 – 4 Might be higher in societies with high
fertility ratesBreastfeeding Women 2.5 Might be higher in societies with high
fertility ratesPeople living with disabilities
Male : Female Ratio
5-10
51 : 49
Depends on definition, may include mental health. Distinguish those in need of assistance.
Source: adapted from SPHERE Handbook, 2004; p. 190
Key Message 2: With the size of the population (denominator) and the common age distribution and some information about standard frequen-cies, the target population and therefore the situation can be better descri-bed. It is for example possible to estimate the number of deliveries to be expected in a given time period. This helps to identify and to understand expected upcoming problems and to plan a relevant intervention.
4. Planning a programme with limited available information
The following section provides information on what to expect when setting up a humanitarian aid programme in a region where only limited information are available. The following tables provide an overview on the
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estimated health status in the various regions (Table 2), what might be expected in terms of reproductive health issues (Table 3) and what can be considered for planning a health care programme.
Table 2: Reference to annual rates and ratios by regionIndicator Sub-
Saharan Africa
South-East Asia
Industrialised Countries
Crude Birth Rate / 1,000 pop. 44 26 13Neonatal Mortality Rate / 1,000 live births
53 36 5
Perinatal Mortality Rate / 1,000 live births
83 51 8
Maternal Mortality Ratio / 100,000 live births
971 447 31
Infant Mortality Rate / 1,000 live births
97 50 14
Coverage of Antenatal Care (%) 63 65 95Low Birth Weight Percentage / 100 live births
16 15 6
Births attended by trained health personnel (%)
42 53 99
Institutional deliveries (% of live births)
20 41 98
Unsafe abortion (1,000 women 15-49 yrs.)
26 15 1
Anaemia in pregnant women (%) 52 57 18Coverage of Tetanus Vaccination (Pregnant Women)
46 49 -
STI Incidence rate / 1,000 pop.AIDS Cases / 100,000
25494
16080
7727
Source: United Nations Development Programme. Human Development Report. New York: United Nations, 1997. IN: Centre for Disease Control and Prevention, Atlanta. 2003. Public Health Surveillance applied to reproductive health; Epidemiology Series Module 1. Atlanta: CDC
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4.1 Reproductive Health
Table 3: Reproductive Health reference rates and ratiosHealth Outcome Estimates Remarks Labor and delivery complications
15% of all pregnancies will require some type of intervention at delivery
3%-7% of all pregnancies will require caesarean section
10%-15% of all women will have some degree of cephalopelvic disproportion (higher in poorer socio-economic populations)
10% of deliveries will involve a secondary postpartum haemorrhage (within 24h of delivery)
0.1%-1% of deliveries will involve a secondary postpartum haemorrhage (occurring 24 h or more after delivery)
0.1%-0.4% of deliveries result in uterine rupture0.25%-2.4% of all deliveries will result in some type of
birth trauma to the baby1.5% of all births will have a congenital
malformation (does not incl. cardiac malformations diagnosed later in neonatal period)
31% of these malformations will result in death
Hypertensive Disorder of Pregnancy (HDP) or Pre-eclampsia
5%-20% of all pregnancies develop HDP/ pre-eclampsia (5%-25% in primigravida)
Spontaneous Abortions
10%-15%
90%15%-20%
of all pregnancies may spontaneously abort before 20 weeks gestationof these will occur during the first 3 monthsof all spontaneous abortions require medical interventions
Source: adapted from reproductive health in refugee settings: an inter-agency field manual. Geneva: UNHCR, 1999 IN: Centre for Disease Control and Prevention, Atlanta. Public Health Surveillance applied to reproductive health; Epidemiology Series Module 1. Atlanta: CDC. 2003, p. 79.
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Key Message 3: Use reference data if none are available for planning your intervention. If you work in sub-Saharan Africa and you plan a repro-ductive health care programme in a certain district, you may expect that only 46% (Table 2) of the pregnant women are fully immunised against tetanus. You may also expect that about up to 7% of the pregnant women (Table 3) may need a caesarean section. Use those references only if there are none available through the Ministry of Health or WHO in the country. However, you have to assess in your area if e.g a caesarean section is actually possible? Is there a facility in your area where women can go for caesarean section? If not, how can you as an organisation address those needs? Dis-cuss with the Ministry of Health and /or WHO how to address the need for e.g. for caesarean section to reduce morbidity and mortality.However, be aware that you can not solve all problems yourself but you can advocate.
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4.2 Nutrition
In emergencies, it is aimed to provide sufficient food baskets to avoid severe malnutrition for a specific target group during a period of time. The aim is not to balance the general inadequate food availability by selective feeding. (Connolly M.A., 2005, p. 69).
The following table (4) provides some indication of the nutrition status by using weight/height as a reference.
Table 4: Nutrition ClassificationMeasure severe moderateWeight for Height severe wasting moderate wasting%median < 70% 70-79%z-scores <-3 SD <-2 SD
Weight for Age severely stunting moderate stunting%median <85% 85-89%z-scores <-3 SD <-2 SDSource: WHO, 1999, p. 4
Rapid nutrition surveys using MUAC (mid-upper arm circumference) or weight/height are helpful to identify the major risk persons while selective supplementing (additional ration) and therapeutic (for rehabilitation for severe malnourished persons) feeding programmes are the major intervention tools. Blanket feeding is only recommended when the prevalence of malnutrition exceeds 15% or 10% if other influencing factors are present such as measles or a diarrhoea outbreak. Targeted feeding focuses on extra food rations for selected individuals and vulnerable groups if the prevalence of malnutrition exceeds 10%, or 5% if other influencing factors are present (Connolly M.A., 2005).
13
WHO Classification of Severity for Acute Malnutrition Wasting, measured by weight for height
severity prevalence in <5 populationacceptable <5%poor 5-9%serious 10-14%critical >15%
‘emergency’ refers to acute malnutrition rates >20%
WHO Criteria for Severity for Chronic Malnutrition Stunting, measured by height for age
severity prevalence in <5 populationlow <20%medium 20-29.9%high 30-39.9%very high >40%
WHO Criteria for Severity of Iodine-Deficiency (Goitre)severity prevalence in populationnormal <5%mild 5.0-19.99%moderate 20.0-29.9%severe >30%
WHO Proposed Criteria for Severity of Anemiaseverity prevalence in populationhigh >40%medium 20-40%low 5.0-20%
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WHO Classification of Severity for Vitamin A Deficiencypublic health problem prevalence in <5 years age groupnight blindness >1%conjunctival xerosis, Bitot spots >0.5%Corneal xerosis, ulceration, keratomalacia
>0.01%
corneal scars >0.05%
WHO Classification of Severity of Thiamine Deficiency severity prevalence in populationmild > 1 clinical casemoderate 1-4% of populationsevere >5% of population
WHO Classification of Severity of Niacin Deficiency severity prevalence in populationmild > 1 clinical casemoderate 1-4% of populationsevere >5% of population
WHO Classification of Severity of Vitamin C Deficiency severity prevalence in populationmild > 1 clinical casemoderate 1-4% of populationsevere >5% of population
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4.3 Immunisation
The most important vaccines in emergency situations are those against measles, meningococcal meningitis and yellow fever (Connolly M.A., 2005). Every mass vaccination campaign should be coordinated with the respective communities, the national Ministry of Health, WHO, UNICEF and other relevant partners. To plan a vaccination campaign, the number of doses is based on the size of the targeted coverage, proportion of vaccine lost during mass campaign (15%), and reserves to be held (25%).
Key Message 4: Adequate nutrition is a basic right and is reflected in the Humanitarian Charter. Malnutrition and micronutrition deficiency are the major causes of morbidity and mortality while adequate and timely in-terventions can drastically reduce diseases such as diarrhoea, respiratory in-fections and severe anaemia among others. When carrying out assessments, always include, where possible and if not done earlier, a rapid nutrition survey. When planning a nutrition programme always consider priority groups and needs, the respective food culture and an exit strategy. Integra-ting local groups in the assessment and implementation is vital.
16
Table 5: Calculation for vaccine campaignTotal Population 50,000Target Population i.e. 6 months to 15 years for measles (45%);Target Population for Meningitis i.e. 2 to 30 years (70% of total)
22,500
35,500
Target for coverage: 100% 22,500 (for measles)Number of doses to administer 22,500Including expected loss of 15% (22,500/85%)
26,470
Adding reserve of 25% (26470 x 125%)
33,088
TO ORDER: 34,000 DOSES (if 50 doses per vial order 680 vials)
Source: Connolly MA. Communicable disease control in emergencies. A field manual. Geneva: World Health Organization, 2005, p. 76.
Cold chain material, monitoring equipment (thermometers, refrigerator control sheets) and vaccination cards are mandatory.
Key Message 5: Immunisation programmes are of high priority in all health interventions in emergencies, conflict and post-conflict. Plan and implement those programmes in cooperation with the Ministry of Health, UNICEF, WHO and other NGOs. Be clear on your target group for pro-per planning purposes (see Table 5). In case of a meningococcal menigitis outbreak contact the International Coordinating Group for Vaccine Provi-sion (ICG) through the Ministry of Health, which ensures rapid access to vaccine since this vaccine is usually not available in country.ICG website: http://www.who.int/csr/disease/meningococcal/ICG_guide-lines_2008_02_09.pdf
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5. Indicators
The following section is aimed at helping managers planning, monitoring and evaluating their programmes.
Definition “Indicator”:”Variable that indicates or shows a given situation, and hence can be used to measure change” (Pavignani E and Colombo A, 2001) or “signals, that measure the impact of processes used and programmes implemented. The indicators may be qualitative or quantitative in nature.” (The SPHERE Project, 2004, p. 8)
In all projects, Malteser International uses indicators to measure and to monitor the implementation process and the effectiveness of the chosen interventions. However, a lot of difficulties on identifying and selecting the right and appropriate indicators are still the reality; but this is normal since there are a lot of international debates on what indicators are measuring where and when, and most important, how it can be achieved that indicators are applied according to an agreed definition in order to make them comparable in different contexts and situations.
However, indicators used need to be, where possible, tested, and adapted before they are accepted for general use. The final decision always depends on the practicality and what information is gained by the indicator on one hand and its reliability, availability and respective costs on the other. Country specific demographic, health, economic and social data are collected routinely at the Ministry of Health, WHO or elsewhere. These data are helpful to compare with own data and are possibilities to use them as a reference.
“It is better to be vaguely right than precisely wrong” John Maynard Keyes
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5.1 Indicators should be• directly linked with the programme or intervention• straightforward and relevant to measure progress• sensitive to changes and based on best practices• cost-effective (worth to spent time and money)• easy to understand (Definition!)• reliable• technically feasible (consistent with data available and the data
collection capacity)The indicators given in this booklet are divided for different periods and sectors within the project cycle and therefore are suitable for the emergency phase, early recovery, relief and rehabilitation and developmental approaches. We emphasized on a minimum set of context indicators (Chapters1 & 2 in the matrix), which are essential for an overall situation analysis and outcome /process indicators (Chapters 3-11 in the matrix).
6. Indicator Matrix
The following matrix provides a set of indicators which are most relevant in Malteser International programmes; they are divided by different phases and or sectors.
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Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ce1.
CO
NT
EXT
IN
DIC
ATO
RS
Polit
itcal
sit
uatio
nPo
litic
al st
abili
ty,
arm
ed c
onfl i
cts,
leve
l of c
rimin
al ri
sks,
chec
k po
ints,
restr
icte
d ar
eas
Th e
exte
nt o
f ins
tabi
lity
infl u
enci
ng a
cces
s to
bene
fi -ci
arie
s due
to se
curit
y pr
oble
ms;
limite
d m
ovem
ent,
chec
k-po
ints
and
restr
ictio
ns a
re th
e re
sult.
Coo
rdin
a-tio
n,
loca
l gov
ern-
men
t, po
lice,
m
ilita
ry,
inte
rnet
Econ
omic
al
indi
cato
rsM
arke
t pric
es fo
r bas
ic
food
,sa
larie
s and
pay
men
ts fo
r dai
ly la
bour
,in
fl atio
n ra
te
Mon
itor p
rice
fl uct
uatio
n ov
er ti
me
Mar
ket,
shop
s,in
terv
iew
s
Soci
o-cu
ltura
l co
ntex
tSp
ecifi
c cu
ltura
l-tra
-di
tiona
l-rel
igio
us a
nd
gend
er is
sues
Con
sider
spec
ial i
ssue
s on
trad
ition
, cus
tom
s, be
liefs
and
norm
s and
gen
der a
spec
ts. C
heck
on
com
mon
ru-
les o
n ho
w to
and
how
not
to in
tera
ct w
ith in
divi
dual
s.In
terc
ultu
ral s
ensit
ivity
, aw
aren
ess a
nd re
spec
t may
be
a pr
econ
ditio
n to
get
info
rmat
ion
and
part
icip
atio
n.
Envi
ronm
enta
l ris
ksEn
viro
nmen
tal r
isks &
co
ncer
ns a
ff ect
ing
the
popu
latio
n &
ope
ratio
n
Envi
ronm
enta
l risk
s and
con
cern
s cre
ated
by
the
disa
s-te
r situ
atio
n an
d / o
r env
ironm
enta
l risk
s exi
sting
on
top
of th
e di
saste
r situ
atio
n.
Exam
ples
are
: col
lect
ion
of fi
re w
ood
& d
efor
esta
tion;
co
ntam
inat
ion
of w
ater
sour
ces;
bene
fi cia
ries´
exp
osur
e to
nat
ure
20
Nut
ritio
n sp
ecifi
c co
ntex
tAs
sess
acc
ess t
o fo
odIs
food
supp
ly a
dequ
ate
to c
over
nut
ritio
nal
need
s of a
ll po
pula
tion
grou
ps?
Asse
ss c
ause
s and
po-
tent
ial r
isks f
or m
alnu
-tr
ition
.
Wha
t are
the
stand
ard
food
ratio
ns in
the
coun
try?
In su
dden
em
erge
ncie
s typ
ical
ly a
ff ect
ed p
opul
atio
ns
have
no
acce
ss to
food
oth
er th
an p
rovi
ded
thro
ugh
aid
agen
cies
ther
efor
e it
is ap
prop
riate
to e
stim
ate
food
re
quire
men
ts.C
onsid
er fo
od a
ssist
ance
pro
gram
mes
also
in c
hron
ic
crisi
s but
bas
ed o
n a
com
preh
ensiv
e as
sess
men
t whi
ch
may
incl
ude
pote
ntia
l and
self-
relia
nt c
opin
g str
ateg
ies
and
with
reso
urce
s ava
ilabl
e.
Geo
grap
hica
l sit
uatio
n an
d ro
ad c
ondi
tions
Road
type
, ave
rage
km
/ho
ur fo
r tra
nspo
rt, d
ry/
rain
y se
ason
, rem
oten
ess,
geog
raph
ical
cha
lleng
es
of d
isaste
r/co
nfl ic
t zon
e,av
aila
bilit
y of
app
ropr
ia-
te m
eans
of t
rans
port
Th e
diff e
renc
es o
f roa
d co
nditi
ons t
rem
endo
usly
aff e
ct
acce
ssib
ility
. Tr
ansp
ort b
y ro
ad m
ight
not
be
poss
ible
at a
ll. E
stim
ate
the
need
of a
irlift
ing
or sh
ippi
ng o
f sta
ff an
d co
mm
o-di
ties.
Coo
rdin
a-tio
n,
loca
l in-
form
atio
n,
asse
ssm
ent
Tech
nica
l Com
-m
unic
atio
n (R
adio
, cel
l ph
ones
net
-w
orks
)
Avai
labi
lity
and
func
tion
of h
igh
frequ
ency
radi
os,
tele
phon
es, s
atel
lite,
m
obile
pho
nes a
nd
coda
n; C
over
age
of c
ell
phon
e ne
ts
Che
ck p
ract
ical
and
tech
nica
l mea
ns o
f com
mun
ica-
tion
and
be a
war
e of
pos
sible
lega
l iss
ues w
hen
usin
g hi
gh fr
eque
ncy
radi
o an
d/or
sate
llite
com
mun
icat
ion.
Coo
rdin
a-tio
n,
loca
l gov
ern-
men
t
21
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ceLo
cal c
apac
ities
an
d pa
rtne
rsAv
aila
bilit
y, ex
perie
nce,
co
mpe
tenc
e an
d ca
pa-
citie
s of l
ocal
par
tner
s (N
GO
s and
gov
ernm
ent
serv
ices
/ str
uctu
res)
Initi
al in
-vo
lvem
ent o
f co
mm
uniti
es
and
loca
l par
t-ne
rs
Loca
l par
tner
s, i.e
. loc
al h
ealth
serv
ices
, loc
al N
GO
s or
com
mun
ity b
ased
org
anisa
tions
are
impo
rtan
t res
our-
ces w
ith o
wn
capa
citie
s. It
is str
ongl
y re
com
med
ed to
id
entif
y, su
ppor
t and
coo
pera
te w
ith th
em.
Stak
ehol
ders
Asse
ss a
ctor
s and
stak
e-ho
lder
s, th
eir r
oles
and
re
spon
sibili
ties.
Iden
tify
supp
ortiv
e ac
tors
and
op
posin
g ac
tors
(ref
ers
to c
onne
ctor
s and
dis-
conn
ecto
rs in
the
“do
no h
arm
” ap
proa
ch)
Supp
ortiv
e ac
tors
as w
ell
as re
sistin
g or
opp
osin
g ac
tors
are
id
entifi
ed.
Stak
ehol
der a
naly
sis th
roug
h id
entifi
cat
ion
and
docu
-m
enta
tion
of th
eir p
artic
ular
stre
ngth
s and
role
s to
play
su
ppor
ts as
sess
men
t, pl
anni
ng a
nd im
plem
enta
tion.
R
isk a
naly
sis a
nd th
e de
velo
pmen
t of a
ssum
ptio
ns a
re
supp
orte
d by
stak
ehol
der a
naly
sis. R
epre
sent
ativ
es o
f aff
ect
ed p
opul
atio
ns a
nd o
f gro
ups w
ithin
the
aff e
cted
po
pula
tion
need
to b
e in
clud
ed.
Stak
ehol
der l
ists a
re im
port
ant p
roje
ct d
ocum
ents
whi
ch h
elp
not l
oosin
g re
leva
nt in
form
atio
n an
d ke
e-pi
ng c
onta
cts a
nd p
artn
ers u
p to
dat
e.
Mee
tings
,in
terv
iew
s,sta
keho
lder
lis
t
2. B
ASI
C S
ET O
F “M
INIM
UM
IN
DIC
ATO
RS“
*
Popu
latio
n by
ag
e an
d se
xTo
tal n
umbe
r of p
opu-
latio
n by
age
and
sex
in
the
proj
ect /
catc
hmen
t ar
ea
See
SPH
ERE
hand
book
, 20
04, p
. 300
Hav
e po
pu-
latio
n da
ta
by a
ge g
roup
as
soon
as
poss
ible
tode
cide
on
deno
min
ator
.
Age
grou
ps c
ould
be
initi
ally
div
ided
into
less
than
5
yrs.
and
abov
e 5
yrs.
and
late
r ada
pted
as n
eede
d (e
.g.
<1; 1
-5; 6
-10;
10-
14; 1
5-19
; 20-
24; >
24).
Incl
ude
estim
ates
on
vuln
erab
le g
roup
s, pe
ople
with
di
sabi
litie
s, el
der p
erso
ns, t
hose
livi
ng w
ith c
hron
ic
dise
ase,
pre
gnan
t wom
en a
nd la
ctat
ing
mot
hers
.
Pre-
exist
ing
loca
l sta
ti-sti
cs
22
Info
rmat
ion
on to
tal p
opul
atio
n is
esse
ntia
l - if
no
acur
ate
data
are
ava
ilabl
e: E
STIM
ATE
base
d on
initi
al
asse
ssm
ent
Num
ber o
f bir-
ths e
xpec
ted
Tota
l num
ber o
f birt
hs
expe
cted
in th
e pr
ojec
t/ca
tchm
ent a
rea
in a
gi
ven
time
perio
d
rang
es a
roun
d 2.
5 - 4
%
from
the
tota
l po
pula
tion
/ ye
ar
E.g.
2.5
% o
ut o
f 10,
000
pop.
=250
esti
mat
ed b
irth/
year
Estim
ated
no.
of b
irths
is m
atch
ing
with
the
no. o
f pr
egna
nt w
omen
in th
e co
mm
unity
. Th e
pro
port
ion
can
be >
2.5
% in
soci
etie
s with
a h
ighe
r fer
tility
rate
.
