This section provides metadata for the data reported for this indicator at the national level and at the global level.
- Goal
Goal 3: Ensure healthy lives and promote well-being for all at all ages
- Target
Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all
- Indicator
Indicator 3.8.1: Coverage of essential health services
- Series
- Related indicators
The UHC service coverage index is designed to summarize existing indicators of health service coverage to ensure consistency with the SDGs and other global initiatives and reduce duplication and reporting burden. Currently, two other SDG indicators are included in the index (3.a.1 and 3.d.1).
Indicator 3.8.1 should always be interpreted together with the other SDG UHC indicator, 3.8.2, which measures financial protection.
- Custodian agencies
World Health Organization (WHO)
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Organisation | Not available for this indicator |
World Health Organization (WHO)
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Contact email address | Not available for this indicator |
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Definition and concepts | Not available for this indicator |
Definition: Coverage of essential health services (defined as the average coverage of essential services based on tracer interventions that include reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases and service capacity and access, among the general and the most disadvantaged population).
The indicator is an index reported on a unitless scale of 0 to 100, which is computed as the geometric mean of 14 tracer indicators of health service coverage.
Concepts: The index of health service coverage is computed as the geometric means of 14 tracer indicators. The 14 indicators are listed below and detailed metadata for each of the components is given in Annex 1. The tracer indicators are as follows, organized by four broad categories of service coverage:
I. Reproductive, maternal, newborn and child health 1. Family planning: Percentage of women of reproductive age (15−49 years) who are married or in-union who have their need for family planning satisfied with modern methods 2. Pregnancy and delivery care: Percentage of women aged 15-49 years with a live birth in a given time period who received antenatal care four or more times 3. Child immunization: Percentage of infants receiving three doses of diphtheria-tetanus-pertussis containing vaccine 4. Child treatment: Percentage of children under 5 years of age with suspected pneumonia (cough and difficult breathing NOT due to a problem in the chest and a blocked nose) in the two weeks preceding the survey taken to an appropriate health facility or provider
II. Infectious diseases 5. Tuberculosis: Percentage of incident TB cases that are detected and treated 6. HIV/AIDS: Percentage of people living with HIV currently receiving antiretroviral therapy 7. Malaria: Percentage of population in malaria-endemic areas who slept under an insecticide-treated net the previous night [only for countries with high malaria burden] 8. Water and sanitation: Percentage of households using at least basic sanitation facilities
III. Noncommunicable diseases 9. Hypertension: Age-standardized prevalence of non-raised blood pressure (systolic blood pressure <140 mm Hg or diastolic blood pressure <90 mm Hg) among adults aged 18 years and older 10. Diabetes: Age-standardized mean fasting plasma glucose (mmol/L) for adults aged 18 years and older 11. Tobacco: Age-standardized prevalence of adults >=15 years not smoking tobacco in last 30 days (SDG indicator 3.a.1, metadata available here)
IV. Service capacity and access 12. Hospital access: Hospital beds per capita, relative to a maximum threshold of 18 per 10,000 population 13. Health workforce: Health professionals (physicians, psychiatrists, and surgeons) per capita, relative to maximum thresholds for each cadre (partial overlap with SDG indicator 3.c.1, see metadata here) 14. Health security: International Health Regulations (IHR) core capacity index, which is the average percentage of attributes of 13 core capacities that have been attained (SDG indicator 3.d.1, see metadata here)
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Unit of measure | Not available for this indicator |
Index. |
Classifications | Not available for this indicator |
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Data sources | Not available for this indicator |
Many of the tracer indicators of health service coverage are measured by household surveys. However, administrative data, facility data, facility surveys, and sentinel surveillance systems are utilized for certain indicators. Underlying data sources for each of the 14 tracer indicators are explained in more detail in Annex 1.
