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Standardized health survey modules

Around the world, household surveys are an essential vehicle for the collection of information on health outcomes, determinants, utilization of health services and coverage of interventions. Household surveys also allow disaggregation of information by equity stratifiers to measure distribution of risks, outcomes and interventions. Surveys provide an affordable and a highly reliable method to gain insight into many different health trends, determinants and inequalities that exist within countries. In fact, for many indicators, household surveys are the only way to obtain information.

In the MDG era, much of the data collection focused on interventions and outcomes related to communicable diseases, nutritional deficiencies and reproductive health. This agenda will continue to be important but at the same time the importance of noncommunicable conditions and injuries has increased rapidly in all regions of the world. This health transition is influencing the discussions on health goals in the post-2015 development agenda, which should address the unfinished MDG agenda, as well as chronic diseases, mental health and injuries, and universal health coverage (UHC). This implies that survey instruments, be it through special health surveys or health modules in socio-economic surveys, will have to cover a broader array of health indicators in the coming decade in all countries. Standardized household survey modules should cover health interventions and risk factors for all priority health conditions, as well as include comprehensive assessments of mortality, health and responsiveness. As countries progressively move towards realizing UHC, it will be important to agree on a set of survey modules that can be used by countries and regional and global survey programs.

This paper proposes a framework for tracking country and global progress towards universal health coverage. Its aim is to inform and guide these discussions and assessments of both aggregate and equitable coverage of essential health services as well as financial protection.

WHO has collaborated with international and multilateral partners and countries to move towards agreement on a global reference list of core health indicators that the global community prioritizes for the purposes of monitoring global progress, maintaining program support and advocating for resources and funding. This list was developed from existing recommended lists that have been proposed in the context of international governing bodies and fora, global and regional health initiatives, technical reference groups and programs.
Project status: Open. The project will run for an initial period of 12 months from January 2014 to December 2014.
Sponsor(s): DFID Trust Fund No TF011722 administered by the World Bank, Development Data Group (WB-DECDG), World Health Organization (WHO) and the World Bank
Implemented by: The project, led by WHO, is implemented jointly by WHO, the World bank and other IHSN member agencies with support of individual consultants A group of experts from multiple agencies will contribute to the project by participating in an expert group meeting.
Type of output: Report on assessment of health modules in existing surveys, and recommendations for improved survey modules (with interviewers' instructions)

IHSN plans to work with WHO and other partners on this agenda as household surveys are the source of many health statistics on population health outcomes, risk factors, and service utilization and allow disaggregation of the results by socio-economic position, gender and other key equity variables.

Developing a common set of questions is essential to obtain comparable data and to enhance the reliability and validity of survey questions. This will improve the quality of data and facilitate the rapid production of results and reports. Furthermore, systematic review of questions and modules is likely to lead to testing of existing and new questions and dropping of questions that have limited information value or suffer persistent measurement problems. Short and long versions of the same module can also be considered and a grading of the strength of evidence for reliability and validity of questions can be assessed. This may have specific cross cultural elements and mean that harmonised questions will require testing before surveys are fielded in countries with a variety of spoken languages.

There are many distinct modules used in health surveys to generate data on different aspects of mortality, health and disease. A suite of survey modules that meet international standards and only include reliable and valid interview questions and biological tests should form the basis of a health survey programme anywhere in the world. Such a set of modules should cover the whole array of priority health issues, non-communicable and communicable diseases, acute and chronic conditions, and the health of children, adults and the older population. If a country had a regular, e.g. bi-annual, health survey programme, this could become the vehicle for flexible implementation of such modules, influenced by national and international data needs and measurement considerations. Inclusion of modules into economic and other surveys is an additional possibility but will remain of limited scope given the complexity of health surveys.

The establishment of norms and standards for health survey modules and questions will enhance quality and comparability, demonstrate validity, minimize the use of poorly tested questions and modules, and facilitate flexible implementation of survey modules to meet country needs.

The documents found in the related resources below are DRAFT reviews of existing survey modules, prepared as input for discussions by a group of experts convened in Washington, DC on November 19-20.