Asse
ssm
ent,
loca
l sta
ti-sti
cs,
EST
IMA-
TES
Cru
de D
eath
R
ate
Num
ber o
f all
deat
hs /
1,00
0 po
p. /
year
by
sex
in p
roje
ct /
catc
hmen
t ar
ea
11-1
5 / 1
,000
/ y
ear
Num
erat
or: N
umbe
r of t
otal
dea
th d
urin
g a
give
n tim
e pe
riod
Den
omin
ator
: Tot
al p
opul
atio
n in
the
com
mun
ity
(mid
-yea
r pop
ulat
ion)
dur
ing
the
sam
e pe
riod
May
com
pare
with
dai
ly o
r mon
thly
rate
s in
emer
gen-
cies
and
chr
onic
cris
es.
Prec
ondi
tion
is ex
isten
ce o
f an
emer
genc
y su
rvei
llanc
e sy
stem
, i.e
. coo
rdin
ate
and
com
mun
icat
e in
form
atio
n on
bod
y co
unts
and
mor
talit
y fi g
ures
bet
wee
n or
gani
-sa
tions
.
Dea
th ra
tes,
loca
l sta
ti-sti
cs,
body
cou
nts
23
* Th
e m
inim
um in
dica
tors
shou
ld h
elp
to g
ive
an o
vera
ll sit
uatio
n an
alys
is of
the
proj
ect a
rea
and
furt
her h
elp
to d
evel
op th
e pr
ojec
t pla
n. A
sses
smen
ts / S
urve
ys o
r a
revi
ew o
f nat
iona
l sta
tistic
s are
nec
essa
ry fo
r a c
onte
xt sp
ecifi
c sit
uatio
n an
alys
is
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ceN
umbe
r of
heal
th fa
cilit
ies
(HF)
Prim
ary
Hea
lth C
are
Cen
tre (P
HC
): pr
o-vi
sion
of e
ssen
tial
drug
s, bi
rth
spac
ing,
Im
mun
isatio
n, A
NC
&
PNC
,Vit.
A, c
urat
ive
care
, hea
lth p
rom
otio
n,
wat
er, s
anita
tion
&
hygi
ene
Cen
tral
Hea
lth F
acili
-ty
: sam
e as
PH
C p
lus
min
or su
rger
y, bl
ood
tran
sfusio
n, la
bora
tory
1 Pr
imar
y H
ealth
Car
e C
entre
for
10,0
00 p
op.
1 C
entr
al
Hea
lth F
acili
-ty
for 5
0,00
0 po
p.
Dep
ends
ver
y m
uch
on th
e lo
cal a
nd c
ultu
ral c
onte
xt.
Get
info
rmat
ion
on c
ount
ry sp
ecifi
c he
alth
syste
m a
nd
the
serv
ices
pro
-vid
ed in
the
vario
us h
ealth
faci
litie
s (H
F). U
sual
ly th
ere
is a
prim
ary,
seco
ndar
y an
d te
rtia
ry
leve
l; th
e te
rtia
ry le
vel i
s a re
ferr
al c
entre
whe
re m
ost
spec
ialis
ed se
rvic
es a
re o
ff ere
d, th
e se
cond
ary
leve
l is
the
distr
ict h
ospi
tal w
here
em
erge
ncy
inte
rven
tion
and
som
e ge
nera
l ope
rativ
e se
rvic
es a
re o
ff ere
d. Th
ere
may
be
no
oper
atio
ns c
arrie
d ou
t at t
ertia
ry le
vel.
On
asse
ssm
ent i
t is u
sefu
l to
fi nd
out w
heth
er th
e H
F ha
s inp
atie
nt b
eds a
nd w
heth
er th
ey c
ondu
ct d
eliv
erie
s.
Nat
iona
l sta
tistic
s,H
IS d
ata
of
the
heal
th
faci
litie
s,pa
tient
re
cord
s, as
sess
men
t
Func
tiona
lity
of
Hea
lth S
yste
m
(faci
litie
s)
Prim
ary
Leve
lSe
cond
ary
leve
lTe
rtia
ry L
evel
Giv
e a
brie
f fun
ctio
nal d
escr
iptio
n of
the
heal
th fa
cili-
ties b
y co
nsid
erin
g: d
rugs
ava
ilabi
lity,
staffi
ng, s
ervi
ce
prov
ided
, use
r fee
s, fu
nctio
nalit
y of
refe
rral
s, eq
uip-
men
t, ge
ogra
phic
al d
istrib
utio
n, fu
ndin
g.
Supe
rviso
ry
chec
klist
s or
HF
chec
k lis
ts G
eogr
aphi
c Ac
cess
to h
ealth
fa
cilit
ies (
in %
of
tota
l pop
.)
Dist
ance
to H
F in
km
an
d w
alki
ng ti
me
in
perc
enta
ge
Th e
perc
en-
tage
of t
he
popu
latio
nliv
ing
< 5k
m
or w
ithin
one
ho
ur w
alk
to
the
HF
Num
erat
or: N
umbe
r of p
opul
atio
n liv
e <
5km
or l
ess
than
one
hou
r wal
k fro
m h
ealth
faci
lity
Den
omin
ator
: Tot
al ta
rget
pop
ulat
ion
NB
: HF
loca
ted
at a
long
er d
istan
ce m
ay b
e m
ore
easy
to
reac
h be
caus
e th
ey m
ay b
e sit
uate
d at
mai
n ro
ad
with
bus
and
taxi
serv
ices
ava
ilabl
e.
Geo
gra-
phic
al d
ata,
m
aps,
asse
ssm
ent
24
Hea
lth W
or-
ker C
over
age
prop
ortio
nal
to p
opul
atio
n (S
taff
dens
ity)
Th e
num
ber o
f hea
lth
prof
essio
nals
per p
opu-
latio
n
1 qu
alifi
ed
HW
/ 10
,000
po
p.
2 au
xilia
ry
nurs
es /
10,0
0010
CH
W /
10,0
00
1 m
edic
al d
oc-
tor /
10,
000
50,0
00 p
op.
Num
erat
or: N
umbe
r of m
edic
al d
octo
rs/n
urse
s/au
xil-
lary
nur
ses/
CH
W/m
idw
ives
Den
omin
ator
: Num
ber o
f pop
ulat
ion
and
then
mul
ti-pl
ied
by 1
0,00
0 or
50,
000
Che
ck st
aff e
stabl
ishm
ent v
ersu
s act
ual s
taff
pres
ent i
n th
e H
F.C
heck
no.
of e
ach
staff
cate
gory
ava
ilabl
e, in
clud
e m
idw
ifes a
nd th
eir s
tatu
s (on
ly m
idw
ife o
r nur
se &
m
idw
ife).
Get
info
rmat
ion
on n
o. o
f aux
iliar
y nu
rsin
g sta
ff an
d th
eir q
ualifi
cat
ion
and
lega
l com
pete
nces
.
Staff
list
s,lo
cal s
tati-
stics
H
F da
ta,
asse
ssm
ent
Wat
er a
vaila
bili-
ty/ p
erso
n / d
ayRe
gula
r ade
quat
e am
ount
of w
ater
ava
ila-
ble
daily
see
SPH
ERE
hand
book
, 20
04, p
. 64
Min
imum
of
15 l
/ per
son
/ day
Num
erat
or: L
itre
of w
ater
ava
ilabl
eD
enom
inat
or: T
otal
pop
ulat
ion
Key
indi
cato
r to
be a
djus
ted
to th
e co
ntex
t and
env
i-ro
nmen
t, i.e
. if r
esid
ent p
opul
atio
n is
used
to 5
ltr.
per
day,
the
IDPs
shou
ld g
et a
sim
ilar a
mou
nt Im
port
ant
aspe
ct fo
r the
ass
essm
ent i
s the
qua
ntity
of w
ater
av
aila
ble,
qua
lity
of w
ater
, and
wat
er so
urce
s suc
h as
su
rface
wat
er, w
ells
clos
ed o
r ope
n, p
iped
wat
er. M
eans
of
dist
ribut
ion,
wat
er tr
ucki
ng, r
eser
voir
are
impo
rtan
t in
form
atio
n to
o.
Asse
ssm
ent,
refe
renc
e do
cum
ents,
rapi
d ho
useh
old
asse
ssm
ent
25
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ce
Acce
ss to
la
trin
esA
max
imum
of 2
0 pe
op-
le u
se o
ne la
trin
e / t
oile
t(s
epar
ated
by
men
and
w
omen
)
1 la
trin
e fo
r 20
per
sons
(n
ot m
ore
than
50
met
res f
rom
dw
ellin
gs)
best
optio
n is:
on
e la
trin
e pe
r fa
mily
Num
erat
or: T
otal
pop
ulat
ion
Den
omin
ator
: 20
popu
latio
n
Part
icip
atio
n of
loca
l pop
ulat
ion
esse
ntia
l in
desig
n an
d bu
ildin
g; re
spec
t cul
ture
and
cus
tom
and
ens
ure
sepa
rate
faci
litie
s for
wom
en a
nd m
en.
Tech
nica
l asp
ects
to b
e co
nsid
ered
like
gro
und
wat
er
leve
l; de
sign;
aff o
rdab
ility
; tec
hnic
ally
soun
d th
roug
hlo
cal a
vaila
ble
mat
eria
l.
Asse
ssm
ent,
tech
nica
l re-
fere
nce
and
stand
ards
Secu
rity
Situ
a-tio
n1.
no
rmal
ope
ratio
n2.
re
stric
ted
mov
e-m
ent /
pre
caut
ion
3.
min
imal
ope
ratio
n
Secu
rity
situa
tion
need
s to
be re
-ass
esse
d re
gula
rly.
Mak
e cl
ear r
efer
ence
to se
curit
y le
vels
as se
t in
the
par-
ticul
ar c
onte
xt. C
omm
unic
ate
to a
ll sta
ff m
embe
rs.
Con
text
an
alys
is (s
ee
Mal
tese
r In
tern
atio
-na
l sec
urity
gu
idel
ines
)Li
tera
cy ra
te(b
y se
x)%
of p
opul
atio
n lit
erat
e (b
y se
x)Th
is in
form
atio
n is
ofte
n av
aila
ble
in g
over
nmen
t offi
-ce
s or t
hrou
gh n
atio
nal s
tatis
tics.
Nat
iona
l sta
tistic
s,ho
useh
old
surv
eyH
DI
Aver
age
mon
th-
ly in
com
e pe
r pe
rson
Aver
age
inco
me
/ per
son
/ mon
thTh
is in
form
atio
n he
lps t
o es
timat
e th
e pu
rcha
sing
pow
-er
of t
he p
opul
atio
n. It
is u
sefu
l to
colle
ct in
form
atio
n on
mon
thly
sala
ries o
f typ
ical
func
tions
like
teac
her,
nurs
e, d
river
, uns
kille
d w
orke
r.
Nat
iona
l sta
tistic
s,ho
useh
old
Surv
ey
26
Gen
eral
gov
ern-
men
t exp
en-
ditu
re o
n he
alth
as
% o
f tot
al
gove
rnm
ent
expe
nditu
re /
year
Budg
et sp
ent a
nnua
lly
by th
e re
spec
tive
coun
-tr
y on
hea
lth a
s % o
f to
tal b
udge
t
NB
: Nee
d of
34
US$
/cap
ita a
re e
ssen
tial f
or b
asic
he
alth
car
e se
rvic
es (J
eff re
y Sa
chs,
Col
umbi
a U
nive
r-sit
y, N
ew Y
ork)
, but
in m
any
deve
lopi
ng c
ount
ries t
he
expe
nditu
re o
n he
alth
is le
ss th
an 1
0 U
S$/c
apita
/a.
Nat
iona
l sta
tistic
s,de
velo
pmen
t re
port
s,H
DI
U 5
mor
talit
y ra
teD
eath
of c
hild
ren
less
5
yrs.
/ 1,0
00 li
ve b
irths
/ y
ear
Aver
age:
Indu
stria
lised
cou
ntrie
s: 6
/ 1,0
00 li
ve b
irths
Dev
elop
ing
coun
trie
s:79
/ 1,
000
live
birt
hs
< 40
/ 1,
000
live
birt
hs /
year
Num
erat
or: D
eath
of c
hild
ren
unde
r 5 y
ears
in a
giv
en
time
perio
dD
enom
inat
or: N
umbe
r of l
ive
birt
h du
ring
the
sam
e tim
e pe
riod
Rem
ark:
Den
omin
ator
can
als
o be
the
tota
l num
ber
of c
hild
ren
< 5
yrs w
ithi
n th
e po
pula
tion
; mak
e de
nom
inat
or c
lear
whe
n re
port
ing.
Mon
thly
sta
tistic
s/ro
utin
e D
ata
Sour
ce,
loca
l HF
mor
bidi
ty
/ mor
talit
y da
ta,
HIS
Cru
de D
eath
R
ate
Num
ber o
f all
deat
hs /
1,00
0 po
p. /
year
OR
tota
l num
ber o
f de
ath
per d
ay p
er
10,0
00 p
opul
atio
n(s
ee u
nder
TO
P 6
Emer
-ge
ncy,
p. 1
1)
1,00
0 / y
ear
Num
erat
or: N
umbe
r of t
otal
dea
th d
urin
g a
give
n tim
e pe
riod
Den
omin
ator
: Tot
al p
opul
atio
n in
the
com
mun
ity
(mid
-yea
r pop
ulat
ion)
dur
ing
the
sam
e pe
riod
NB
: Dea
th ra
tes c
an re
late
to d
iff er
ing
time
perio
ds
and
diff e
ring
popu
latio
ns.
May
com
pare
with
dai
ly o
r mon
thly
rate
s in
emer
gen-
cies
and
chr
onic
cris
es.
Mon
thly
sta
tistic
s/ro
utin
e D
ata
Sour
ce
27
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ce3.
EM
ERG
ENC
Y PH
ASE
(Che
ck c
ase
defi n
ition
and
stan
dard
repo
rtin
g fo
rms -
kee
p it
clea
r and
sim
ple)
Mor
talit
y
Dea
ths o
f U 5
ye
ars /
10,
000
/ day
Prop
ortio
n of
tota
l nu
mbe
r of d
eath
s < 5
yr
s per
10,
000
popu
lati-
on p
er d
ay
< 1
/ 10,
000
/ day
(pre
-cris
is ra
te
coul
d be
use
d)
Num
erat
or: D
eath
s of c
hild
ren
< 5
yrs.
X n
umbe
r of
days
Den
omin
ator
: Tot
al n
umbe
r of c
hild
ren
< 5
yrs d
u-rin
g sa
me
time
fram
e
NB
: Sen
sitiv
e pa
ram
eter
to a
n up
com
ing
crisi
s
Dai
ly st
atis-
tics f
rom
HF,
co
mm
unity
an
d ce
met
e-ry
staff
,bo
dy c
ount
s
All d
eath
s /
10,0
00 /
day
Cru
de M
orta
lity
Rat
e (C
MR
)
Prop
ortio
n of
tota
l nu
mbe
r of d
eath
s per
10
,000
pop
ulat
ion
per
day
< 0.
3-0.
5 /
10,0
00 /
day
Num
erat
or: A
ll de
aths
dur
ing
give
n tim
e pe
riod
Den
omin
ator
: Tot
al p
opul
atio
n du
ring
sam
e tim
e pe
riod
Dai
ly st
atis-
tics f
rom
HF,
co
mm
unity
an
d ce
met
e-ry
staff
Fo
od
Food
supp
lySu
ffi ci
ent f
ood
that
pe
ople
are
use
d to
of d
e-fi n
ed q
ualit
y is
avai
labl
e
2,10
0 kc
al /
pers
on /
day
Incl
. 12%
pro
tein
, 17%
fat,
thia
min
e, io
dine
salt,
Vit.
C
, nia
cin;
div
ersit
y of
food
shou
ld b
e m
ajor
inte
rven
-tio
n.C
onsid
er c
ultu
ral t
radi
tiona
l con
text
; foo
d in
take
be
havi
our.
Sphe
re st
anda
rds o
n fo
od a
nd fo
od se
curit
y to
be
appl
ied.
Asse
ssm
ent,
nu
triti
onal
su
rvey
28
Mal
nutr
ition
ra
te%
of c
hild
ren
with
gl
obal
(mod
erat
e pl
us
seve
re) m
alnu
triti
on
NB
: New
ant
hrop
ome-
tric
refe
renc
e da
ta h
ave
been
pub
lishe
d re
cent
ly
by W
HO
< 10
% in
ch
ildre
n 6-
59 m
onth
s
Num
erat
or: N
umbe
r of c
hild
ren
with
a Z
-sco
re -3
or
-2 (<
70%
or <
80%
of m
edia
n)D
enom
inat
or: N
umbe
r of c
hild
ren
< 59
mon
thN
B: W
eigh
t per
hei
ght;
Acut
e m
alnu
triti
on m
ay ri
se
with
out s
ubsta
ntia
l inc
reas
es in
mor
talit
y (4
.5).
Th e
caus
e of
and
the
exte
nt o
f mal
nutr
ition
nee
d to
be
un-
ders
tood
to c
hoos
e ap
prop
riate
resp
onse
. Con
sider
also
m
alnu
triti
on a
dole
scen
ts an
d ad
ults
in fa
min
e re
late
d em
erge
ncie
s.
Rap
id a
nth-
ropo
met
ric
surv
ey
Vita
min
A C
o-ve
rage
For s
uppl
emen
tatio
n:
< 1
yr. 4
00,0
00 IU
/ in
fi r
st ye
ar1-
5 yr
s. 20
0,00
0 IU
/ ev
ery
3 m
onth
sLa
ctat
ing
mot
hers
: 20
0,00
0 IU
afte
r birt
h
> 95
% c
o-ve
rage
Num
erat
or: C
hild
ren
in re
spec
tive
age
grou
ps re
ceiv
ed
Vita
min
AD
enom
inat
or: T
otal
chi
ldre
n in
resp
ectiv
e ag
e gr
oups
NB
: In
emer
genc
ies,
do n
ot w
aste
tim
e as
sess
ing
Vita
min
A d
efi c
ienc
y bu
t rat
her i
nclu
de V
itam
in A
in a
m
easle
vac
cina
tion
cam
paig
n.
Dai
ly /
wee
kly
stati-
stics
,cl
inic
al
asse
ssm
ent
Imm
unis
atio
n
Mea
sles V
acci
-na
tion
cove
rage
% o
f chi
ldre
n co
vere
dIf
avai
labl
e in
form
atio
n su
gges
t tha
t cov
erag
e w
as <
90%
, mea
sles
vacc
inat
ion
shou
ld b
e a
PRIO
RIT
Y.Se
e SP
HER
E ha
ndbo
ok,
2004
, p. 2
75
At le
ast 9
5%
of c
hild
-re
n ag
ed 6
m
onth
s to
15
year
s rec
eive
d m
easle
s vac
ci-
natio
n
Num
erat
or: N
umbe
r of c
hild
ren
imm
unise
d in
resp
ec-
tive
age
grou
pD
enom
inat
or: T
otal
num
ber o
f chi
ldre
n in
the
resp
ec-
tive
age
grou
ps im
mun
ised
NB
: Chi
ldre
n w
ith H
IV a
re m
ore
succ
eptib
le to
mea
s-le
s, th
eref
ore
ensu
re th
at th
ey re
ceiv
e tw
o do
ses.N
B:
Age
depe
nds o
n na
tiona
l pol
icy;
how
ever
, age
gro
up
shou
ld b
e ex
pand
ed w
here
rout
ine
mea
sles v
acci
natio
n is
low
; re-
vacc
inat
e at
9 m
onth
s; ot
her v
acci
natio
n ca
mpa
igns
can
be
adde
d ac
cord
ingl
y.
Dai
ly /
wee
kly
stati-
stics
29
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ceVa
ccin
atio
n co
vera
gePr
opor
tion
of C
hild
ren
imm
unise
d ag
ains
t M
easle
s, D
PT, P
olio
, BC
G a
nd H
epat
itis B
(a
nd a
dditi
onal
vac
cine
such
as Y
ellow
feve
r or
Japa
nese
Ence
phal
itis
acco
rdin
g to
the r
espec
tive
coun
try p
roto
col)
> 90
%N
umer
ator
: Num
ber o
f chi
ldre
n im
mun
ised
with
re
spec
tive
antig
ens
Den
omin
ator
: Tot
al n
umbe
r of c
hild
ren
in th
e re
spec
-tiv
e ag
e gr
oup
NB
: Fol
low
Nat
iona
l pro
toco
l for
EPI
. Rep
ort o
n an
ti-ge
n co
vera
ge ra
te a
nd/o
r EPI
cov
erag
e ra
te.
Rout
ine
Dat
a So
urce
,EP
I cha
rts,
hous
ehol
d su
rvey
Com
mun
icab
le d
isea
se c
ontr
ol a
nd p
ublic
hea
lth
issu
es
Dise
ase
Con
trol
Iden
tify
outb
reak
th
resh
old
for r
elev
ant
com
mun
icab
le d
iseas
es
in th
e re
gion
.