In terms of values used to compute the index, values are taken from existing published sources. This includes assembled data sets and estimates from various UN agencies. This is summarized in the above link. |
Data collection method | Not available for this indicator |
The mechanisms for collecting data from countries vary across the 14 tracer indicators, however in many cases a UN agency or interagency group has assembled and analysed relevant national data sources and then conducted a formal country consultation with country governments to review or produce comparable country estimates. For the UHC service coverage index, once this existing information on the 14 tracer indicators is collated, WHO conducts a country consultation with nominated focal points from national governments to review inputs and the calculation of the index. WHO does not undertake new estimation activities to produce tracer indicator values for the service coverage index; rather, the index is designed to make use of existing and well-established indicator data series to reduce reporting burden. |
Data collection calendar | Not available for this indicator |
Data collection varies from every 1 to 5 years across tracer indicators. For example, country data on immunizations and HIV treatment are reported annually, whereas household surveys to collect information on child treatment may occur every 3-5 years, depending on the country. More details about individual tracer indicators are available in Annex 1. |
Data release calendar | Not available for this indicator |
The first release of baseline values for the UHC service coverage index took place in December 2017. Updates are released every two years. |
Data providers | Not available for this indicator |
In most cases, Ministries of Health and National Statistical Offices oversee data collection and reporting for health service coverage indicators. |
Data compilers | Not available for this indicator |
The World Health Organization, drawing on inputs from other international agencies. |
Institutional mandate | Not available for this indicator |
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Rationale | Not available for this indicator |
Target 3.8 is defined as “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”. The concern is with all people and communities receiving the quality health services they need (including medicines and other health products), without financial hardship. Two indicators have been chosen to monitor target 3.8 within the SDG framework. Indicator 3.8.1 is for health service coverage and indicator 3.8.2 focuses on health expenditures in relation to a household’s budget to identify financial hardship caused by direct health care payments. Taken together, indicators 3.8.1 and 3.8.2 are meant to capture the service coverage and financial protection dimensions, respectively, of target 3.8. These two indicators should be always monitored jointly.
Countries provide many essential services for health protection, promotion, prevention, treatment and care. Indicators of service coverage – defined as people receiving the service they need – are the best way to track progress in providing services under universal health coverage (UHC). Since a single health service indicator does not suffice for monitoring UHC, an index is constructed from 14 tracer indicators selected based on epidemiological and statistical criteria. This includes several indicators that are already included in other SDG targets, thereby minimizing the data collection and reporting burden. The index is reported on a unitless scale of 0 to 100, with 100 being the optimal value. |
Comments and limitations | Not available for this indicator |
These tracer indicators are meant to be indicative of service coverage, not a complete or exhaustive list of health services and interventions that are required for universal health coverage. The 14 tracer indicators were selected because they are well-established, with available data widely reported by countries (or expected to become widely available soon). Therefore, the index can be computed with existing data sources and does not require initiating new data collection efforts solely to inform the index. |
Method of computation | Not available for this indicator |
The index is computed with geometric means, based on the methods used for the Human Development Index. The calculation of the 3.8.1 indicator requires first preparing the 14 tracer indicators so that they can be combined into the index, and then computing the index from those values.
The 14 tracer indicators are first all placed on the same scale, with 0 being the lowest value and 100 being the optimal value. For most indicators, this scale is the natural scale of measurement, e.g., the percentage of infants who have been immunized ranges from 0 to 100 percent. However, for a few indicators additional rescaling is required to obtain appropriate values from 0 to 100, as follows:
rescaled non raised blood pressure = (X-40) / (100-40) * 100 rescaled tobacco non-use = (X-30)/(100-30)*100
rescaled value = (7.1 - original value) / (7.1-5.1) * 100
rescaled hospital beds per 10,000 = minimum (100, original value / 18*100) rescaled physicians per 1,000 = minimum (100, original value / 0.9*100) rescaled psychiatrists per 100,000 = minimum (100, original value / 1*100) rescaled surgeons per 100,000 = minimum (100, original value / 14*100)
Once all tracer indicator values are on a scale of 0 to 100, geometric means are computed within each of the four health service areas, and then a geometric mean is taken of those four values. If the value of a tracer indicator happens to be zero, it is set to 1 (out of 100) before computing the geometric mean. The following diagram illustrates the calculations.
Note that in countries with low malaria burden, the tracer indicator for use of insecticide-treated nets is dropped from the calculation.