Defi
ne
outb
reak
al
ert l
evel
s (th
resh
old
or
inde
x ca
se)
A qu
antifi
ed
defi n
ition
of o
utbr
eaks
for a
ll di
seas
es
does
not
exi
st. H
owev
er, i
f the
num
ber i
ncre
ases
hig
her
than
exp
ecte
d in
a d
efi n
ed p
opul
atio
n an
d de
fi ned
ge
ogra
phic
al a
rea,
it m
ay in
dica
te a
n ou
tbre
ak.
For t
he fo
llow
ing
dise
ases
a si
ngle
cas
e m
ay in
dica
te a
n ou
tbre
ak: c
hole
ra, m
easle
s, ye
llow
feve
r, sh
igel
la, v
iral
haem
orrh
agic
feve
r and
men
ingo
cocc
al m
enig
itis.
Epid
emio
lo-
gica
l dat
a,co
ordi
natio
n,H
IS
Mor
bidi
tyM
alar
iaN
umbe
r of p
ositi
ve c
on-
fi rm
ed te
sted
mal
aria
ca
ses i
n pr
opor
tion
to
popu
latio
n (in
per
cent
)
Prev
ent
incr
ease
of
mal
aria
cas
es
and
resp
ond
to o
utbr
eaks
Num
erat
or: N
umbe
r of c
ases
with
a p
ositi
ve m
alar
ia
smea
r or r
apid
test
in a
giv
en ti
mef
ram
eD
enom
inat
or: T
otal
pop
ulat
ion
Loca
l mal
aria
epi
dem
iolo
gy n
eeds
to b
e an
alys
ed re
fer-
ring
to m
obid
ity, p
atte
rns o
f tra
nsm
issio
n, p
reve
ntio
n an
d tre
atm
ent.
Dai
ly /
wee
kly
stati-
stics
,as
sess
men
t an
d cl
inic
al
data
of H
F
30
Acce
ss to
long
-la
sting
inse
ctic
i-da
l net
s
No.
of h
ouse
hold
s tha
t ha
ve a
t lea
st on
e im
p-re
gnat
ed n
et.
Net
s are
ava
ilabl
e in
di
ff ere
nt si
zes s
o th
at a
ll ho
useh
old
mem
bers
are
pr
otec
ted.
Full
cove
rage
of
all
peop
le
at ri
sk o
f m
alar
ia
Num
erat
or: N
umbe
r of h
ouse
hold
s rec
eive
d lo
ng-
lasti
ng-im
preg
nate
d ne
tsD
enom
inat
or: T
otal
num
ber o
f hou
seho
lds
NB
: Ide
ntify
risk
gro
ups a
nd se
t prio
ritie
s for
LLI
Ns
distr
ibut
ion;
Sca
ling
up o
f mal
aria
pre
vent
ion
thro
ugh
free
or
high
ly su
bsid
ized
dis
trib
utio
n of
LL
INs e
ithe
r di
rect
ly o
r th
roug
h vo
uche
rs a
ccom
pa-
nied
wit
h in
form
atio
n se
ssio
ns o
n ut
ilisa
tion
.
Long
-lasti
ng in
sect
icid
es (L
LIT
N) r
ecco
men
ded
by
WH
O a
re P
erm
aNet
® &
Oly
sset
Net
® with
a b
iolo
gica
l effi
cac
y of
at l
east
thre
e ye
ars.
Posit
ion
pape
r WH
O: h
ttp://
ww
w.w
ho.in
t/mal
aria
/do
cs/it
n/IT
Nsp
ospa
perfi
nal.p
df
Wee
kly
statis
tics,
hous
ehol
d su
rvey
,sp
ot c
heck
s &
cou
ntin
g
Shig
ella
dys
en-
tery
cas
e fa
talit
y ra
te
No.
of p
ositi
ve c
onfi r
-m
ed te
sted
case
s die
d
No.
of c
ases
with
blo
ody
diar
rhoe
a di
ed
See
SPH
ERE
hand
book
, 20
04, p
. 281
< 1%
of S
hi-
gella
cas
esN
umer
ator
: Num
ber o
f pos
itive
teste
d Sh
igel
la in
fec-
tions
in a
giv
en ti
me
perio
d di
edD
enom
inat
or: N
umbe
r of
tota
l sh
igel
la c
ases
NB
: Man
y ou
tbre
aks h
ave
occu
rred
in S
ub-S
ahar
an
Afric
a an
d w
ere
the
mai
n ca
use
of d
eath
.
Onc
e Sh
igel
la h
as b
een
iden
tifi e
d in
an
emer
genc
y, it
can
be a
ssum
ed th
at b
lood
y di
arrh
oea,
i.e.
dys
ente
ry
case
s are
cau
sed
by sh
igel
la.
Che
ck se
nsiti
vity
/ re
sista
nce
of a
ntib
iotic
s.
Dai
ly /
wee
kly
stati-
stics
,la
bora
tory
te
sts fo
r di-
agno
sis a
nd
sens
itivi
ty o
f an
tibio
tics,
coor
dina
tion
31
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ceC
hole
ra c
ase
fata
lity
rate
No.
of c
ases
with
“ric
e w
ater
dia
rrho
ea”
died
(the
colo
r doe
s not
ne-
cess
arily
look
onl
y lik
e ‚ri
ce w
ater
‘; th
e co
lor c
an
be y
ello
w o
r gre
enas
wel
l)
See
SPH
ERE
hand
book
, 20
04, p
. 281
-282
< 1%
of c
hole
-ra
cas
esN
umer
ator
: Num
ber o
f cas
es w
ith “r
ice
wat
er d
iar-
rhoe
a” in
a g
iven
tim
e pe
riod
died
Den
omin
ator
: Num
ber o
f tot
al c
hole
ra c
ases
dur
ing
the
sam
e tim
e pe
riod
NB
: Cho
lera
is a
sens
itive
dia
gnos
e fo
r a re
gion
or
coun
try
aff e
cted
. Con
fi rm
atio
n by
labo
rato
ry is
of
grea
t im
port
ance
. Onc
e co
nfi rm
ed fo
r som
e ca
ses,
it ca
n be
ass
umed
that
the
case
s of w
ater
y di
arrh
oea
are
chol
era
case
s.
Dai
ly /
wee
kly
stati-
stics
,la
bora
tory
te
sts,
clin
ical
as
sess
men
t,co
ordi
natio
n
Mor
bidi
ty
Men
ingo
cocc
al
Men
ingi
tis
No.
of p
ositi
ve c
onfi r
-m
ed te
sted
case
s
See
SPH
ERE
hand
book
, 20
04, p
. 281
-283
Stra
tegy
in o
utbr
eak:
pr
even
t dea
th w
ith c
ase
man
agem
ent;
prev
en-
tion
of n
ew c
ases
with
re
activ
e im
mun
isatio
n (K
ey m
essa
ge 5
, p.1
7)
< 5
case
s / 1
00,0
00 /
wee
k (d
e-pe
nds o
n re
gion
)
Num
erat
or: N
umbe
r of M
M c
ases
in a
giv
en ti
me
perio
dD
enom
inat
or: T
otal
pop
ulat
ion
NB
: Dur
ing
outb
reak
s, ca
se fa
talit
y ra
tes c
an b
e as
hig
h as
20%
or m
ore.
Aler
t thr
esho
ld in
Afri
can
Belt:
5 c
ases
/ 10
0,00
0 /
wee
kEp
idem
ic in
Afri
can
Belt:
> 1
0 ca
ses /
100
,000
/ w
eek
Dai
ly /
wee
kly
statis
tic,
clin
ical
as
sess
men
t,co
ordi
natio
n
Wat
ery
diar
-rh
oea
in c
hild
-re
n <
5 ye
ars
No.
of c
hild
ren
< 5
yrs.
with
> 3
tim
es w
ater
y di
arrh
oea
in 2
4 ho
urs
< 10
0 ca
ses
/ per
1,0
00
child
ren
< 5
yrs.
Num
erat
or: N
umbe
r of c
hild
ren
< 5
yrs.
with
wat
ery
diar
rhoe
a in
a g
iven
tim
e pe
riod
Den
omin
ator
: Tot
al n
umbe
r of c
hild
ren
< 5
yrs.
in th
e sa
me
time
perio
d
Dai
ly /
wee
kly
stati-
stics
32
Wat
er
Wat
er q
ualit
yN
umbe
r of
col
iform
ba
cter
ia in
100
ml fi
lte-
red
wat
erSe
e SP
HER
E ha
ndbo
ok,
2004
, p. 6
6-67
, wat
er
qual
ity E
CH
O G
uide
-lin
e
No
faec
al
colif
orm
es
per 1
00 m
l at
poin
t of
deliv
ery
Che
ck w
ater
qua
lity
alon
g th
e su
pply
cha
in –
mai
nly
at
the
poin
t of u
se.
NB
: Ens
ure
qual
ity w
ith a
disi
nfec
tant
so th
at th
ere
is a
free
chlo
rine
resid
ual a
t the
tap
of 0
.5 m
g pe
r litr
e an
d tu
rbid
ity is
bel
ow 5
NT
U.
Mon
thly
/bi
-mon
thly
sc
reen
ing,
asse
ssm
ent
Jerr
y C
an a
vaila
-bi
lity
Jerr
y C
ans a
vaila
ble
for
each
hou
seho
ldSe
e SP
HER
E ha
ndbo
ok,
2004
, p. 6
9
Each
ho
useh
old
has
at le
ast t
wo
10-2
0 lit
re
Jerr
y C
ans
Num
erat
or: N
umbe
r of 2
0 l J
erry
Can
s ava
ilabl
eD
enom
inat
or: N
umbe
r of h
ouse
hold
sH
ouse
hold
su
rvey
,as
sess
men
t
Dist
ance
to n
ext
wat
er d
istrib
uti-
on p
oint
Dist
ance
to th
e ne
xt
wat
er d
istrib
utio
n po
int
shou
ld n
ot b
e m
ore
than
15
min
utes
wal
kSe
e S
PHER
E ha
nd-
book
200
4, p
. 63
< 50
0 m
.N
umbe
r of f
amili
es w
ho w
alk
< 50
0 m
. to
wat
er p
oint
pe
r tot
al n
o. o
f fam
ilies
Geo
grap
hi-
cal s
urve
y,as
sess
men
t
Num
ber o
f di
strib
utio
n po
ints
Dist
ribut
ion
poin
ts w
hich
pro
vide
safe
and
ad
equa
te W
ater
See
SPH
ERE
hand
-bo
ok, 2
004,
p. 6
5 gu
idan
ce n
ote
One
dist
ribu-
tion
poin
t for
25
0 pe
ople
Num
erat
or: T
otal
pop
ulat
ion
Den
omin
ator
: 250
Po
pula
tion
estim
ates
, as
sess
men
t
33
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ce
Hyg
iene
& S
anit
atio
n
Han
d w
ashi
ng
know
ledg
e%
of p
erso
ns w
ashi
ng
thei
r han
ds a
t lea
st at
3
of th
e 5
criti
cal t
imes
per d
ay
Han
d w
ashi
ng
at le
ast 3
of
the
5 cr
itica
ltim
es p
er d
ay
Num
erat
or: n
umbe
r of r
espo
nden
ts w
ashi
ng h
ands
at
leas
t 3 ti
mes
dai
lyD
enom
inat
or: n
umbe
r of s
urve
ypa
rtic
ipan
ts
Crit
ical
Tim
es:
1.
Afte
r def
ecat
ing
2.
Befo
re e
atin
g3.
Af
ter c
hang
ing
diap
ers
4.
Befo
re p
repa
ring
food
5.
Befo
re fe
edin
g in
fant
Hou
seho
ld
Surv
ey,
obse
rvat
ion
Repo
rts
of C
HW
an
d ho
me
visit
ors
Dia
rrho
ea
Tran
smiss
ion
Kno
wle
dge
% o
f res
pond
ents
kno-
win
g at
leas
t tw
o w
ays
to p
reve
nt d
iarr
hoea
Resp
onde
nts
know
at l
east
two
way
s to
prev
ent d
iar-
rhoe
a
Num
erat
or: n
umbe
r of r
espo
nden
ts kn
owin
g at
leas
t 2
prev
entio
n m
etho
dsD
enom
inat
or: n
umbe
r of s
urve
y pa
rtic
ipan
ts
NB
: Tra
nsm
issio
n Ro
utes
: “F”
Dia
gram
= co
ntam
ina-
ted
fi eld
s, fl u
ids,
fl ies
, fi n
gers
and
food
Hou
seho
ld
Surv
ey,
exit
inte
r-vi
ews a
t HF,
esta
blish
w
ater
safe
ty
plan
s.Ac
cess
to so
apSo
ap is
ava
ilabl
e in
su
ffi ci
ent q
uant
ities
See
SPH
ERE
hand
book
, 20
04, p
. 69
250
mg
bar o
f so
ap /
pers
on
/ mon
th
Can
be
less
soap
; also
dep
ends
on
the
purc
hasin
g po
wer
an
d th
e m
arke
t situ
atio
nH
ouse
hold
su
rvey
OR
di
strib
utio
n re
giste
r
34
Acce
ss to
gen
der
sens
itive
ba-
thin
g fa
cilit
ites
for m
en a
nd
wom
en
See
SPH
ERE
hand
-bo
ok, 2
004,
p.6
9-70
Num
ber,
loca
tion
and
desig
n de
pend
s on
the
need
s.
Shou
ld b
e di
scus
sed
with
com
mun
ity a
nd sp
ecifi
cally
w
ith w
omen
and
ado
lesc
ent g
irls o
r wom
en o
rgan
isa-
tions
.
Com
mun
ity
surv
ey,
map
ping
obse
rvat
ion
repo
rts o
f C
HW
and
ho
me
visit
orW
ashi
ng b
asin
sTh
ere
is at
leas
t one
w
ashi
ng b
asin
ava
ilabl
e fo
r 100
peo
ple
See
SPH
ERE
hand
book
, 20
04, p
.69
1 ba
sin p
er
100
popu
la-
tion
Num
erat
or: T
otal
pop
ulat
ion
Den
omin
ator
: 100
NB
: Lau
nder
ing
area
s sho
uld
be a
vaila
ble
for w
omen
to
was
h an
d dr
y un
derg
arm
ents
and
sani
tary
clo
thes
.
Hou
seho
ld
surv
ey
Latr
ine
cove
rage
Latr
ine/
toile
t per
20
peop
le
See
SPH
ERE
hand
book
, 20
04, p
.71-
75
1 la
trin
e pe
r 20
per
sons
Fo
r hea
lth
faci
litie
s: 1
latr
ine
for 2
0 in
patie
nts o
r 50
out
patie
nts
Num
erat
or: P
opul
atio
nD
enom
inat
or: 2
0 O
R n
o. o
f bed
s in
HF
or n
o. O
PD
case
s in
a da
y
Map
ping
obse
rvat
ion,
da
ta
Envi
ronm
ent/
Vec
tor
Con
trol
Area
was
te
man
agem
ent
Abou
t 10-
15 fa
mili
es
have
acc
ess t
o re
fuse
bin
co
ntai
ner n
ot m
ore
than
100
met
re fr
om
thei
r hou
seSe
e SP
HER
E ha
ndbo
ok,
2004
, p. 8
3-85
At le
ast o
ne
100
litre
refu
-se
bin
co
ntai
ner f
or
10 fa
mili
es
Num
erat
or: N
umbe
r of f
amili
esD
enom
inat
or: 1
0 O
R 1
5C
omm
unity
su
rvey
35
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ceC
omm
unity
w
aste
man
age-
men
t
Fina
l disp
osal
are
a1
refu
se p
it
2m x
5m
de
ep p
er 5
00
pers
ons
Shou
ld b
e di
scus
sed
with
com
mun
ity; p
refe
rabl
y ou
t-sid
e co
mm
unity
.
Che
ck a
vaila
bilit
y, sa
fety
and
pro
tect
ion
of th
e ar
ea.
Com
mun
ity
surv
ey,
obse
rvat
ion
repo
rts
Med
ical
was
te
man
agem
ent
Inci
nera
tor f
or sa
fe d
is-po
sal o
f all
med
ical
was
te a
vaila
ble
1 in
cine
rato
r pe
r hea
lthfa
cilit
y
Che
ck a
vaila
bilit
y an
d fu
nctio
n of
inci
nera
tor.
Com
mun
ity
/ hos
pita
l su
rvey
Mos
quito
net
co
vera
ge (l
ong-
lasti
ng
inse
ctic
idal
net
s)
No.
of L
LIN
s dist
ribu-
ted
1 ne
t / 2
-3
pers
ons
Get
qua
ntifi
ed in
form
atio
n on
whe
ther
peo
ple
are
used
to L
LIN
s bef
ore
distr
ibut
ion
(see
gui
danc
e no
te
Com
mun
icab
le D
iseas
e/Pu
blic
Hea
lth a
bove
).
Year
ly
hous
ehol
d su
rvey
s
Den
gue
cont
rol
by C
onta
iner
In
dex
(CI)
or
Hou
seho
ld
Inde
x (H
I)
% o
f wat
er h
oldi
ng
cont
aine
rs in
feste
d w
ith la
rvae
or p
upae
(O
R h
ouse
s inf
este
d by
la
rvae
)
CAV
EAT:
CI a
nd H
I do
pro
vide
info
rmat
ion
on th
e ge
nera
l dist
ribu-
tion
but d
o no
t pro
vide
in
form
atio
n on
the
dyna
mic
of t
he d
iseas
e.
Of t
he sc
ree-
ned
cont
aine
r, le
ss th
an 1
0%
are
cont
ami-
nate
d w
ith
aede
s agy
pti
Num
erat
or: N
umbe
r of c
onta
iner
s inf
este
d w
ith la
rvae
or
pur
pae
Den
omin
ator
: Num
ber o
f con
tain
ers i
nspe
cted
NB
: For
Hou
seho
ld In
dex
the
num
bers
of h
ouse
s inf
es-
ted
divi
ded
by n
umbe
r of h
ouse
s che
cked
; mul
tiplie
d by
100
Mon
thly
su
rvey
s of
wat
er c
onta
i-ne
rs
36
Site
pla
nnin
g
Spac
e fo
r she
lter,
hous
ing
and
serv
ices
Area
for c
amp
cons
truc
-tio
n av
aila
ble
divi
ded
by
popu
latio
n
See
SPH
ERE
hand
book
, 20
04, p
. 215
-218
45 sq
m. /
pe
rson
with
at
leas
t 2m
bet
-w
een
shel
ters
Incl
udin
g al
l pub
lic p
lace
s exc
ept g
arde
n ar
eaC
omm
unity
su
rvey
,sit
e in
spec
-tio
n
Shel
ter
Cov
ered
Sh
elte
rSe
e SP
HER
E ha
ndbo
ok,
2004
, p. 2
19-2
213.
5 sq
m /
pers
onM
ater
ial s
houl
d be
ado
pted
to th
e sit
uatio
n su
ch a
s w
inte
rized
tent
s in
cold
clim
ates
.C
omm
unity
su
rvey
,sit
e in
spec
-tio
nEm
erge
ncy
tem
-po
rary
shel
ter
4m x
6m
sh
eet (
tarp
au-
lins)
per
ho
useh
old
of
5 pe
ople
Th is
is a
quic
k in
itial
shor
t-ter
m so
lutio
n fo
r acu
te
emer
genc
ies.
It ha
s to
be re
plac
ed b
y sh
elte
r acc
ordi
ng
to m
inim
um st
anda
rds a
s soo
n as
pos
sible
.
Com
mun
ity
surv
ey
Prof
essi
onal
staff
dep
loye
d
Num
ber o
f co
mm
unity
he
alth
wor
kers
1 C
HW
/ 1,
000
popu
la-
tion
Ensu
re fe
mal
e sta
ff C
HW
can
be
trai
ned
on si
te.
Staff
reg
ister
, as
sess
men
t
Num
ber o
f tr
aine
d bi
rth
atte
ndan
ts
1 tr
aine
d bi
rth
atte
ndan
t /
2,00
0 po
pula
-tio
n
Trad
ition
al m
idw
ives
are
NO
T in
clud
ed.
Che
ck n
o. o
f del
iver
ies a
ssist
ed b
y T
BA/m
onth
!
Staff
reg
ister
, as
sess
men
t
37
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ceN
umbe
r of
qual
ifi ed
hea
lth
wor
kers
(clin
i-ci
an)
See
SPH
ERE
hand
book
20
04, p
. 266
1 qu
alifi
ed
heal
th w
orke
r fo
r 50
cons
ul-
tatio
ns /
day
Ensu
re fe
mal
e sta
ff - q
ualifi
ed
heal
th w
orke
rs a
re p
ro-
fess
iona
l nur
ses,
med
ical
doc
tors
or m
edic
al a
ssist
ants.
Staff
reg
ister
, as
sess
men
t
Num
ber o
f la
bora
tory
tech
-ni
cian
s
1 la
bora
tory
te
chni
cian
/ 10
,000
pop
.
Staff
reg
ister
, as
sess
men
t
Num
ber o
f in
patie
nt h
ealth
fa
cilit
ies
1 ce
ntra
l he
alth
faci
lity
/ 10,
000
pop.
Num
ber o
f HF
with
inpa
tient
bed
s and
tota
l num
ber
of b
eds p
er H
F to
be
asse
ssed
.H
ealth
au
thor
ities
, as
sess
men
tN
umbe
r of
heal
th c
entre
s1
heal
th c
en-
tre /
10,0
00
pop.
Hea
lth
auth
oriti
es,
asse
ssm
ent
Num
ber o
f se
nior
cam
p m
anag
ers
1 ca
mp
man
a-ge
r / 1
0,00
0 po
p.
Staff
reg
ister
, as
sess
men
t
Cas
e M
anag
emen
t
Stan
dard
ised
es-
sent
ial d
rug
list
is es
tabl
ished
by
the
lead
hea
lth
auth
ority
Esse
ntia
l dru
gs th
at
satis
fy th
e pr
imar
y he
alth
car
e ne
eds o
f the
po
pula
tion.
See:
EC
HO
FPA
on
proc
urem
ent o
f med
i-ci
nes
Esse
ntia
l D
rug
list
used
Esse
ntia
l med
icin
es a
re se
lect
ed w
ith d
ue re
gard
to
dise
ase
prev
alen
ce, e
vide
nce
on e
ffi ca
cy a
nd sa
fety
, and
co
st-eff
ect
iven
ess.
Esse
ntia
l med
icin
es a
re a
vaila
ble
with
in th
e co
ntex
t of f
unct
ioni
ng h
ealth
syste
ms a
t all
times
in a
dequ
ate
amou
nts,
in th
e ap
prop
riate
dos
age
form
s, w
ith a
ssur
ed q
ualit
y, an
d at
a p
rice
the
indi
vidu
-al
and
the
coom
unity
can
aff o
rd.
Nat
iona
l gu
idel
ine
38
Stan
dard
ised
case
man
age-
men
t pro
toco
ls
are
avai
labl
e
Cas
e m
anag
emen
t gu
idel
ines
are
bas
ed o
n di
seas
e pa
ttern
s, av
aila
bilit
y of
dia
g-no
stics
and
trea
tmen
t op
tions
.
Cas
e m
anag
e-m
ent e
stabl
is-he
d an
d us
ed
Nat
iona
l tre
atm
ent g
uide
lines
nee
d to
be
resp
ecte
d an
d fo
llow
ed. a
ll ac
tors
hav
e to
col
lect
rele
vant
info
rmat
ion.
Th
ere
mig
ht b
e a
need
to c
heck
effi
cacy
of m
edic
ines
an
d re
sista
nce
patte
rn.
Nat
iona
l Tr
eatm
ent
prot
ocol
s
4. H
EALT
H S
YST
EM A
ND
IN
FRA
STR
UC
TU
RE
Out
patie
nt
utili
satio
n ra
teN
umbe
r of N
EW c
ases
O
R v
isits
/ pop
ulat
ion
/ yea
rN
B: E
xpec
t 50
– 10
0 ne
w c
onsu
ltatio
ns /
10,0
00 p
er d
ay
See
SPH
ERE
hand
book
20
04, p
. 302
0.5
– 1
new
ca
se O
R v
isit
/ pop
ulat
ion
/ yea
r
Num
erat
or: N
umbe
r of n
ew c
ases
OR
new
visi
ts in
on
e w
eek
x 52
Den
omin
ator
: To
tal p
opul
atio
n
Very
goo
d in
dica
tor t
o as
sess
acc
ess t
o he
alth
serv
ices
an
d to
pla
n no
. of p
atie
nts t
o be
exp
ecte
d in
a H
F.
Util
isatio
n ra
te v
arie
s and
may
get
up
to 5
in a
cute
em
erge
ncie
s and
in a
refu
gee
cam
p sit
uatio
n.
Mon
thly
St
atist
ics a
nd
HF
patie
nt
reco
rds
Bed
occu
panc
y ra
teAc
tual
util
izatio
n of
a
inpa
tient
hea
lth fa
cilit
y fo
r a g
iven
tim
e pe
riod
expr
esse
d in
per
cent
> 80
%N
umer
ator
: Sum
of d
aily
inpa
tient
s for
365
day
sD
enom
inat
or: B
ed d
ays a
vaila
ble
(num
ber o
f bed
s x
365
days
)R
emar
k: I.
e. a
dmiss
ion
in th
e ev
e ni
ng a
nd d
ischa
rged
ne
xt m
orni
ng c
ount
s 2 d
ays!
Con
sider
to c
ombi
ne w
ith A
LS (a
vera
ge le
ngth
of s
tay)
to
get
the
real
pic
ture
.
Mon
thly
St
atist
ics
39
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ce
Num
ber o
f tra
i-ne
d he
alth
staff
/
popu
latio
n
Num
ber o
f qua
lifi e
d sta
ff re
com
men
ded
to
mee
t the
nee
ds w
ithin
PH
C se
rvic
e pr
ovisi
on
for t
he p
opul
atio
n
See
SPH
ERE
hand
book
20
04, p
. 266
-267
Prim
ary
Hea
lth C
en-
tre: m
in. 2
- 5
skill
ed st
aff
Cen
tral
H
ealth
Fac
ili-
ty: m
inim
um
5 sk
illed
staff
Ensu
re e
qual
bal
ance
of f
emal
e: m
ale
heal
th w
orke
rs
and
appr
opria
te sk
ills m
ix.
Are
the
posts
of t
he st
aff e
stabl
ishm
ent fi
lled
or v
acan
t?
Staff
esta
-bl
ishm
ent,
staff
lists
and
staff
pres
ent
in th
e H
F
Con
sulta
tion
per s
kille
d he
alth
wor
ker
(by
doct
or,
clin
ical
ass
istan
t, nu
rse)
No.
of c
onsu
ltatio
ns
divi
ded
by sk
illed
hea
lth
wor
ker w
orki
ng fu
ll tim
e in
hea
lth fa
cilit
y pe
r day
Not
mor
e th
an 5
0 co
n-su
ltatio
n / d
ay
Num
erat
or: N
umbe
r of a
ll co
nsul
tatio
ns /d
ayD
enom
inat
or: N
umbe
r of s
kille
d he
alth
wor
kers
/day
A sk
illed
hea
lth w
orke
r sho
uld
not c
onsu
lt m
ore
than
50
pat
ient
s per
day
. If t
his t
hres
hold
is e
xcee
ded
mor
e sta
ff ne
eds t
o be
recr
uite
d.
Mon
thly
St
atist
ics,
staff
esta
b-lis
hmen
t
Num
ber o
f sta
ff re
ceiv
ed tr
ai-
ning
per
yea
r
Hea
lth c
are
staff
are
trai
ned
and
supe
rvise
d in
the
rele
vant
topi
cs
At le
ast o
ne
trai
ning
per
sta
ff pe
r yea
r
Hea
lth w
orke
rs sh
ould
hav
e th
e pr
oper
trai
ning
and
sk
ills f
or th
eir l
evel
of r
espo
nsib
ility
. Hea
lth p
rovi
ders
ha
ve th
e ob
ligat
ion
to tr
ain
staff
to e
nsur
e th
eir k
now
-le
dge
is up
-to-d
ate W
here
pos
sible
trai
ning
shou
ld b
e sta
ndar
dise
d an
d lin
ked
to n
atio
nal p
rogr
amm
es.
Staff
list
s,H
F re
cord
s
5. R
EPR
OD
UC
TIV
E H
EALT
H I
ND
ICAT
OR
S &
MO
RTA
LIT
Y R
ATES
Age-
spec
ifi c
fert
ility
rate
Num
ber o
f liv
e bi
rths
in
each
age
gro
up d
ivid
ed
by th
e to
tal f
emal
e po
-pu
latio
n (in
thou
sand
s)
No
targ
et
defi n
ed.
Fert
ility
rate
s ar
e hi
gh in
Rat
e gi
ven
per t
hous
and
wom
en in
the
part
icul
ar a
ge
grou
p. V
arie
s fro
m a
ppro
x. 1
00 fo
r the
age
gro
up 1
5 –
19 y
ears
ove
r 300
for t
he a
ge 2
5 –
29 a
nd b
elow
100
fo
r the
age
gro
up o
lder
45
year
s.
Nat
iona
l an
din
tern
atio
nal
data
40
in e
ach
5 ye
ar a
ge g
roup
deve
lopi
ng
coun
trie
s and
w
ithin
pov
er-
ty c
onte
xt
Anal
yse
in d
evel
opm
ent c
onte
xt li
nkin
g w
ith U
5 m
or-
talit
y an
d m
ater
nal m
orta
lity.
Tota
l fer
tility
ra
teN
umbe
r of c
hild
ren
born
to a
wom
en d
urin
g he
r life
time
(glo
bal
aver
age
is 2.
6)
No
targ
etVa
ries f
rom
cou
ntry
to c
ount
ry: h
ighe
st in
Mal
i with
7.
34 a
nd lo
w in
Ger
man
y w
ith 1
.41.
Anal
yse
in d
evel
opm
ent c
onte
xt li
nkin
g w
ith U
5 m
or-
talit
y an
d m
ater
nal m
orta
lity.
Nat
iona
l an
din
tern
atio
nal
data
Birt
h ra
teN
umbe
r of b
irth
per
1,00
0 po
pula
tion
per
year
(glo
bal a
vera
ge is
20
.19)
No
targ
et
Birt
h ra
te is
a
good
pro
xy
for e
stim
ates
on
pop
ulat
ion
grow
th.
Annu
al b
irth
rate
can
be
expr
esse
d in
per
cent
age:
glo
-ba
lly 2
.02%
, Afg
hani
stan
4.50
%, K
enya
3.8
9%,
Indi
a 2.
2%.
Use
birt
h ra
te to
esti
mat
e no
.pf p
regn
anci
es a
nd d
eliv
e-rie
s to
be e
xpec
ted.
Anal
yse
in d
evel
opm
ent c
onte
xt li
nkin
g w
ith U
5 m
or-
talit
y an
d m
ater
nal m
orta
lity.
Nat
iona
l an
din
tern
atio
nal
data
41
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ceH
IV S
erop
reva
-le
nce
and
inci
-de
nce
(che
ck fo
r sp
ecifi
c gr
oups
: ag
e gr
oup,
pre
g-na
nt w
omen
, ID
U, C
SW e
tc)
% o
f a sp
ecifi
ed p
op.
who
se b
lood
tests
are
H
IV p
ositi
ve (r
epor
t as
prev
alen
ce o
r inc
iden
ce)
Typi
cal s
entin
el su
rvey
ar
e in
clud
ing
preg
nant
w
omen
atte
ndin
g AN
C
visit
s, pa
tient
s in
STI
clin
ics,
bloo
d do
nors
. Th
e pr
eval
ence
in th
ese
grou
ps sh
ow a
tren
d ov
er y
ears
.
Prev
ent a
nd
redu
ce fu
rthe
r tr
ansm
issio
n of
HIV
PR
EVA
LEN
CE:
Num
erat
or: N
umbe
r of p
erso
ns w
ith a
pos
itive
HIV
sta
tus i
n th
e sp
ecifi
c gr
oup
Den
omin
ator
: Tot
al n
umbe
r of s
peci
fi c g
roup
inve
sti-
gate
d (a
ge g
roup
, pre
gnan
t wom
en e
tc.)
INC
IDEN
CE:
Num
erat
or: N
umbe
r of N
EW p
erso
ns w
ith a
pos
itive
H
IV st
atus
in th
e sp
ecifi
c gr
oup
(coh
ort)
durin
g gi
ven
time
fram
eD
enom
inat
or: T
otal
num
ber o
f spe
cifi c
gro
up (c
ohor
t) fo
llow
ed o
ver s
ame
time
perio
d (a
ge g
roup
, pre
gnan
t w
omen
etc
.)N
B: H
IV d
ata
are
sens
itive
dat
a. M
ake
sure
that
they
ar
e us
ed a
ppro
pria
tely.
Nat
iona
l sta
tistic
s and
H
IS
Inci
denc
e an
d pr
eva-
lenc
e da
ta
are
offi c
ially
re
port
ed b
y go
vern
men
ts.
STI p
reva
lenc
e (1
5-49
)%
of p
op. a
ged
15-4
9 tre
ated
for S
TIs
< 1%
Num
erat
or: N
umbe
r of p
erso
ns tr
eate
d in
the
age
15-
49 fo
r ST
Is in
a sp
ecifi
c tim
e pe
riod
Den
omin
ator
: Tot
al n
umbe
r of p
op. 1
5-49
yea
rsN
B: 5
% p
reva
lenc
e of
ST
Is m
ay b
e re
alist
ic in
som
e co
untr
ies.
STI p
re-
vale
nce
in
ANC
(RPR
po
s. ra
te)
Birt
h sp
acin
g co
vera
ge%
of w
omen
of r
epro
-du
ctiv
e ag
e (1
5-49
) who
ar
e us
ing
(or w
hose
pa
rtne
r is u
sing)
a b
irth
spac
ing
met
hod
at a
pa
rtic
ular
poi
nt in
tim
e
40-7
5%N
umer
ator
: Wom
en a
ge 1
5-49
pra
ctic
e bi
rth
spac
ing
at a
giv
en ti
me
perio
dD
enom
inat
or: T
otal
fem
ale
pop.
age
d 15
-49
durin
g th
e sa
me
time
perio
dN
B: B
irth
spac
ing
refl e
cts a
ll m
etho
ds—
trad
ition
al &
na
tura
l.
Rout
ine
data
so
urce
, ho
useh
old
surv
ey
42
Birt
h sp
acin
g fo
cuse
s on
safe
mot
herh
ood
and
allo
ws
suffi
cien
t tim
e be
twee
n pr
egna
ncie
s; th
is in
terv
entio
n ha
s an
imm
ense
impa
ct o
n th
e re
duct
ion
of c
hild
and
m
ater
nal d
eath
. Inf
orm
atio
n an
d ed
ucat
ion
on th
e m
etho
ds a
re e
sent
ial.
Nut
ritio
n sta
tus
in c
hild
ren
% o
f chi
ldre
n m
al-
nour
ished
(Wei
ght f
or
heig
ht in
child
ren
< 5
year
s; co
nsid
er sp
ecifi
c ag
e gr
oup)
W
eigh
t / h
eigh
t refl
ect
s bo
dy p
ropo
rtio
n an
dis
part
icul
arly
sens
i-tiv
e to
acu
te g
row
th
distu
rban
ce. I
n ch
roni
c m
alnu
triti
on, w
eigh
t or
heig
ht fo
r age
is re
com
-m
ende
d; B
MI (
body
m
ass i
ndex
)
Mal
nutr
ition
of
:< 5
% (a
c-ce
p ta
ble)
5-9%
(poo
r)10
-14%
(ser
i-ou
s )>
15%
(cri-
tical
)
Num
erat
or: N
umbe
r of c
hild
ren
in re
spec
tive
age
grou
p w
ith m
oder
ate
or se
vere
mal
nutr
ition
resp
ec-
tivel
yscr
eene
d at
one
poi
nt in
tim
e D
enom
inat
or: T
otal
num
ber o
f chi
ldre
n sc
reen
ed in
re
spec
tive
age
grou
p at
the
sam
e tim
e pe
riod
Defi
nit
ion:
Perc
ent o
f med
ian:
70
-80%
= m
oder
ate
(-2
Z sc
ores
)<
70%
= se
vere
(- 3
Z sc
ores
)
Surv
eys i
n ge
ogra
phi-
cal a
reas
or
popu
latio
n su
b-gr
oups
Del
iver
ies a
tten-
ded
by tr
aine
d pe
rson
nel
% o
f birt
hs a
ttend
ed
by sk
illed
/trai
ned
heal
th w
orke
r suc
h as
a
doct
or, n
urse
, mid
wife
(e
xclu
ded
are
trai
ned
or
untr
aine
d T
BA’s)
40 –
80%
of
tota
l del
iver
ies
Num
erat
or: N
umbe
r of b
irths
atte
nded
by
trai
ned
pers
onne
l in
a gi
ven
time
perio
dD
enom
inat
or: T
otal
num
ber o
f birt
hs d
urin
g th
e sa
me
time
perio
d
Mon
thly
sta
tistic
s/
Rout
ine
Dat
a So
urce
43
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ceD
eliv
erie
s in
HF
% o
f HF
base
d vs
%
hom
e de
liver
ies
< 10
% h
ome
deliv
erie
sU
natte
nded
hom
e de
liver
ies b
ear a
hig
h ris
k fo
r the
m
othe
r and
the
new
born
. Th e
refo
re p
rom
otio
n of
fa
cilit
y ba
sed
deliv
erie
s sho
uld
be p
rom
oted
.
Safe
mo-
ther
hood
as
sess
men
t re
port
s,ro
utin
e da
taD
eliv
erie
s ass
is-te
d by
trai
ned
or
untr
aine
d T
BA
or o
ther
s with
no
trai
ning
Num
ber o
f del
iver
ies a
t-te
nded
by
the
indi
vidu
al
TBA
per
mon
th /
year
Qua
lity
of T
BA d
epen
ds
on w
heth
er th
ey a
re
linke
d to
a H
F.
< 60
% o
f tot
al
deliv
erie
s
TBA
regi
ste-
red
at H
F
TBA
may
be
very
exp
erie
nced
bas
ed o
n th
e fre
quen
cy
they
are
invo
lved
in p
regn
anci
es a
nd d
eliv
erie
s.
Avai
labi
lity
of C
EOC
and
ope
rativ
e se
rvic
es p
lays
a
cruc
ial r
ole
in re
duci
ng in
fant
and
mat
erna
l dea
th.
TBA
repo
rts
Prev
alen
ce o
f an
aem
ia in
wo-
men
age
d 15
-49
(can
also
focu
s on
pre
gnan
t/ no
n-pr
egna
nt
wom
en)
% o
f wom
en o
f rep
ro-
duct
ive
age
(15-
49)
with
a h
aem
oglo
bin
leve
l bel
ow 1
10g/
l (p
regn
ant)
and
120g
/l (n
on-p
regn
ant)
< 30
%N
umer
ator
: Num
ber o
f (pr
egna
nt) w
omen
(or 1
5-49
ye
ars)
scre
ened
hav
ing
a ha
emog
lobi
n<
110g
/ l O
R 1
20g/
lD
enom
inat
or: T
otal
num
ber o
f (pr
egna
nt)
wom
en
OR
thos
e ag
ed 1
5-49
yea
rs
Can
be
also
lim
ited
to p
regn
ant w
omen
onl
y; c
urre
nt
glob
al a
naem
ia in
abo
ut 5
0%.
Mon
thly
sta
tistic
s/
Rout
ine
data
Teta
nus
Imm
unisa
tion
cove
rage
in
perc
ent
Prop
ortio
n of
wom
en in
ch
ildbe
arin
g ag
e (1
5-49
) im
mun
ised
agai
nst T
eta-
nus (
TT
2 or
boo
ster)
OR
pro
port
ion
of p
reg-
nant
wom
en w
ho h
ave
Hig
h le
vel
of c
over
age
aim
ing
at 1
00
% fo
r TT
2 (tw
o do
sis o
f te
tanu
s tox
oid
Num
erat
or: N
umbe
r of d
oses
adm
inist
ered
Den
omin
ator
: Esti
mat
ed n
umbe
r of n
ewbo
rns (
in
unsta
ble
setti
ngs)
OR
num
ber o
f wom
en 1
5-49
(in
stabl
e se
tting
s)
Rout
ine
data
44
rece
ived
at l
east
TT
2+
durin
g th
e m
ost r
ecen
t pr
egna
ncy
rece
ived
)N
umer
ator
: Num
ber o
f pre
gnan
t wom
en w
ho h
ave
rece
ived
TT
2+ T
T3+
TT
4+T
T5
/ 4 (=
aver
age)
dur
ing
a gi
ven
timef
ram
eD
enom
inat
or: N
umbe
r of p
regn
ant w
omen
dur
ing
the
sam
e tim
e pe
riod
Ante
nata
l car
e co
vera
ge (A
NC
co
vera
ge)
% o
f wom
en w
ho
atte
nded
at l
east
thre
e or
mor
e (3
+) A
NC
visi
ts du
ring
her m
ost r
ecen
t pr
egna
ncy.
Th e
shar
e of
birt
hs a
t-te
nded
by
skill
ed h
ealth
sta
ff is
an in
dica
tor o
f a
heal
th sy
stem
’s ab
ility
to
prov
ide
adeq
uate
car
e fo
r pre
gnan
t wom
en.