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Adjustments | Not available for this indicator |
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Treatment of missing values (i) at country level and (ii) at regional level | Not available for this indicator |
The starting point for computing the index is to assemble existing information for each tracer indicator. In many cases, this involves using country time series that have been produced or collated by UN agencies in consultation with country governments (e.g., immunization coverage, access to sanitation, HIV treatment coverage, etc). Some of these published time series involve mathematical modelling to reconcile multiple data sources or impute missing values, and these details are summarized in Annex 1.
After assembling these inputs, there are still missing values for some country-years for some indicators. Calculating the UHC service coverage index requires values for each tracer indicator for a country, so some imputation is necessary to fill these data gaps. The current approach involves a simple imputation algorithm. For each indicator:
Given the timing and distribution of various health surveys and other data collection mechanisms, countries do not collect and report on all 14 tracer indicators of health service coverage on an annual basis. In addition, monitoring at country level is most suitably done at broader time intervals, e.g., every 5 years, to allow for new data collection across indicators. Therefore, the extent to which imputation has been used to fill missing information should be communicated along with the index value.
Any needed imputation is done at country level. These country values can then be used to compute regional and global ones. |
Regional aggregations | Not available for this indicator |
Regional and global aggregates use United Nations population estimates at the country level to compute a weighted average of country values for the index. This is justified because UHC is a property of countries, and the index of essential services is a summary measure of access to essential services for each country’s population. United Nations population estimates at country level are used to ensure consistency and comparability of estimates within countries and between countries over time. |
Methods and guidance available to countries for the compilation of the data at the national level | Not available for this indicator |
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Quality management | Not available for this indicator |
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Quality assurance | Not available for this indicator |
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Quality assessment | Not available for this indicator |
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Data availability: Summarizing data availability for the UHC service coverage index is not straightforward, as different data sources are used across the 14 tracer indicators. Additionally, for many indicators comparable estimates have been produced, in many cases drawing on different types of underlying data sources to inform the estimates while also using projections to impute missing values. Time series: A baseline value for the UHC service coverage index for 2015 across 183 countries was published in late 2017. As part of this process, data sources going back to 2000 were assembled. In 2019, UHC service coverage index were estimates for the years: 2000, 2005, 2010, 2015 and 2017. In 2021, the index is estimated for all years from 2000 to 2019 and for all countries. Disaggregation: Equity is central to the definition of UHC, and therefore the UHC service coverage index should be used to communicate information about inequalities in service coverage within countries. This can be done by presenting the index separately for the national population vs disadvantaged populations to highlight differences between them.
For countries, geographic location is likely the most feasible dimension for sub-national disaggregation based on average coverage levels measured with existing data sources. To do this, the UHC index can be computed separately by, e.g., province or urban vs rural residence, which would allow for subnational comparisons of service coverage. Currently, the most readily available data for disaggregation on other dimensions of inequality, such as household wealth, is for indicators of coverage within the reproductive, maternal, newborn and child health services category. Inequality observed in this dimension can be used as a proxy to understand differences in service coverage across key inequality dimensions. This approach should be replaced with full disaggregation of all 14 tracer indicators once data are available to do so. |
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Sources of discrepancies: The service coverage index draws on existing, publicly available data and estimates for tracer indicators. These numbers have already been through a country consultation process (e.g., for immunization coverage), or are taken directly from country reported data. |
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URL: http://www.who.int/healthinfo/universal_health_coverage/en/
References: http://www.who.int/healthinfo/universal_health_coverage/report/2017/en/ http://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(17)30472-2.pdf http://www.who.int/healthinfo/universal_health_coverage/en/ For historical development of methods, see: http://www.who.int/healthinfo/universal_health_coverage/UHC_WHS2016_TechnicalNote_May2016.pdf?ua=1 (superseded by this document) http://www.who.int/healthinfo/universal_health_coverage/report/2015/en/ http://www.who.int/healthinfo/universal_health_coverage/report/2014/en/ http://collections.plos.org/uhc2014
Annex 1: Metadata for tracer indicators used to measure the coverage of essential health services for monitoring SDG indicator 3.8.1. Please send any comments or queries to: uhc_stats@who.int
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