> 50
%N
umer
ator
: Num
ber o
f pre
gnan
t wom
en w
ho a
t-te
nded
at l
east
thre
e vi
sits t
o tr
aine
d he
alth
per
sonn
el
durin
g he
r mos
t rec
ent p
regn
ancy
dur
ing
a gi
ven
time
perio
dD
enom
inat
or: T
otal
num
ber o
f birt
hs d
urin
g th
e sa
me
time
perio
dO
R e
xpec
ted
no. o
f pre
gnan
cies
in th
e sa
me
time
perio
d.
Goo
d an
tena
tal a
nd p
ostn
atal
car
e im
prov
e m
ater
nal
heal
th a
nd re
duce
mat
erna
l and
infa
nt m
orta
lity.
Mon
thly
sta
tistic
s /
Rout
ine
data
,su
rvey
s
Avai
labi
lity
of
basic
ess
entia
l ob
stetr
ic c
are
(BEO
C)
Num
ber o
f fac
ilitie
s w
ith fu
nctio
ning
bas
ic
esse
ntia
l obs
tetr
ic c
are
/ 50
0,00
0 po
pula
tion
Min
imum
4
BEO
C /
500,
000
pop.
Num
erat
or: N
umbe
r of f
acili
ties w
ith fu
nctio
ning
BE
OC
Den
omin
ator
: Tot
al p
opul
atio
n
NB
: It i
s of u
tmos
t im
port
ance
to e
nsur
e ac
cess
ible
BE
OC
for p
regn
ant w
omen
.
Basic
ess
entia
l obs
tetr
ic c
are
shou
ld in
clud
e pa
rent
eral
an
tibio
tics,
oxyt
ocic
s and
seda
tives
for e
clam
psia
; the
m
anua
l rem
oval
of p
lace
nta
and
reta
ined
pro
duct
s; an
d va
gina
l del
iver
y (in
cl. m
anua
l vac
uum
ext
ract
ion
or
forc
eps)
.
Rout
ine
data
, as
sess
men
t
45
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ceAv
aila
bilit
y of
co
mpr
ehen
sive
esse
ntia
l obs
tet-
ric c
are
(CEO
C)
Num
ber o
f fac
ilitie
s th
at p
erfo
rm su
rger
y (c
aesa
rean
sect
ion)
and
bl
oodt
rans
fusio
n
1 C
EOC
/ 50
0,00
0 po
p.N
umer
ator
: Num
ber o
f fac
ilitie
s with
func
tioni
ng
CEO
CD
enom
inat
or: T
otal
pop
ulat
ion
If em
erge
ncy
inte
rven
tions
like
Cae
sare
an S
ectio
n (C
S)
can
not b
e pe
rform
ed, m
ater
nal m
orta
lity
will
not
de
clin
e!
HF
data
,lo
cal s
tati-
stics
Infa
nt m
orta
lity
rate
D
eath
of c
hild
ren
less
th
an 1
yr.
/ 1,0
00 li
ve
birt
hs/ y
ear
59-7
9 / 1
,000
liv
e bi
rths
/ye
ar
Num
erat
or D
eath
s of c
hild
ren
less
than
one
yea
r old
pe
r yea
r D
enom
inat
or: N
umbe
r of l
ive
birt
hs in
the
sam
e ye
ar
Th e
mor
talit
y in
dica
tors
und
er T
OP
3 ar
e re
fl ect
ing
the
heal
th st
atus
of “
low
inco
me
“ co
untr
ies r
efer
ence
d by
th
e Wor
ld B
ank
(200
4).
Mon
thly
sta
tistic
s/Ro
utin
e da
ta
Perin
atal
mor
ta-
lity
rate
Dea
th o
f foe
tus o
r new
-bo
rn i
n th
e pe
rinat
al
perio
d / 1
,000
live
&
still
birt
hs /
year
Peri
nata
l Per
iod:
from
22
com
plet
ed w
eeks
of
gesta
tion
to 7
day
s afte
r bi
rth
30-3
5 / 1
,000
liv
e &
still
bi
rths
/ ye
ar
Num
erat
or: N
umbe
r of d
eath
dur
ing
perin
atal
per
iod
per y
ear
Den
omin
ator
: Num
ber o
f tot
al li
ve b
irth
and
still
birt
h du
ring
the
sam
e ye
ar
NB
: Per
inat
al m
orta
lity
is an
indi
cato
r ide
ntify
ing
prob
lem
s aris
ing
with
in th
e po
stnat
al p
erio
d, i.
e. th
e fi r
st da
ys in
the
life
of th
e ne
wbo
rn.
Perin
atal
mor
talit
y is
subs
tant
ially
con
trib
utin
g to
m
orta
lity
of a
ll ch
ildre
n un
der 5
yea
rs o
f age
. Ana
lyse
da
ta o
n ch
ild m
orta
lity
and
iden
tify
peak
s rel
ated
to
age
grou
p of
chi
ldre
n <
5 ye
ars o
f age
.
Mon
thly
sta
tistic
s/Ro
utin
e da
ta
46
Mat
erna
l dea
ths
No.
of m
ater
nal d
eath
s in
the
popu
latio
n
Defi
niti
on o
f ma-
tern
al d
eath
is o
ften
not k
now
n. U
nder
-re
port
ing
is co
mm
on!
No
mat
erna
l de
aths
Mat
erna
l dea
th is
a ra
re e
vent
and
it ta
kes p
lace
mos
tly
outsi
de th
e he
alth
faci
litie
s; bu
t if s
o, it
nee
ds to
be
repo
rted
to th
e he
alth
aut
horit
ies.
It is
reco
mm
ende
d to
con
duct
a v
erba
l aut
opsy
to a
naly
se th
e re
ason
s for
th
e de
ath.
Safe
mo-
ther
hood
as
sess
men
t
Mat
erna
l mor
ta-
lity
ratio
No.
of m
ater
nal d
eath
s pe
r 100
,000
live
birt
hs
in a
yea
r
(in L
DC
& L
LDC
25
0-15
00/1
00,0
00 li
ve
birt
hs; i
n D
C 1
0-20
/ 10
0,00
0 liv
e bi
rths
)
No
mat
erna
l de
aths
Num
erat
or: D
eath
s of w
omen
dur
ing
preg
nanc
y or
up
to 4
2 da
ys a
fter d
eliv
ery
in a
cou
ntry
per
yea
rD
enom
inat
or: N
umbe
r of l
ive
birt
hs in
the
coun
try
in
the
sam
e ye
arN
B: R
epor
t to
heal
th a
utho
ritie
s.R
ates
of m
ater
nal m
orta
lity
are
only
mea
sura
ble
on
natio
nal l
evel
bec
ause
it is
rela
ted
to a
hig
h nu
mbe
r of
live
birt
hs. H
owev
er, m
ater
nal m
orta
lity
ratio
is h
elpf
ul
for c
ompa
rison
reas
ons.
Impo
rtan
t ind
icat
or fo
r the
ove
rall
qual
ity a
nd a
vaila
bi-
lity
of h
ealth
serv
ices
in a
regi
on o
r cou
ntry
Nat
iona
l da
ta,
DH
S,m
orta
lity
surv
ey,
mon
thly
sta
tistic
s/Ro
utin
e da
ta
6. M
ALA
RIA
SPE
CIF
IC I
ND
ICAT
OR
S
Mal
aria
stra
tegy
Early
dia
gnos
is an
d tre
atm
ent
Redu
ce
mor
bidi
ty a
nd
mor
talit
y
Dep
endi
ng o
n th
e qu
ality
of c
are
and
acce
ssib
ility
of
heal
th se
rvic
es it
mig
ht ra
nge
from
: eve
ry fe
ver c
ase
is tre
ated
for m
alar
ia (d
on’t
miss
oth
er o
r add
i-tio
nal d
iseas
e, i.
e. p
neum
onia
); O
R o
nly
lab-
confi
rmed
cas
es a
re tr
eate
d fo
r mal
aria
as
soon
as p
ossib
le (p
reco
nditi
on is
24
h fu
nctio
ning
lab
diag
nosis
).
Loca
l or
regi
onal
m
alar
ia
strat
egie
s to
be fo
llow
ed
47
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ceSl
ide
posit
ive
rate
% o
f mal
aria
cas
es c
on-
fi rm
ed b
y bl
ood
smea
r of
the
tota
l tes
ted
Num
erat
or: N
umbe
r of s
lides
pos
itive
Den
omin
ator
: Num
ber o
f tot
al sl
ides
scre
ened
NB
: Th i
ck d
rop
= G
old
Stan
dard
Labo
rato
ry
repo
rts
(Rap
id) T
est
posit
ive
rate
% o
f mal
aria
cas
es
confi
rmed
by
rapi
d te
st of
thos
e te
sted
Num
erat
or: N
umbe
r of p
ositi
ve ra
pid
tests
Den
omin
ator
: num
ber o
f tot
al ra
pid
tests
don
eN
B: R
DT
use
ful i
n ou
tbre
aks o
r whe
re n
o m
icro
sco-
pists
are
ava
ilabl
e.
Labo
rato
ry
repo
rts
Ende
mic
ity o
f m
alar
iaH
igh
or h
yper
end
emic
ar
eas w
ith p
eren
nial
or
seas
onal
tran
smiss
ion
See
Mal
aria
Con
trol i
n co
mpl
ex e
mer
genc
ies:
An in
ter-
agen
cy fi
eld
hand
book
. Gen
eva:
W
orld
Hea
lth O
rgan
iza-
tion,
200
5
Inci
denc
e of
sy
mpt
oma-
tic m
alar
ia
rem
ains
fairl
y co
nsta
nt
CAV
EAT:
Res
iden
t pop
ulat
ion
deve
lop
part
ial
imm
unity
ove
r tim
e; th
eref
ore
peop
le c
arry
mal
aria
pa
rasit
es w
ithou
t sho
win
g cl
inic
al sy
mpt
oms o
f dise
ase,
he
nce
pres
ence
of p
aras
ites i
s not
a c
lear
indi
cato
r tha
t m
alar
ia is
the
caus
e of
illn
ess.
Whi
le m
ore
than
60%
of
the
popu
latio
n m
ay b
e pa
rasit
e po
sitiv
e at
any
tim
e,
child
ren
are
at h
ighe
st ris
k fo
r sev
ere
mal
aria
. Rul
e ou
t ot
her d
iseas
e.
Low
or m
oder
ate
ende
-m
ic a
reas
< 10
% p
ara-
sitae
mia
in
popu
latio
n an
d se
ason
al p
eaks
of
mal
aria
in
cide
nce
No
or lo
w le
vel o
f im
mun
ity. A
pos
itive
test
for m
alar
ia
is lik
ely
to b
e m
alar
ia. T
rans
miss
ion
rate
may
be
unsta
-bl
e, o
utbr
eaks
may
occ
ur
48
Mal
aria
ass
ess-
men
t- T
rans
miss
ion
- Sea
sona
lity
- Epi
dem
ics V
ecto
r
Hig
h –
low
Wha
t per
iod
of th
e ye
ar
and
whe
reRe
serv
oir,
Vect
or, b
iting
tim
e, b
ree-
ding
Inci
denc
e, p
reva
lenc
e an
d tr
ansm
issio
n of
mal
aria
de
pend
on
the
geog
raph
ical
regi
on, a
ltitu
de, c
limat
e,
the
vect
or sp
ecie
s – th
ese
fact
ors n
eed
to b
e as
sess
ed to
pl
an p
reve
ntio
n an
d tre
atm
ent.
Shar
e in
form
atio
n an
d co
or-
dina
te w
ith
acto
rs in
the
heal
th se
ctor
Plas
mod
ium
Fa
lcip
arum
–
Plas
mod
ium
V
ivax
Rat
io
% o
f P. f
alci
paru
m c
ases
an
d %
of P
. viv
ax c
ases
of
the
tota
l dia
gnos
ed
Exam
ples
for
coun
trie
s:Af
ghan
istan
: 15
% p
.f./ 8
5%p.
vD
R C
ongo
: 9
5% p
.f. /
5% p
.m.+
p.o.
Tim
or L
este
: 60
% p
.f. /
40%
p.v.
P.v. m
alar
ia m
ight
requ
ire tr
eatm
ent w
ith p
rimaq
uine
Labo
rato
rysu
rvey
s
Mal
aria
pr
eval
ence
rate
Num
ber o
f con
fi rm
ed
mal
aria
cas
es p
er 1
,000
po
pula
tion/
yea
r
Num
erat
or: N
umbe
r of a
ll m
alar
ia c
ases
at a
giv
en
time
fram
eD
enom
inat
or: T
otal
pop
ulat
ion
at ri
sk a
t the
sam
e tim
e pe
riod
NB
: Con
sider
to re
port
cas
es b
y P.
falc
ipar
um; P
. viv
ax
and
othe
rs.
Get
info
rmat
ion
on la
bora
tory
con
fi rm
ed c
ases
vs.
clin
ical
ly d
iagn
osed
cas
es
Brea
kdow
n by
sex,
age
and
may
be g
roup
s (et
hnic
ity,
wor
kers
, mig
rant
s etc
.)
Wee
kly
or
mon
thly
he
alth
sta
tistic
s (E
pide
mic
co
ntro
l)
49
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ceC
ases
of
unco
mpl
icat
ed
mal
aria
/ per
1,
000/
mon
th
Num
ber o
f cas
es p
er
1,00
0 po
pula
tion
per
mon
th
DEF
INIT
ION
: U
ncom
plic
ated
are
th
ose
wit
h Fe
ver,
Chi
lls,
Swea
ts, H
eada
ches
, N
ause
a an
d vo
miti
ng,
Body
ach
es &
gen
eral
m
alai
se.
Num
erat
or: N
umbe
r all
unco
mpl
.mal
aria
cas
es a
t a
give
n tim
e fra
me
Den
omin
ator
: Tot
al p
opul
atio
n at
risk
at t
he sa
me
time
perio
d
Brea
k do
wn
by a
ge/s
ex (C
DC
, Atla
nta
http
://w
ww.
cdc.
gov/
mal
aria
/dise
ase.
htm
#unc
ompl
icat
ed)
Wee
kly
or
mon
thly
he
alth
stat
i-sti
cs
Cas
es o
f com
pli-
cate
d m
alar
ia/
1,00
0/m
onth
Num
ber o
f cas
es p
er
1,00
0 po
pula
tion
per
mon
th
DEF
INIT
ION
: C
ompl
icat
ed a
re th
ose
wit
h C
ereb
ral m
alar
ia,
with
abn
orm
al b
eha-
viou
r, im
pairm
ent o
f co
nsci
ousn
ess,
seizu
res,
com
a, o
r oth
er n
euro
lo-
gica
l abn
orm
aliti
es;
Seve
re a
naem
ia, p
ul-
mon
ary
oede
ma
or
acut
e re
spira
tory
dist
ress
sy
ndro
me
(AR
DS)
.
Num
erat
or: N
umbe
r of a
ll co
mpl
icat
ed m
alar
ia c
ases
at
a g
iven
tim
e fra
me
Den
omin
ator
: Tot
al p
opul
atio
n at
risk
at t
he sa
me
time
perio
d
Wee
kly
or
mon
thly
he
alth
stat
i-sti
cs,
HF
reco
rds
50
Mal
aria
fata
lity
rate
/ per
1,0
00/
mon
th (w
eek)
No.
of c
onfi r
med
mal
a-ria
cas
es d
eath
s div
ided
by
no
. of c
onfi r
med
po
sitiv
e ca
ses p
er 1
,000
/ m
onth
(wee
k)
Num
erat
or: N
umbe
r of a
ll m
alar
ia c
ases
die
d pe
r m
onth
Den
omin
ator
: Tot
al p
ositi
ve m
alar
ia c
ases
at t
he sa
me
time
perio
d
Wee
kly
or
mon
thly
he
alth
stat
i-sti
cs,
HF
reco
rds
Mal
aria
pre
va-
lenc
e in
pre
g-na
nt w
omen
% o
f tot
al m
alar
ia c
ases
la
bora
tory
con
fi rm
ed in
pr
egna
nt w
omen
Num
erat
or: N
umbe
r of a
ll pr
egna
nt w
omen
with
po
sitiv
e m
alar
ia te
st in
a g
iven
tim
e pe
riod
Den
omin
ator
: Tot
al n
umbe
r of p
regn
ant w
omen
at
the
sam
e tim
e pe
riod
Wee
kly
or
mon
thly
he
alth
stat
i-sti
cs%
of p
regn
ant
wom
en re
cei-
ving
Inte
rmit-
tent
Pro
phyl
axis
Trea
tmen
t (IP
T)
% o
f tot
al p
regn
ant w
o-m
en re
ceiv
ing
mal
aria
pr
ophy
laxi
s
See:
Mal
aria
Con
trol i
n co
mpl
ex e
mer
genc
ies:
an in
ter-
agen
cy fi
eld
hand
book
. Gen
eva:
W
orld
Hea
lth O
rgan
iza-
tion,
200
5 (p
. 99-
101)
Num
erat
or: N
umbe
r of p
regn
ant w
omen
rece
ivin
g IP
T a
t a g
iven
tim
e fra
me
Den
omin
ator
: Tot
al n
umbe
r of p
regn
ant w
omen
at
the
sam
e tim
e pe
riod
NB
: Fol
low
nat
iona
l pro
toco
l; ot
herw
ise S
P fu
ll tre
atm
ent c
ours
e in
the
seco
nd a
nd th
ird tr
imes
ter h
as
prov
en to
be
eff e
ctiv
e .
CAV
EAT:
Wom
en w
ith H
IV a
ppea
r to
resp
ond
less
w
ell t
o IP
T w
ith S
P, th
eref
ore
IPT
shou
ld b
e gi
ven
on
a m
onth
ly b
asis.
Wee
kly
or
mon
thly
he
alth
stat
i-sti
cs
Sens
itivi
ty(Q
ualit
y C
on-
trol L
abor
ator
y)
% o
f slid
es c
orre
ctly
posit
ive
teste
d by
fi rs
t la
bora
tory
and
con
fi r-
med
by
cont
rol L
ab.
95-1
00%
A sa
mpl
e of
10-
30 m
alar
ia p
ositi
ve sl
ides
of t
otal
slid
es
shou
ld b
e co
ntro
lled
ever
y six
mon
ths.
Qua
lity
of L
abor
ator
y pl
ays a
cru
cial
rol
e in
mal
aria
co
ntro
l!
Refe
renc
e/C
ontro
l La
bora
tory
51
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ceSp
ecifi
city
(Q
ualit
y C
on-
trol L
abor
ator
y)
% o
f slid
es c
orre
ctly
ne
gativ
e te
sted
by fi
rst
labo
rato
ry a
nd c
onfi r
-m
ed b
y co
ntro
l Lab
95-1
00%
A sa
mpl
e of
10-
30%
mal
aria
neg
ativ
e sli
des o
f tot
al
slide
s sho
uld
be c
ontro
lled
ever
y six
mon
ths.
Refe
renc
e
/ Con
trol
Labo
rato
ry
No.
of m
icro
-sc
opist
s tra
ined
/un
derg
one
re-
fresh
er tr
aini
ng
No.
of m
icro
scop
ists
trai
ned
/ ref
resh
ertr
aini
ng
2-3
mic
ro-
scop
ist’s
for 1
0,00
0 po
pula
tion
Hea
lth
auth
oriti
es
or h
ealth
se
rvic
e pr
o-vi
der
No.
of s
lides
do
ne p
er m
icro
-sc
opist
s / d
ay
Num
ber o
f slid
es
divi
ded
by n
umbe
r of
mic
rosc
opist
s / d
ay
50-6
0 sli
des /
m
icro
scop
ist /
per d
ay
Base
d on
exp
erie
nce,
one
Lab
tech
nici
an c
an re
ad
abou
t 50-
60 sl
ides
per
day
(8-1
0 m
inut
es p
er sl
ide)
.La
bora
tory
7. T
UB
ERC
ULO
SIS
SPEC
IFIC
IN
DIC
ATO
RS
Cas
e D
etec
tion
rate
% o
f TB
case
s det
ecte
d fro
m th
e to
tal n
atio
nal
TB
case
s esti
mat
ed to
oc
cur c
ount
ryw
ide
each
ye
ar.
WH
O e
stim
ates
of
inci
denc
e fo
r eac
h co
untr
y.R
epor
t dat
a to
nat
io-
nal l
evel
.Se
e: W
HO
200
1. T
B/H
IV, A
clin
ical
man
ual
70%
of
exist
ing
case
s de
tect
ed
Num
erat
or: N
umbe
r of n
ew sm
ear-
posit
ive T
B ca
ses
dete
cted
Den
omin
ator
: Esti
mat
ed n
umbe
r of n
ew sm
ear-
posit
i-ve
TB
case
s cou
ntry
wid
e
NB
: Nat
iona
l pre
vale
nce
rate
nee
ds to
be
asse
ssed
to
calc
ulat
e th
e ca
se d
etec
tion
rate
. An
eff e
ctiv
e na
tiona
l T
B pr
ogra
mm
e ha
s a h
igh
cure
rate
and
a lo
w le
vel o
f ac
quire
d dr
ug re
sista
nce.
Nat
iona
l Tu
berc
ulos
is Re
giste
r
52
Cur
e ra
te o
f sm
ear p
ositi
vePT
B (P
ulm
ona-
ry T
uber
culo
sis)
% o
f tot
al n
ew P
TB
case
s who
was
initi
ally
smea
r pos
itive
and
who
w
as sm
ear n
egat
ive
in th
e la
st m
onth
of
treat
men
t
85%
of n
ew
dete
cted
cas
esN
umer
ator
: Num
ber o
f new
sput
um p
ositi
ve c
ases
in
a gi
ven
time
who
com
plet
ed tr
eatm
ent a
nd h
ad a
t lea
st tw
o sm
ear n
egat
ive
resu
ltsD
enom
inat
or: T
otal
num
ber o
f new
smea
r pos
itive
ca
ses d
urin
g th
e sa
me
time
TB
regi
ster,
HF
data
Trea
tmen
t com
-pl
eted
% o
f TB
case
s com
ple-
ted
treat
men
t but
did
not m
eet t
he c
riter
ia fo
r ‘cu
red’
or ‘
failu
re’
Num
erat
or: N
umbe
r of T
B ca
ses c
ompl
eted
trea
tmen
t in
a c
erta
in ti
me
perio
d.D
enom
inat
or: N
umbe
r of t
otal
TB
case
s und
er tr
eat-
men
t dur
ing
the
sam
e tim
e pe
riod
Trea
tmen
t suc
-ce
ss ra
te%
of t
otal
TB
case
s re
giste
red
in a
cer
tain
pe
riod
that
succ
essfu
lly
com
plet
ed tr
eatm
ent
whe
ther
with
bac
terio
lo-
gic
evid
ence
of s
ucce
ss
(‘cur
ed’)
or w
ithou
t (‘t
reat
men
t com
plet
ed’)
Num
erat
or: N
umbe
r of n
ew sm
ear-
posit
ive
pulm
onar
y T
B ca
ses r
egist
ered
in a
spec
ifi ed
per
iod
that
wer
e cu
red
plus
the
num
ber t
hat c
ompl
e te
d tre
atm
ent
Den
omin
ator
: Tot
al n
umbe
r of n
ew T
B ca
ses r
egist
e-re
d du
ring
the
sam
e tim
e
NB
: Th e
indi
cato
r mea
sure
s a p
rogr
amm
e’s c
apac
ity to
re
tain
pat
ient
s thr
ough
a c
ompl
ete
cour
se o
f che
mo-
ther
apy
with
a fa
vour
able
clin
ical
resu
lt. It
is th
e on
ly
outc
ome
indi
cato
r tha
t can
be
used
at a
ll le
vels.
TB
regi
ster,
HF
data
Trea
tmen
t fa
ilure
% o
f sm
ear p
ositi
ve T
B ca
ses u
nder
trea
tmen
tan
d w
here
the
sput
um
rem
aine
d p
ositi
ve o
r be
cam
e po
sitiv
e ag
ain
at le
ast 5
mon
ths a
fter
start
ing
treat
men
t
Num
erat
or: N
umbe
r of n
ew sp
utum
pos
itive
cas
es
who
rem
aine
d or
bec
ame
posit
ive
afte
r 5 m
onth
s of
treat
men
t or l
ater
Den
omin
ator
: Tot
al n
umbe
r of n
ew sm
ear p
ositi
ve
case
s dur
ing
the
sam
e tim
e
TB
regi
ster,
HF
data
53
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ce
Def
aulte
r rat
e (r
etur
n af
ter
inte
rrup
tion
of
treat
men
t)
% o
f TB
case
s und
er
treat
men
t and
whe
retre
atm
ent w
as in
terr
up-
ted
for t
wo
cons
ecut
ive
mon
ths o
r mor
e
Num
erat
or: N
umbe
r of n
ew sp
utum
pos
itive
cas
es
who
se tr
eatm
ent w
asin
terr
upte
d fo
r 2 m
onth
s or m
ore
Den
omin
ator
: Tot
al n
umbe
r of n
ew sm
ear p
ositi
ve
case
s dur
ing
the
sam
e tim
e
TB
regi
ster,
HF
data
Tran
sferr
ed o
ut%
of T
B pa
tient
s tra
ns-
ferr
ed to
ano
ther
repo
rtin
g un
it an
d fo
r w
hom
the
treat
men
t ou
tcom
e is
not k
now
n
Num
erat
or: N
umbe
r of T
B pa
tient
s und
er tr
eatm
ent
& tr
ansfe
rred
to a
noth
er re
port
ing
unit
Den
omin
ator
: Num
ber o
f tot
al T
B pa
tient
s und
er
treat
men
t and
in th
e su
rvei
llanc
e sy
stem
TB
regi
ster,
HF
data
Mor
talit
y ra
te
thro
ugh
PTB
No.
of c
ases
that
die
d of
PT
B fro
m to
tal P
TB
case
s per
1,0
00 /
yr.
TB
regi
ster,
HF
data
Mul
ti D
rug
Re-
sista
nce
(MD
R)
% o
f PT
B un
der t
reat
-m
ent t
hat h
ave
deve
lo-
ped
MD
R
Ofte
n th
e ab
solu
t num
ber o
f MD
R c
ases
repo
rted
. M
DR
cas
es a
re re
sista
nt to
Ison
iazid
and
Rifa
mpi
cin.
Exes
sive
drug
resis
istan
ce a
re X
DR
cas
es. X
DR
cas
es
are
resis
tant
to a
ll fl u
oroq
uino
lone
s, Is
onia
zid a
nd R
i-fa
mpi
cin
as w
ell a
s to
seco
nd li
ne a
ntib
iotic
s (C
apre
o-m
ycin
, Kan
amyc
in a
nd A
mic
acin
).
TB
regi
ster,
HF
data
HIV
Ser
opre
va-
lenc
e am
ong
TB
patie
nts
% o
f all
new
ly re
giste
red
TB
patie
nts w
ith p
ositi
-ve
HIV
stat
us
Num
erat
or: T
otal
num
ber o
f all
new
ly re
giste
red
TB
patie
nts o
ver a
cer
tain
per
iod
who
are
HIV
pos
itive
Den
omin
ator
: Tot
al n
umbe
r of a
ll ne
wly
regi
stere
d T
B pa
tient
s ove
r the
sam
e tim
e pe
riod
who
wer
e te
sted
for H
IV a
nd in
clud
ed in
the
surv
eilla
nce
syste
m
Rout
ine
testi
ng o
f T
B pa
tient
s, se
ntin
el
met
hods
, or
spec
ial
54
NB
: It i
s rec
omm
ende
d to
test
all T
B ca
ses f
or H
IV
and
test
all H
IV p
ositi
ve p
erso
n fo
r TB.
surv
eys
Dru
g an
d eq
uipm
ent
supp
ly
Dru
g re
gim
ent f
ol-
low
ing
natio
nal p
roto
col
and
equi
pmen
t for
di
agno
stic
avai
labl
e
Uni
nter
rup-
ted
supp
ly o
f T
B es
sent
ial
drug
s and
di
agno
stic
mat
eria
ls en
sure
d
Supp
lies o
f med
icin
es fo
r TB
treat
men
t is e
ssen
tial.
It ne
eds t
o be
org
anise
d in
the
part
icul
ar D
OTs
(dire
ct
obse
rved
ther
apy,
shor
t cou
rse)
sche
me.
Blis
ter p
acs,
arra
nged
acc
ordi
ng to
com
bina
tion
ther
apy,
incr
ease
co
mpl
ianc
e an
d su
ppor
ts m
onito
ring.
TB
regi
ster,
HF
dara
Repo
rtin
g Sy
stem
Nat
iona
l rep
ortin
g gu
idel
ine
or in
tern
ati-
onal
stan
dard
s (W
HO
, U
NH
CR
etc
.) co
uld
be
esta
blish
ed a
nd fo
llow
ed
for t
he ti
me
bein
g
Stan
dard
ised
repo
rtin
g sy
s-te
m a
vaila
ble
Whe
re p
ossib
le sh
ould
follo
w n
atio
nal s
yste
m
Sens
itivi
ty
(Qua
lity
Con
-tro
l Lab
orat
ory)
% o
f TB
slide
s cor
rect
ly
posit
ive
teste
d by
fi rs
t la
bora
tory
and
con
fi r-
med
by
cont
rol l
ab.
100%
A sa
mpl
e of
10-
30%
TB
posit
ive
slide
s of t
otal
slid
es
shou
ld b
e co
ntro
lled
ever
y six
mon
ths.
Refe
renc
e
/ Con
trol
Labo
rato
ry
Spec
ifi ci
ty
(Qua
lity
Con
-tro
l Lab
orat
ory)
% o
f TB
slide
s cor
rect
ly
nega
tive
teste
d by
fi rs
t la
bora
tory
and
con
fi r-
med
by
cont
rol l
ab.
100%
A sa
mpl
e of
10-
30%
TB
nega
tive
slide
s of t
otal
slid
es
shou
ld b
e co
ntro
lled
ever
y six
mon
ths.
Refe
renc
e
/ Con
trol
Labo
rato
ry
55
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ceD
OT
S co
vera
ge%
of t
he p
opul
atio
n liv
ing
in a
n ar
ea o
f bas
ic
man
agem
ent u
nits
im
plem
entin
g D
OT
S str
a-te
gy in
pro
port
ion
to to
tal p
opul
atio
n
1 ba
sic m
a-na
gem
ent u
nit
impl
emen
ting
DO
TS
per
50,0
00 p
opu-
latio
n
NB
: A b
asic
man
agem
ent u
nit i
s whe
re a
TB
regi
ster
is ke
pt a
nd q
uart
erly
repo
rts a
re m
ade.
Inte
rnat
iona
lly,
it is
reco
mm
ende
d to
hav
e a
basic
uni
t per
50,
000
to
150,
000
peop
le.
DO
TS
is a
com
mon
stra
tegy
in T
B co
ntro
l to
ensu
re
that
TB
patie
nts t
ake
thei
r med
icat
ion
regu
larly
and
on
time
to p
rohi
bit r
esist
ance
dev
elop
men
t. Th
e in
dica
tor
mea
sure
s the
ext
ent o
f a c
ount
ry’s
popu
latio
n co
vere
d by
DO
TS.
Loca
l hea
lth
auth
oriti
es
or fr
om th
e di
rect
hea
lth
serv
ice
pro-
vide
r.
Trai
ning
No.
of (
refre
sher
) tra
i-ni
ngs h
eld
for C
HW
s (c
omm
unity
hea
lth
wor
kers
)
CW
Hs s
houl
d ha
ve re
gula
r tra
inin
gs o
n PT
B an
d D
OT
S bu
t also
feed
back
on
thei
r wor
k.St
aff /
Tra
i-ni
ng d
ata
IEC
Info
rmat
ion,
Edu
catio
n an
d C
omm
unic
atio
n str
ateg
y to
war
ds P
TB
is en
sure
d
IEC
stra
tegy
de
velo
ped
and
esta
blish
ed
IEC
is a
ver
y im
port
ant i
nter
vent
ion
tool
in m
ost
heal
th p
rogr
amm
es, w
hich
nee
ds to
be
wel
l dev
elop
ed
and
esta
blish
ed a
ccor
ding
to th
e pr
oble
ms a
nd n
eeds
.
Prot
ocol
av
aila
bilit
y
8. H
IV/A
IDS
SPEC
IFIC
IN
DIC
ATO
RS*
HIV
Ser
opre
va-
lenc
e%
of a
spec
ifi ed
pop
. w
hose
blo
od te
sts a
re
HIV
pos
itive
(can
be
spec
ifi ed
by
age
grou
p)
Num
erat
or: N
o. o
f all
HIV
cas
es p
er y
ear
Den
omin
ator
: No.
of p
opul
atio
n at
risk
in th
e sa
me
year
C
AVEA
T: P
reva
lenc
e is
ofte
n re
port
ed a
s adu
lt pr
eva-
lenc
e ag
ed 1
5-49
or r
efer
s to
spec
ifi c
grou
ps su
ch a
s pr
egna
nt w
omen
or y
outh
15-
24 y
ears
.
Sent
inel
su
rvei
llanc
e an
d re
gula
r te
sting
56
HIV
inci
denc
e ra
te%
of n
ew H
IV in
fec-
tions
per
yea
rN
umer
ator
: No.
of n
ew H
IV in
fect
ions
per
yea
rD
enom
inat
or: N
o. o
f pop
ulat
ion
at ri
sk in
the
sam
e ye
ar
NB
: A c
ohor
t is v
ery
diffi
cult
to fo
llow
in u
nsta
ble
situa
tions
; it n
eeds
also
info
rmat
ion
on th
e po
pula
tion
expo
sed.
Annu
al
statis
tics
STI p
reva
lenc
e ra
te%
of S
TIs
in sp
ecifi
c po
pula
tion
grou
p (b
y ag
e or
sex
or so
cial
gr
oup)
STIs
am
ong
preg
nant
wom
en is
a v
ery
good
indi
cato
r to
ass
ess t
he S
TI s
ituat
ion
in a
pop
ulat
ion.
Peo
ple
ofte
n do
not
repo
rt S
TIs
bec
ause
of e
mba
rras
smen
t.
ANC
dat
a
Hea
rd a
bout
H
IV/A
IDS
% o
f res
pond
ents
who
ha
ve h
eard
of H
IV o
r AI
DS
Prev
alen
ce o
f ha
ving
som
e kn
owle
dge
of
AID
S
Base
line
surv
ey re
quire
d; c
an b
e as
sess
ed in
a sp
ecifi
c ag
e gr
oup
such
as y
oung
peo
ple
15-2
4 yr
s sin
ce in
ter-
vent
ions
are
mor
e eff
ect
ive
in y
oung
peo
ple.
Popu
latio
n su
rvey
,K
AP S
urve
ys
Acce
ptin
g At
ti-tu
de%
of r
espo
nden
ts sa
ying
that
they
wou
ld
be w
illin
g to
car
e fo
r a
fam
ily m
embe
r who
be
cam
e sic
k w
ith th
e AI
DS
viru
s
> 60
% h
ave
a po
sitiv
e at
ti-tu
de to
war
ds
carin
g fo
r a
fam
ily m
em-
ber i
nfec
ted
with
HIV
Base
line
surv
ey re
quire
d.Po
pula
tion
surv
ey
57
* Th
e WH
O c
ase
defi n
ition
for A
IDS
surv
eilla
nce
whe
re H
IV te
sting
is n
ot a
vaila
ble
is fu
lfi lle
d in
the
pres
ence
of a
t lea
st 2
maj
or a
nd a
t le
ast 1
min
or si
gn.
Maj
or si
gns:
wei
ght l
oss >
10%
of b
ody
wei
ght;
chro
nic
diar
rhoe
a m
ore
than
one
mon
th; p
rolo
nged
feve
r mor
e th
an o
ne m
onth
Min
or si
gn: p
ersis
tent
cou
gh m
ore
than
one
mon
th; g
ener
alise
d pr
uriti
c de
rmat
itis;
histo
ry o
f her
pes z
oste
r; or
opha
ryng
eal c
andi
dias
is;
chro
nic
prog
ress
ive
or d
issem
inat
ed h
erpe
s sim
plex
infe
ctio
n; g
ener
alise
d ly
mph
aden
opat
hy
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ce
Kno
wle
dge
abou
t AID
S an
d re
ject
ing
misc
once
ptio
ns
in y
outh
15-
24
Th e
perc
ent o
f res
pon-
dent
s age
15-
24 y
rs.
who
cor
rect
ly id
entif
y th
e tw
o m
ajor
way
s of
prev
entin
g th
e se
xual
tr
ansm
issio
n of
HIV
(u
sing
cond
oms a
nd
limiti
ng se
x to
one
fa
ithfu
l, un
infe
cted
pa
rtne
r), w
ho re
ject
th
e tw
o m
ost c
omm
on
loca
l misc
once
ptio
ns
abou
t HIV
tran
smiss
ion,
an
d w
ho k
now
that
a
heal
thy-
look
ing
pers
on
can
have
HIV
Th is
indi
cato
r is c
onstr
ucte
d fro
m re
spon
ses t
o th
e fo
llow
ing
set o
f pro
mpt
ed q
uesti
ons:
• C
an th
e ris
k of
HIV
tran
smiss
ion
be re
duce
d by
ha
ving
sex
with
onl
y on
e fa
ithfu
l, un
infe
cted
p
artn
er?
• C
an th
e ris
k of
tran
smiss
ion
be re
duce
d by
usin
g co
dom
s?
• C
an a
hea
lthy-
look
ing
pers
on h
ave
HIV
? •
Can
a p
erso
n ge
t HIV
from
mos
quito
bite
s?
• C
an a
per
son
get H
IV b
y sh
arin
g a
mea
l with
so
meo
ne w
ho is
infe
cted
?
Onl
y resp
onde
nts w
ho a
nsw
er co
rrec
tly o
n al
l fi v
e pro
mp-
ted
quest
ions
are
inclu
ded
in th
enum
erat
or. Th
e d
enom
i-na
tor i
s all
resp
onde
nts,
rega
rdles
s of w
heth
er th
ey h
ave
ever
hea
rd o
f AID
S.
Popu
latio
n su
rvey
Cou
nsel
lors
tr
aine
dBe
cle
ar o
n qu
alifi
catio
n an
d le
vel o
f tra
inin
g of
co
unse
llors
who
mig
ht
be p
rofe
ssio
nal o
r lay
pe
ople
.
Cou
nsel
lors
are
mos
t im
port
ant i
n H
IV p
reve
ntio
n bu
t al
so to
off e
r psy
cho-
soci
al c
are
for P
LWH
A or
fam
ilies
aff
ect
ed.
Trai
ning
da
ta,
perfo
rman
ce
date
Peer
cou
nsel
lors
tr
aine
dPe
er c
ouns
ello
rs p
er n
o.
of p
eers
No.
of p
eer g
roup
s
No.
of p
eer
cous
ello
rs
trai
ned
Peer
cou
nsel
ling
and
educ
atio
n ha
s pro
ven
to b
e ve
ry
eff e
ctiv
e to
shar
e in
form
atio
n on
the
tran
smiss
ion
of
HIV
/AID
S in
the
com
mun
ity.
Trai
ning
da
ta,
perfo
rman
ce
data
58
No.
of V
CT
se
ssio
ns in
last
12 m
onth
% o
f pop
. 15-
49 y
rs.
that
wer
e te
sted
and
rece
ived
resu
lts
Num
erat
or: N
umbe
r of p
op. a
ged
15-4
9 te
sted
and
rece
ived
resu
ltD
enom
inat
or: P
opul
atio
n 15
-49
yrs.
Regu
lar
statis
tics o
r po
pula
tion
surv
eyN
o. o
f VC
T
sess
ions
for n
ewT
B pa
tient
sin
last
12
mon
th
% o
f new
TB
patie
nts
that
wer
e te
sted
and
rece
ived
resu
lts
Num
erat
or: N
umbe
r of n
ew T
B pa
tient
s tes
ted
for
HIV
dur
ing
last
12 m
onth
sD
enom
inat
or: T
otal
num
ber o
f new
TB
case
s in
last
12 m
onth
Mon
thly
he
alth
stat
i-sti
cs
Hea
lth p
rom
oti-
on -
IEC
strat
egy
is im
-pl
emen
ted
Info
rmat
ion,
Edu
catio
n an
d C
omm
unic
atio
n (I
EC) s
trat
egy
tow
ards
H
IV/A
IDS
is av
aila
ble
IEC
stra
tegy
de
velo
ped
and
esta
blish
ed.
Ove
rall
obje
ctiv
e is
beha
viou
r of
chan
ge
IEC
is a
ver
y im
port
ant i
nter
vent
ion
tool
in m
ost
heal
th p
rogr
amm
es w
hich
nee
ds to
be
wel
l dev
elop
ed
and
esta
blish
ed a
ccor
ding
to th
e pr
oble
ms a
nd n
eeds
.
Resp
ect c
ultu
re a
nd c
usto
ms o
f tar
get p
opul
atio
n.
Test
all I
CE-
mat
eria
ls in
the
loca
l con
text
.
Prog
ram
me
prot
ocol
ARV
trea
t-m
ent p
roto
col
avai
labl
e an
d el
igib
ility
crit
e-ria
esta
blish
ed
ARV
trea
t-m
ent p
roto
col
esta
blish
ed
and
follo
wed
Acce
ssab
ility
to A
RVs h
as to
be
stren
gthe
ned
and
treat
-m
ent n
eeds
to fo
llow
Nat
iona
l Gui
delin
es.
Follo
w
natio
nal
prot
ocol
,da
ta o
n AR
T
cove
rage
M
ater
nal o
r-ph
an p
reva
lenc
e%
of c
hild
ren
<15
year
s of
age
who
se n
atur
al
mot
her h
ad d
ied
Num
erat
or: N
o. o
f chi
ldre
n <1
5 ye
ars w
hose
mot
her
died
Den
omin
ator
: Tot
al n
o. o
f chi
ldre
n in
the
sam
e ag
e gr
oup
Dat
a on
nu
mbe
r of
OV
C (o
r-ph
ans a
nd
vuln
erab
le
child
ren)
59
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ceN
o. o
f sch
o-la
rshi
ps fo
r or
phan
s
Amou
nt p
aid
/ Orp
han
/ yea
rAi
med
to
cove
r sch
ool
fee
and
livin
g co
sts
Aim
ed to
supp
ort o
rpha
ns. O
rpha
ns o
ften
have
oth
er
care
take
rs su
ch a
s gra
ndpa
rent
s who
may
not
be
able
to a
ff ord
scho
ol fe
es, w
hich
are
requ
ired
in m
ost
coun
trie
s.
Loca
l re-
cord
s
9. V
IOLE
NC
E AG
AIN
ST W
OM
EN A
ND
CH
ILD
REN
*
Con
fi den
tial
Dat
a Ba
seRe
cord
s of i
ncid
ence
s w
here
acc
ess i
s res
tric
-te
d to
the
resp
onsib
le
pers
on in
cha
rge
Defi
niti
on o
n w
hat i
s G
BV is
requ
ired
Cre
ate
a co
nfi d
entia
l da
ta b
ase
for
reco
rdin
g in
-ci
denc
es b
utal
so m
easu
res
take
n
Asse
ss a
nd u
se th
e da
ta to
impr
ove
the
situa
tion
for
mos
t lik
ely
wom
en a
nd c
hild
ren;
alw
ays c
oord
inat
e an
d ex
pand
resp
onse
to th
e m
ost p
ossib
le n
eeds
.
Dat
a on
pr
eval
ence
of
GBV
di
ffi cu
lt to
col
lect
, be
caus
e of
sti
gma
and
disc
rimin
a-tio
nR
ate
of se
xual
vi
olen
ceN
o. w
omen
& c
hild
ren
viol
ated
mul
tiplie
d by
10
0%, d
ivid
ed b
y to
tal
no. o
f the
se g
roup
s
Prev
entio
n,
care
and
su
ppor
t of
surv
ivor
s
Indi
cato
r can
also
add
ress
a sp
ecifi
c ag
e gr
oup
(15-
49;
15-6
5 et
c.)
Th e
prim
ary
aim
is th
at a
ll hu
man
itaria
n ac
tors
mus
t ta
ke a
ctio
n fro
m th
e ea
rlies
t sta
ges o
f an
emer
genc
y to
pr
even
t sex
ual v
iole
nce
and
prov
ide
appr
opria
te a
ssis-
tanc
e to
surv
ivor
s and
fam
ilies
.
Popu
latio
n su
rvey
or
regu
lar s
tati-
stics
No.
of w
omen
/ch
ildre
n m
edi-
cally
trea
ted
/ m
onth
Abso
lute
num
ber /
m
onth
To e
nsur
e pr
o-pe
r dia
gnos
tic,
treat
men
t and
ps
ycho
logi
cal
Con
duct
phy
sical
exa
min
atio
n on
ly w
ith th
e su
rviv
or‘s
cons
ent;
it sh
ould
be
com
pass
iona
te, s
yste
mat
ic, c
om-
plet
e an
d co
nfi d
entia
l.
Mon
thly
he
alth
stat
i-sti
cs
60
supp
ort
To p
reve
nt
tran
smiss
ion
of S
TIs
incl
u-di
ng H
IV
Con
sider
synd
rom
ic tr
eatm
ent o
f ST
Is a
nd /
or P
EP. I
n ca
se o
f inj
urie
s con
sider
refe
rral
to sp
ecia
lised
serv
ices
.
No.
of w
omen
re
ceiv
ed p
sych
o-so
cial
car
e
Abso
lute
num
ber /
mon
thsu
ppor
tive
coun
selli
ngdi
scus
s saf
ety
issue
s
With
the
surv
ivor
‘s co
nsen
t disc
uss r
efer
ral t
o sa
fety
zo
nes o
r oth
er so
cial
supp
ort.
Mon
thly
sta
tistic
s
No.
of w
omen
w
ho re
ceiv
edPE
P
Abso
lute
num
ber/
m
onth
To e
nsur
e ac
cess
to P
EP
if ap
plic
able
See
PEP
guid
elin
esM
onth
ly
statis
tics
No.
of w
omen
ca
me
for V
CT
Abso
lute
num
ber/
m
onth
Stro
ng re
com
men
datio
n in
a c
onte
xt w
here
HIV
pre
va-
lenc
e is
high
Mon
thly
sta
tistic
sN
o. o
f fam
ily
grou
p di
scus
-sio
ns
Abso
lute
num
ber/
m
onth
Rai
se a
wa-
rene
ss, o
ff er
supp
ort,
pre-
vent
stig
ma
Can
be
orga
nise
d an
d off
ere
d w
ithin
com
mun
ity
supp
ort a
nd a
war
enes
s pro
gram
mes
for d
iff er
ent t
arge
t gr
oups
.
Mon
thly
sta
tistic
s
* Th
e to
pic
refl e
cts t
he re
com
men
datio
ns m
ade
by th
e In
ter A
genc
y St
andi
ng C
omm
ittee
Tas
k Fo
rce
on G
ende
r and
Hum
anita
rian
Assis
tanc
e, G
enev
a, 2
005
61
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ceIE
C c
ampa
igns
w
ith c
omm
u-ni
ties,
mili
tary
, po
lice
Sess
ions
don
e fo
r the
re
spec
tive
grou
ps in
a
mon
th
To p
reve
nt
GBV
thro
ugh
diss
imin
atio
n of
info
rmat
i-on
to p
oten
ti-al
per
petr
ator
s to
info
rm o
n ps
ycho
soci
al
supp
ort a
nd
to re
duce
di
scrim
ina-
tion
Info
rm su
rviv
ors /
vict
ims a
bout
the
pote
ntia
l sev
ere
and
life
thre
aten
ing
cons
eque
nces
.
Info
rm c
omm
unity
abo
ut a
vaila
bilit
y of
serv
ices
, how
to
acc
ess t
hem
and
that
it w
ill sa
ve su
rviv
ors a
nd
fam
ilies
.
Build
trus
t in
the
com
mun
ity.
Info
rm th
e co
mm
unity
abo
ut h
e ne
ed to
pro
tect
and
ca
re fo
r sur
vivo
rs o
f vio
lenc
e an
d no
t to
disc
rimin
ate
them
.
Mon
thly
sta
tistic
s
No.
of w
omen
re
ceiv
ed le
gal
supp
ort
Abso
lute
num
ber /
mon
thAi
m fo
r hig
h co
vera
geAc
tion
coul
d be
take
n by
the
polic
e, se
curit
y, U
NH
CR
, N
GO
s and
CBO
s, le
gal a
dvic
e in
stitu
tions
, hum
an
right
s gro
ups l
ocal
lead
ers o
r hea
lth c
are
prov
ider
s.
Dep
ends
on
the
resp
onsib
le
insti
tutio
nC
apac
ity B
uil-
ding
No.
of l
ocal
gro
ups
or p
erso
ns tr
aine
d in
SG
BV p
reve
ntio
n an
d re
spon
se
Mos
t sta
ff is
trai
ned
on
gend
er e
qual
i-ty
issu
es, G
BV,
guid
ing
prin
cipa
ls &
le
gal s
tan-
dard
s
Stre
ngth
en lo
cal c
apac
ity to
mon
itor a
nd n
etw
ork
to
rele
vant
sect
ors.
Dev
elop
a c
ompl
aint
mec
hani
sm a
nd in
vesti
gatio
n str
ateg
y.
Min
imise
risk
of s
exua
l exp
loita
tion
of b
enefi
cia
ry
com
mun
ity b
y hu
man
itaria
n w
orke
rs a
nd p
eace
keep
ers.
Repo
rts o
n ac
tiviti
es
62
10. P
SYC
HO
-SO
CIA
L C
AR
E A
ND
MEN
TAL
HEA
LTH
No.
of p
sych
o-so
cial
supp
ort
serv
ices
ava
ila-
ble
(indi
vidu
al o
r in
stitu
tion)
Serv
ice
whi
ch is
off e
red
by la
y co
unse
llors
or
othe
r per
sonn
el tr
aine
d on
men
tal h
ealth
or
psyc
hoso
cial
supp
ort
To p
rovi
de so
-ci
al a
nd e
mo-
tiona
l sup
port
w
ithin
the
com
mun
ities
To p
reve
nt
stres
s diso
rder
Peop
le in
nee
d in
clud
es th
ose
who
are
vul
nera
ble,
liv
ing
with
disa
bilit
ies,
men
tal h
ealth
pro
blem
s or
chro
nic
dise
ases
and
/or n
eed
assis
tanc
e in
dai
ly li
fe
refe
rrin
g to
mob
ility
, per
sona
l hyg
iene
, foo
d in
take
and
pr
otec
tion.
Asse
smen
t re
port
s
No.
of p
erso
ns
trai
ned
on
psyc
ho-s
ocia
l su
ppor
t or m
en-
tal h
ealth
No.
of l
ay c
ouns
ello
rs
and
supe
rviso
rs fo
r PSC
av
aila
ble
in th
e co
mm
u-ni
ty o
r in
the
aff e
cted
po
pula
tion
To c
over
em
o-tio
nal s
uppo
rt
with
in th
e co
mm
uniti
es
Com
mun
ity m
embe
rs a
re tr
aine
d to
iden
tify
and
asse
ss
PSC
nee
ds in
the
com
mun
ity b
ased
on
the
crite
ria.
Th ey
pro
vide
soci
al a
nd e
mot
iona
l sup
port
. PSC
pro
vi-
ders
them
selv
es n
eed
supp
ort a
nd su
perv
ision
.
Repo
rts
Num
ber o
f pe
ople
who
are
in
nee
d of
soci
al
and
emot
iona
l su
ppor
t
Th os
e aff
ect
ed b
y di
-sa
ster a
nd c
onfl i
ct w
ho
cann
ot c
ope.
See:
IASC
gui
delin
es o
n PS
C a
nd M
enta
l Hea
lth
To a
sses
s and
qu
antif
y th
e ne
ed fo
r PSC
an
d m
enta
l he
alth
supp
ort
PSC
is a
cro
ss-
cutti
ng is
sue
and
clus
ter i
n H
uman
itaria
n As
sista
nce
Nee
d fo
r Psy
cho-
Soci
al C
are
(PSC
) is d
epen
ding
on
to w
hat e
xten
d th
e co
ping
stra
tegi
es o
f the
com
mun
ity
are
over
stret
ched
.
Poss
ible
crit
eria
for
ass
essin
g ne
eds f
or P
SC in
a c
om-
mun
ity a
re:
• lo
ss o
f hom
e / h
ouse
• da
mag
e of
the
hous
e •
loss
and
/or d
amag
e of
bel
ongi
ngs
• in
jurie
s and
dea
ths o
f rel
ativ
es
• w
itnes
sing
mat
eria
l and
hum
an lo
sses
of n
eigh
-bo
urs a
nd fr
iend
s
Repo
rts,
asse
ssm
ent
63
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
cePe
ople
livi
ng
with
disa
bilit
ies
Pers
on w
ith a
ny k
ind
of
disa
bilit
y an
d/or
chr
onic
di
seas
e.
5 –
10%
of t
he p
opul
ati-
on m
ight
live
with
disa
-bi
litie
s. N
eeds
atte
ntio
n du
ring
asse
ssm
ent a
nd
plan
ning
.
To id
en-
tify
and
to
supp
ort t
hose
pe
rson
s with
di
sabi
litie
sw
ho n
eed
supp
ort a
ndto
pre
vent
fu
ture
diss
abi-
litie
s thr
ough
ap
prop
riate
ca
re a
nd
supp
ort
Dur
ing
asse
ssm
ent a
nd im
plem
enta
tion
it is
impo
rtan
t to
iden
tify
thos
e gr
oups
in th
e co
mm
unity
who
are
m
ost v
ulne
rabl
e be
caus
e of
imm
obili
ty, d
iseas
e an
d di
sabi
lity.
Furt
herm
ore,
follo
win
g di
saste
r and
con
fl ict
, the
re is
a
need
to re
fer p
atie
nts t
o ap
prop
riate
trea
tmen
t to
prev
ent f
utur
e di
sabi
lity
resu
lting
from
lack
of c
are
and
supp
ort.
Asse
ss in
jurie
s and
dise
ases
for p
oten
tial c
ause
of f
utur
e di
sabi
lity.
Asse
ssm
ent,
repo
rts
Peop
le e
xpos
ed
to tr
aum
atic
ev
ents
Peop
le e
xpos
ed to
di
saste
r are
not
dire
ctly
tr
aum
atise
d. Th
ere
is
a po
tent
ial t
o de
velo
p ch
roni
c str
ess d
isord
er
Mos
t in
the
com
mun
ity
deve
lop
acut
e str
ess r
eact
ion
and
can
cope
with
som
esu
ppor
t.
Disa
ster i
s exc
eedi
ng u
sual
cop
ing
capa
citie
s. Th
eref
ore
ther
e is
a ne
ed fo
r PSC
whi
ch su
ppor
ts th
e lo
cal c
opin
g ca
paci
ty.
Asse
ssm
ent
Trau
mat
ised
pers
onPT
SD –
pos
t tra
umat
ic
stres
s diso
rder
: psy
chia
t-ric
dia
gnos
is. Th
ose
who
ar
e at
risk
to d
evel
op
PTSD
nee
d re
ferr
al to
m
enta
l hea
lth se
rvic
es.
PTSD
– c
ases
sh
ould
be
prev
ente
d th
roug
h PS
C.
Th er
e ar
e a
few
cas
es w
ho m
ight
dev
elop
PT
SD a
nd
need
pro
fess
iona
l men
tal h
ealth
inte
rven
tion.
Mos
t co
mm
unity
mem
bers
get
alo
ng w
ith e
mot
iona
l sup
port
w
hich
can
be
prov
ided
by
trai
ned
lay
coun
sello
rs.
Asse
ssm
ent
64
11. P
ERFO
RM
AN
CE
BA
SED
IN
DIC
ATO
RS
(
Can
be
appl
ied
in a
ll se
tting
s)%
of s
ympt
oms
and
diag
nosti
c th
at a
re c
orre
ct
Doc
umen
ted
sym
ptom
s an
d cl
inic
al fi
ndin
gs
mat
ch w
ith d
iagn
oses
> 75
% a
re
corr
ect
Inte
nsiv
e tr
aini
ng p
rior t
o th
e in
trodu
ctio
n of
the
indi
-ca
tor i
s im
port
ant;
case
defi
niti
ons s
houl
d be
ava
ilabl
e as
wel
l as t
reat
men
t gui
delin
es.
Mon
thly
sa
mpl
e of
5-
10%
from
re
cord
s in
the
HF
% o
f dia
gnos
tic
and
pres
crip
tion
that
are
cor
rect
Pres
crip
tion
and
treat
men
t mat
ches
with
di
agno
sis
> 75
% a
re
corr
ect
Inte
nsiv
e tr
aini
ng p
rior t
o th
e in
trodu
ctio
n of
the
indi
-ca
tor i
s im
port
ant;
case
defi
niti
ons s
houl
d be
ava
ilabl
e as
wel
l as t
reat
men
t gui
delin
es.
Mon
thly
sa
mpl
e of
5-
10%
from
re
cord
s
% o
f NC
(new
ca
ses)
that
rece
i-ve
d no
t mor
eth
an 3
med
ica-
men
ts
No.
of
med
icam
ents
pres
crib
ed o
r giv
en to
on
e pa
tient
> 80
%
rece
ived
< 3
m
edic
amen
ts
Rat
iona
l use
of m
edic
ines
refl e
cted
in ta
rget
ed tr
eat-
men
t, i.e
. use
of a
ntib
iotic
s acc
ordi
ng to
trea
tmen
tgu
idel
ines
Mon
thly
sa
mpl
e of
5-1
0%
draw
n fro
m
reco
rds
Refe
rral
rate
per
N
CN
o. o
f pat
ient
s ref
erre
d to
seco
ndar
y he
alth
se
rvic
e
> 5
/ 1,0
00 /
year
Refe
rral
s are
from
prim
ary
care
to se
cond
ary
heal
th
serv
ice.
Dep
ends
on
the
size
of th
e he
alth
faci
lity
and
the
com
-pe
tenc
e an
d ca
paci
ties o
f pro
fess
iona
l sta
ff .
Mon
thly
he
alth
stat
i-sti
cs
Pric
e lis
t for
he
alth
car
e se
rvic
e is
tran
spar
ent a
nd
resp
ecte
d
Avai
labi
lity,
aff o
rdab
ility
, tr
ansp
aren
cy,
qual
ity o
f car
e
In so
me
setti
ngs p
eopl
e pa
y fe
es fo
r hea
lth se
rvic
e; it
is
impo
rtan
t tha
t pat
ient
s are
not
ove
r cha
rged
.Th
is ca
n be
ens
ured
by
havi
ng c
omm
unity
repr
esen
ta-
tives
par
ticip
atin
g in
hea
lth c
entre
man
agem
ent i
ssue
s an
d co
nsen
ting
on fe
es to
be
paid
.
Min
istry
of
Hea
lth o
r di
rect
hea
lth
serv
ice
pro-
vide
r
65
Indi
cato
rD
efi n
ition
/ Re
fere
nce
Aim
Rem
arks
and
com
men
tsD
ata
sour
ceFr
ee h
ealth
se
rvic
e fo
r mos
t vu
lner
able
No.
of t
hose
rece
ived
fre
e se
rvic
e ou
t of t
otal
po
pula
tion
100%
(vul
nera
bilit
y cr
iteria
ava
ila-
ble)
List
shou
ld b
e es
tabl
ished
of t
he n
eedi
est.
Crit
eria
sh
ould
be
set a
nd c
larif
yed
who
is e
ligib
le fo
r fre
e se
rvic
es. T
ry to
ver
ify if
thos
e ar
e re
ally
rece
ivin
g fre
e se
rvic
es.
HF,
Com
mun
ity
repr
esen
ta-
tives
Avai
labi
lity
of
esse
ntia
l dru
gsAv
aila
bilit
y of
ess
entia
l dr
ugs
No
stock
rup-
ture
OR
1-5
m
edic
amen
tsar
e no
tav
aila
ble
for
less
than
5
days
Stoc
k ru
ptur
e is
espe
cial
ly c
omm
on in
rem
ote
and
con-
fl ict
are
as. M
ay re
fl ect
poo
r pla
nnin
g an
d pr
ocur
emen
tpr
oced
ures
.
HF
Adm
inist
ratio
n fo
rms a
re u
pda-
ted
and
in u
se
All f
orm
s are
av
aila
ble
and
in
use
Refe
rs to
gen
eral
man
agem
ent a
nd re
port
ing,
fi na
ncia
l m
anag
emen
t. pr
ocur
emen
t and
inve
ntor
y, pe
rson
nel
man
agem
ent.
HF
Com
mun
ity
part
icip
atio
nN
o. o
f mee
tings
hel
d w
ith c
omm
uniti
es/
mon
th
1 / m
onth
Com
mun
ities
nee
d to
be
invo
lved
in H
F m
anan
ge-
men
t and
pla
nnin
g th
roug
h vi
llage
com
mitt
ees o
r vi
llage
hea
lth w
orke
r in
the
HF.
HF,
com
mun
ity
repr
esen
ta-
tives
66
67
AN
C
Ant
enat
al C
are
ARV
A
ntire
trovi
ral
BEO
C
Bas
ic E
ssen
tial O
bste
tric
Car
eC
EOC
C
ompr
ehen
sive
Ess
entia
l Obs
tetri
c C
are
CH
W
Com
mun
ity H
ealth
Wor
ker
CM
R
Cru
de M
orta
lity
Rat
eC
SW
Com
mer
ial S
ex W
orke
rD
OTS
D
irect
Obs
erve
d Tr
eatm
ent S
trate
gyEP
I Ex
pand
ed P
rogr
amm
e of
Imm
unis
atio
nG
BV
G
ende
r Bas
ed V
iole
nce
HF
Hea
lth F
acili
tyH
HS
Hou
seho
ld su
rvey
HIS
H
ealth
Info
rmat
ion
Syst
emH
W
Hea
lth W
orke
rID
P In
tern
ally
Dis
plac
ed P
erso
nID
U
Intra
veno
us D
rug
Use
rIE
C
Info
rmat
ion
Educ
atio
n an
d C
omm
unic
atio
n
IPT
Inte
rmitt
ent P
roph
ylax
is T
reat
men
tIU
In
tern
atio
nal U
nits
LDC
Le
ss D
evel
oped
Cou
ntry
LLD
C
Leas
t Dev
elop
ed C
ount
ryM
DR
M
ulti
Dru
g R
esis
tanc
eN
TU
Non
-Tur
bity
Uni
tO
PD
Out
patie
nts D
epar
tmen
tO
VC
O
rpha
ns a
nd V
ulne
rabl
e C
hild
ren
PE
P Po
st-e
xpos
ure
prop
hyla
xis
PHC
Pr
imar
y H
ealth
Car
ePL
WH
A P
eopl
e Li
ving
With
HIV
/AId
sPN
C
Post
nata
l Car
ePT
SD
Post
-Tra
umat
ic S
tress
Dis
orde
rST
I Se
xual
ly T
rans
mitt
ed In
fect
ion
TBA
Tr
aditi
onal
Birt
h A
ttend
ant
VC
T Vo
lunt
ary
Cou
nsel
ling
and
Test
ing
Abb
revi
atio
ns
7. Annex
7.1 Case defi nitions1
Measles: generalised rash lasting > 3 days and temperature >38 C and one of the following: cough, runny nose, red eyesDysentery: three or more liquid stool per day and presence of visible blood in stoolsCommon Diarrhoea: severe, profuse, watery diarrhoea with or without vo-miting.Acute Respiratory Infection (ARI): cough or diffi cult breathing > 50/mi-nute for infant age 2 months to 1 year; breathing >40/minute children 1-4 years; and no chest indrawing, stridor or danger signs.Meningitis: sudden onset of fever > 38.9 C neck stiff ness or purpura.
7.2 Glossary of terms2
Th e following paragraph clarifi es common terms in the area of public health, humanitarian aid and development. Th e authors opted for the ones that may be most applicable to Malteser’s work while other sources may off er diff erent defi nitions.
Accountability: Th e ability to call state offi cials, public employees, or pri-vate actors to account, requiring that they be answerable for their policies, actions, and use of funds. Access to information and analysis about the per-formance of services and policies builds pressure for accountability.
Accuracy: Th e degree to which a measurement or an estimate based on mea-surements represents the true value of the attribute that is being measured.
1 Referenced from SPHERE handbook2 Defi nitions are drawn from various World Bank publications and websites as well as Abbot and Guijt’s Changing Views on Change: Participatory Approaches to Monitoring the Environment (1998) AND the European Commission handbook on AID Delivery Methods, March 2004
68
Benefi ciary Assessments: A qualitative method of information-gathering which assesses the value of an activity as it is perceived by its principal users. Th e approach is qualitative, systematic but fl exible, action-oriented, and tar-geted to decision makers. Benefi ciary Assessments are often used during the project preparation phase, but are also performed during M&E phases as well. Key techniques involve participant observation and semi-structured interviews with individuals and focus groups.
Bias: Inferences leading to inaccuracy of results (selection bias, information bias, interview bias and others)
Coverage: Th e proportion of people benefi ting from the intervention and usually expressed in percentage or proportions.
Cure Rate: Effi cacy of a treatment (or drug) regimen; it is not really a rate but a proportion (Source: F. Checci et al, 2007)
Effi cacy: Optimal administration of intervention (Source: F. Checci et al, 2007)
Empowerment: Th e expansion of assets and capabilities of poor people to participate in, negotiate with, infl uence, control, and hold accountable ins-titutions that aff ect their lives.
Endemic Disease: Diseases that occur during the whole year in the area/community (Source: F. Checci et al, 2007)
Epidemic: A sudden increase of a disease that is usually absent or present on a low level
Epidemiology: Th e study of the distribution of diseases in the community by looking at factors aff ecting health or illness i.e what disease, when did it occur, which persons are aff ected, how has it been transmitted. Logic inter-ventions and methodologies are applied.
Equity: Inputs and benefi ts reach the various stakeholders fairly.
69
Eff ectiveness: Th e contribution made by results to achievement of the pro-ject purpose; and how assumptions have aff ected project achievements.
Effi ciency: Project results have been achieved at reasonable costs; this requi-res usually comparisons to alternative approaches.
Evaluation: Evaluation systematically judges the value of changes (planned and unplanned) resulting from project outputs and outcomes, in compa-rison against original plans. Evaluation provides an assessment of achieve-ment of project objectives, effi ciency, eff ectiveness, impact and sustainability. Evaluation should take into consideration the impact upon individuals and the community in terms of the development of new ideas and quality of life, resource mobilization, income distribution, self-reliance, and environ-mental and natural resource conservation. Evaluation helps to target project outcomes and qualify project benefi ts.
Evidence Based Public Health: “Evidence-based public health is defi ned as the development, implementation, and evaluation of eff ective programs and policies in public health through application of principles of scientifi c reasoning, including systematic uses of data and information systems, and appropriate use of behavioural science theory and program planning mo-dels” (Brownson et al., 2003).
Excess Mortality: Death that would not have occurred if the crisis had not taken place (Source: F. Checci et al, 2007).
Exposure: Th e event and degree of an individual getting in contact with an infectious pathogen or substance or other risk factors that increases the risk of a disease (Source: F. Checci et al, 2007).
Famine: A famine is a social and economic crisis that is commonly accom-panied by widespread malnutrition, starvation, epidemics and increased mortality
Household Survey: Type of epidemiological study in which representatives from household level are selected to provide health information (or others).
70
Analogue to cross-sectional surveys; and are often used for baseline data or monitoring/evaluation of an intervention program.
Incidence: Occurrence of new cases of infection/diseases in a specifi c po-pulation
Impact: Impact indicators measure the ultimate eff ect of an intervention on a key dimension of the living standards (mortality rates or prevalence of diseases) of individuals- such as freedom from hunger, literacy, good health, empowerment or security
Impact Evaluation: Th e systematic identifi cation of a development activity’s eff ects – positive or negative, intended or not – on individuals, households, institutions, and the environment. Impact evaluation helps explain the ex-tent to which activities reach poor people and the magnitude of their eff ects on people’s welfare.
Impact Monitoring: Th e regular assessment of changes over time in the status of project benefi ciaries.
Indicator: A variable to measure the progress of activities or changes resul-ting from the project activity, which assesses whether a change is in the desi-red direction and whether the objective will be achieved. A good indicator refl ects both quantitative and qualitative change. Quantitative indicators (numerical) can be displayed as a single factor or a cumulative fi gure. Qua-litative indicators measure either a behaviour or an indirect representation and often require open-ended responses.
Input: Input indicators track all the fi nancial and physical resources used for an intervention.
Local Capacity Building: Development of skills and capacity either through training or technical assistance to either civil society’s representa-tives (NGO’s, Red Cross, church groups etc.) or to government/adminis-tration structures. Local capacity building does not include budgetary or fi nancial support.
71
Local Organisational Capacity: Th e ability of people to work together, or-ganize themselves, and mobilize resources to solve problems of common interest. Local organisational capacity may take the form of informal associ-ations – lending circles or family groups – or formal associations – farmers’ groups or neighbourhood associations. Local organisational capacity ena-bles communities to collectively make decisions, manage funds, and solve problems.
Management: Th e act of controlling and directing an organisation
Methods: A regular systematic way of doing something
Monitoring: Monitoring is a continuous process to assess whether a project or policy is being implemented as planned, has made good progress, and faced any problems. It also considers how to solve such problems. Monito-ring plays an important role to ensure that activities are performed on sche-dule and within the allocated budget, that all concerned are satisfi ed, and that project outputs and outcomes correspond to stated objectives. It ena-bles a more responsive, accountable, and transparent system of operating.
Monitoring and Evaluation: Separate but interrelated activities to gather information and report fi ndings on project or policy performance and re-sults. Monitoring is a periodic, rather than a one-off , reassessment of indi-cators that are chosen to determine the eff ects of certain interventions or policies. Monitoring is almost always guided by pre-determined indicators, while evaluations are usually based on more general questions. Monitoring and evaluation yield the greatest benefi ts when they are performed in a par-ticipatory manner.
Outcome: Outcome indicators measure the level of access to public servi-ces (number of health facilities), use of these services (children vaccinated) and the level of satisfaction of users. Outcome typically depends on factors beyond the control of the implementing agency (such as behaviour of the individuals or other demand-side factors).
72
Outbreak: Equivalent to epidemic but usually refers to the very fi rst group of epidemic cases (Source: F. Checci et al, 2007).
Output: Output indicators cover all the goods and services generated (staf-fi ng, availability of medicine) by the use of the inputs. Th ese measure the supply of goods and services provided to individuals. Outputs typically are fully under the control of the agency that provides them.
Participation: A process through which stakeholder’s infl uence and share control over development initiatives and the decisions and resources that af-fects them. Th ere are diff erent levels of stakeholder involvement, including information dissemination (one-way fl ow of information), consultation (two-way fl ow of information), collaboration (shared control over decision making), and empowerment (the transfer of control over decisions and re-sources). Diff erent levels of participation ensure varying degrees of responsi-veness, transparency, accountability, and equity.Participation eff ects monitoring and evaluation in the following ways:
• Purpose of the evaluation• Criteria and indicators identifi ed• Design and implementation of the evaluation• Who participates in the monitoring and analysis• How the information is used
Participatory Monitoring and Evaluation (PME): A systematic manage-ment tool designed to reveal the degree of eff ectiveness and effi ciency in the achievement of objectives according to the perspectives of stakeholders. PME brings together diverse stakeholders, giving them an opportunity to negotiate regarding what success should look like and what indicators should be used to evaluate success. In this process, all stakeholders discuss and plan the project together from the outset, jointly setting the objectives, targets, indicators, and work process. It is a process that leads to knowledge generation, collaborative problem solving, and corrective action by invol-ving all levels of stakeholders in shared decision-making.
Participatory Rural Appraisal (PRA)A growing family of participatory approaches and methods that emphasize
73
local knowledge and enable local people to do their own appraisal, analysis and planning. Th e approach also enables shared learning and planning of appropriate interventions among local people and outsiders (development practitioners and government offi cials). PRA techniques have mainly been used early in the project cycle, but can also be applied during other phases. Visual techniques such as mapping, seasonal calendars or cause-impact dia-grams are often featured so that non-literate people can participate. Other common methods include semi-structured interviewing with individuals and focus groups. Although originally developed for use in rural areas, PRA has been used successfully in a variety of settings.
Performance Monitoring: Continual assessment of actual results to de-monstrate whether project, program, or policy is achieving its stated goals. Performance monitoring promotes effi ciency, transparency, and targeting.
Point Prevalence: Proportion or percentage of the population (or sub-group) that has the infection/disease at a specifi c point in time i.e. yesterday. It is the most expressed type of prevalence (Source: F. Checci et al, 2007).
Prevalence: Number of cases of infection or diseases present in a popu-lation or sub-group; this includes incident (new cases) as well as existing cases(Source: F. Checci et al, 2007).
Process Monitoring: Continual assessment of how the processes, procedu-res and criteria of a project are working.
Proportion: Quantity A over quantity N; or A is a fraction of N (e.g. 15% of the population [=A] of 12.000 people [=N] got malaria); (Source: F. Checci et al, 2007).Proxy: Indicator of something which is, by its complex nature, not measu-rable.
Primary Health Care (Alma Ata, 1978): WHO’s holistic concept for pro-viding equal access to health care for all, which include eight elements such as curative care, provision of essential drugs, health promotion, mother and child health, immunization, water and sanitation facilities, control of en-
74
demic diseases and capacity building. Participation of communities, decen-tralisation and sustainability are the key strategies or principals. Although there have been rapid changes in the last 30 years PHC is still valid and will play an important part to tackle diseases such as HIV/AIDS, TB, maternal health, mental health among others.
Public Health: It’s a science and art of preventing diseases, prolonging life and promoting health. Health systems, epidemiology, health services, health economics, environmental and social behaviour are some of the important sub-fi elds.
Quality: Degree to which of the stated results of a project or programme at the outputs, outcome and impact levels, are being or have been achieved.
Quantitative and Qualitative Approaches: Quantitative and qualitative research methods are complementary techniques. Th e choice of methods will depend on the availability of time, skills, technology, and resources. Quantitative methods refer to random sampling for survey research, struc-tured individual interviews for data collection and subsequent statistical analyses that allow the results to be considered representative, comparab-le and generalizable to a wider population. Qualitative methods refer to a spectrum of data collection and analysis techniques where sampling is not necessarily random and more in-depth, unstructured, open-ended eff orts are incorporated. Th is allows for in-depth analysis of social, political, and economic issues.
Rate: Th e number of events occurring per unit (e.g. number of births per year). In epidemiology rates are expressed as events per unit people and unit time e.g. fertility rate: number of children per woman per lifetime. Note that incidence rates refl ecting only new cases of a disease per unit people per unit time e.g. new HIV positive cases in pregnant women during the last 12 month.
Relevance: Th e appropriateness of project objectives to the problems that it was supposed to address, and to the physical and policy environment within which it operated.
75
Responsiveness: Project objectives are met according to the priorities of all stakeholders.
Sampling: Th e number of people, households, communities or other units of a population that have been selected in a systematic way.
Sensitivity: Often used for diagnostic quality control i.e. for the laboratory: the test are capturing the positive diagnosed cases (e.g. malaria or TB) as true positive.
Specifi city: Often used for diagnostic quality control i.e. for the laboratory: the test are capturing the negative diagnosed cases (e.g. malaria or TB) as true negative.
Stakeholder: People, groups, or institutions those are likely to be aff ected by a proposed Intervention (either negatively or positively), or those which can aff ect the outcome of the intervention. Examples of stakeholders inclu-de: client governments, the poor and other vulnerable groups (e.g. landless, women, children, indigenous people, and minority groups), other individu-als, families, communities or groups aff ected by the project or policy, and interested groups (donors, NGOs, religious and community organisations, local authorities, and private fi rms).
Stakeholder Analysis: Th e starting point of most participatory work and social assessments. It is used to develop an understanding of the power rela-tionships, infl uence and interests of the various people involved in an activi-ty, and to develop an appropriate plan for their participation.Strategic Monitoring: Analysis of monitoring and evaluation data or spe-cial studies to help assess lessons learned in terms of needed policy changes or larger scale adjustments of programming strategies.
Surveillance: Systematic collection, analysis and interpretation of health data; used for regular monitoring, early detection of outbreaks and outbreak control.
76
Sustainability: An attempt to ensure that the best or desirable outcomes will be maintained and continue into the future.
Transparency: Clarity and openness regarding activities and relationships.
Vector: Pathogens, organism, parasite, insects or others that is involved in the transmission of diseases (e.g. aedes aegypti, anopheles etc.).
8. References and web addresses
8.1 Health
Brownson, Ross C., Elizabeth A. Baker, Terry L. Leet, and Kathleen N. Gillespie, Editors. Evidence-Based Public Health. New York: Oxford Uni-versity Press, 2003.
Checci F and Roberts L. Interpreting and using mortality data in humani-tarian emergencies. London: Overseas Development Institute. 2005.
Connolly MA. Communicable disease control in emergencies. A fi eldma-nual. Geneva: World Health Organization, 2005.
Demographic and Health Surveys. Available at: http://www.measuredhs.com. Accessed 29.10.2007. Centre for Disease Control and Prevention (CDC) Atlanta. Famine-Aff ected, Refugee, and Displaced.
Populations: Recommendations for Public Health Issues. MMWR - Vol. 41, No. RR-13. Publication date: 07/24/1992. Available at: http://wonder.cdc.gov/wonder/prevguid/p0000113/p0000113.asp#head01200600000000. Accessed 05.09.2007.
European Commission. Aid Delivery Methods. Project Cycle Manage-ment. March 2004.
77
F. Checci, M. Gayer, R. Freeman Grais and E.J. Mills. Public Health incrisis aff ected populations. London: Overseas Development Institute, 2007.
Handbook for Emergencies (2nd edition). Geneva: UNHCR, 1999.
Harries AD, Maher D, Raviglione MC, Chaulet P, Nunn PP, Praag vanE. TB/HIV, A clinical manual. Geneva: WHO, 1996.
http://www.worldbank.org
Malaria control in complex emergencies: An Inter-Agency Field Hand-book. Geneva: WHO and the RBM Technical Support network, 2005.
Murray CJL. Towards good practice for health statistics: lessons from the Millenium Development Goal health indicators. Lancet 2007; 369:862-73.
Report on the analysis of “Quality Management” tools in the humanitar-ian sector and their application by NGO’s. Brussels: ECHO, 2002.
Salma P, Spiegel P, Talley L and Waldman R. Lessons learned fromcomplex emergencies over past decade. Th e Lancet, Vol 364, November 13. 2004.
Technical Guidelines for Humanitarian Assistance. Geneva: WHO, 2001. Available at www.who.int/hac/techguidance/tools/disrupted_sectors/mod-ule_01/en/print.html. Accessed 25.02.2008.
Th e SPHERE Project. Humanitarian Charter and Minimum Standards in Disaster Response. Geneva: 2004 Edition.
United Nations. World Mortality Report 2005. Department of Economic and Social Aff airs; Population Division. 2006.
78
WHO Bulletin online. Available at: http://www.who.int/bulletin/en/. Ac-cessed 15.03.2008.
WHO Health Action in Crisis Technical Guidelines. Available at http://www.who.int/hac/techguidance/en/. Accessed 15.03.2008.
WHO. Reproductive Health Indicators: guidelines for their generation, interpretation and analysis for global monitoring. 2006.
Yip R and Sharp TW. Acute malnutrition and high childhood mortality related to diarrhoea: lessons learned from the Kurdish refugee crisis. JAMA 1993; 270: 587-90.
Young H and Haspers S. Nutrition disease and death in times of famine. Disasters 1995; 19:94-109.
8.2 Reproductive Health
Minimum Initial Service package (MISP) for Reproductive health in Crisis Situations: A distance learning Module. Women’s Commission for Refugee Women and Children. Available at: http://misp.rhrc.org/.
ICW and Young Positives. 2008. Available at:http://www.unfpa.org/upload/lib_pub_fi le/815_fi lename_lnkages_rapid_tool.pdf.
Rapid Assessment Tool for Sexual &Reproductive Health and HIV linkages. A Generic Guide. Prepared and published by IPPF, UNFPA, WHO, UN-AIDS, GNP and ICW and Young Positives. 2008. Available at: http://www.unfpa.org/upload/lib_pub_fi le/815_fi lename_lnkages_rapid_tool.pdf.
79
Reproductive Health in Refugee Situations: An Inter-Agency Field Manual UNHCR/UNFPA/WHO, 1999. Available at:http://www.unfpa.org/emer-gencies/manual/.
Reproductive Health Kits for Crisis Situations, 3rd edition. New York: UN-FPA, 2004.
8.3 Sexual gender based violence (SGBV) and Mental Health
C. Lindsey-Curtet, F.T. Holst-Roness, L. Anderson. Addressing the Needs of Women Aff ected by Armed Confl ict: an ICRC Guidance. Geneva: ICRC, 2004. Available at: http://www.icrc.org/Web/Eng/siteeng0.nsf/htmlall/p0840/$File/ICRC_002_0840_WOMEN_GUIDANCE.PDF!Open.
Clinical management of survivors of rape. Geneva: WHO, UNHCR, 2004. Available at: http://www.unfpa.org/upload/lib_pub_fi le/373_fi lename_cli-nical-mgt-2005rev1.pdf.
Guidelines for Gender-based Violence Interventions in Humanitarian Set-tings. Inter Agency Standing Committee, Geneva, 2005.
Mental Health in Emergencies: Psychological and Social Aspects of Health of Populations exposed to extreme stressors. Geneva: WHO, 2003. http://www.who.int/mental_health/media/en/640.pdf.
Mental Health of Refugees. Geneva: WHO & UNHCR, 1996.
Sexual and Gender based Violence against Refugees, Returnees, and Inter-nally Displaced Persons. Geneva: UNHCR, 2003. Available at: http://www.rhrc.org/pdf/gl_sgbv03.pdf.
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8.4 Nutrition
Food and Nutrition Needs in Emergencies. Geneva, New York, Rome: UNHCR, UNICEF, WFP, WHO, 2004. Available at: http://whqlibdoc.who.int/hq/2004/a83743.pdf
H.Young and S. Jaspers. Th e meaning and measurement of acute malnu-trition in emergencies. A primer for decision-makers. London: Overseas Development Institute, 2006.
Management of severe malnutrition: a manual for physicians and other senior health workers. Geneva: WHO, 1999.
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82
Imprint:2009
Authors: Marie T. Benner, K. Peter SchmitzLayout: Esther Suchanek
Druck: LUTHE Druck und Medienservice KGPhotos: M.T. Benner, K.P. Schmitz, E. Suchanek,
Malteser International Published by Malteser International 2009
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