Table 1.
| Health facility level indicator | ||||
|---|---|---|---|---|
| No | Indicator | Source of data | Reporting frequency | Health system considerations |
| 1 | Six‐monthly control of blood pressure among people treated for hypertension | Hypertension treatment register in the facility | Once in 3 mo | Feasible in all settings in primary health care and a core indicator for quality of services |
| Subnational (District/Province/State)‐level aggregated indicators from health facilities offering the services within the program | ||||
|---|---|---|---|---|
| Indicator | Source of data | Reporting frequency | Considerations in the interpretation | |
| 2 | Control of blood pressure among people with hypertension within the program | Aggregated reports from all the health facilities reporting the hypertension indicator in a defined subnational area; estimation of hypertension prevalence | Once in 12 mo | This will give estimated community control rates with the numerator coming from facilities reporting as part of the program (in some instances patients maybe receiving BP meds from private sector or other levels of care within the public system) |
| 3 | Availability of core cardiovascular disease/diabetes drugs | Aggregated reports from all the health facilities reporting drug availability indicators in a defined subnational area. | Once in 3 mo | This is for the program quality control and will assist with forecasting of medicines and improvements in supply chain management |
| Population‐level indicators of control of hypertension, diabetes, and CVD risk | ||||
|---|---|---|---|---|
| Indicator | Survey method | Frequency | Other considerations | |
| 4 | Hypertension control in the population | Population‐based sample survey (STEPS or similar survey) | Once in 3‐5 y | Population‐level survey as part of national survey or a special survey for the program |
| 5 | Proportion of eligible persons receiving drug therapy and counseling (including glycaemic control) to prevent heart attacks and stroke. | Population‐based sample survey (STEPS or similar survey) | Once in 5 y | Population‐based (preferably nationally representative) survey including behavioral parameters with physical and biochemical measurements |
| 1. Six‐monthly control of blood pressure among people treated for hypertension | |
| Definition | Proportion of patients registered for hypertensive treatment at the health facility whose blood pressure is controlled 6 mo after treatment initiation |
| Purpose | To measure the effectiveness of clinical services in the program to control blood pressure among cohorts of treated patient |
| Method of calculation | A = Number of patients with controlled blood pressure (SBP < 140 and DBP < 90) at the last clinical visit in the most recent quarter (just before the reporting quarter) out of BB = Number of patients registered for treatment of hypertension during the quarter that ended 6 mo previouslyCalculation: A ÷ B |
| Source of data | Health facility register for hypertension |
| Recommended target | Fix a target as per the local context |
| Key data elements | Date of registration, date of last visit, systolic blood pressure, diastolic blood pressure |
| Frequency of reporting | Quarterly |
| Users of data | Facility managers: to understand what proportion of patients at their facility are achieving the blood pressure goalDistrict‐level manager: to assess the overall quality of hypertension treatment services, to identify poorly performing facilities and rectify problems at an early stage |
| Data collection tool | Facility register for hypertension‐Annex 2 included in WHO module (Available at http://www.who.int/cardiovascular_diseases/hearts/en/) |
| 2. Control of blood pressure among people with hypertension | |
| Definition | The proportion of hypertensive people at health facilities in a given geographical area such as a district, province, or state with controlled blood pressure |
| Purpose | To measure the increase in coverage of the program to treat and control hypertension in a given geographical area such as a district, province, or state |
| Method of calculation | A = Cumulative number of registered patients with controlled blood pressure (SBP < 140 and DBP < 90) in the most recent quarter at all health facilities in a given geographical area, such as a district, province, or state.B = Estimated number of people with hypertension at the subnational level.Calculation: A ÷ B |
| Source of data | Numerator: Registers from health facilities reporting in the given geographical area such as a district, province, or stateDenominator: Prevalence of hypertension from population‐ based survey (STEPS or similar survey) |
| Disaggregated by | Health facility |
| Recommended target | Fix a target as per local context |
| Key data elements | Date of last visit, systolic blood pressure, diastolic blood pressure |
| Frequency of reporting | Annual |
| Users of data | District, province, or state program managers to monitor increase in program coverage of hypertension services within a geographical area.National program managers to monitor progress towards universal health coverage |
| Data collection tool example | Health facility register for hypertension Annex 2 WHO Module.Health facility report – Annex 3 included in WHO module (Available at http://www.who.int/cardiovascular_diseases/hearts/en/) |
| 3. Availability of core cardiovascular disease/diabetes drugs | |
| Definition | The proportion of facilities in a given geographical area that have core CVD/diabetes drugs available (see list of drugs below) |
| Purpose | To ensure uninterrupted supply of essential CVD drugs and thereby improve patient treatment adherence |
| Method of calculation | A = number of health facilities in the program reporting “no stock‐out” of core CVD/Diabetes Mellitus drugs in the last quarterB = Number of health facilities participating in the program.Calculation: A ÷ B |
| Source of data | Aggregated health facility drug stock register; health facility report |
| Disaggregated by | Health facility |
| Recommended target | No stock‐out |
| Key data elements | Count of number of facilities reporting “no drug stock‐out” in the last quarter; number of days of drug stock‐out of selected medicine at each health facility |
| Frequency of reporting | Quarterly |
| Users of data | District‐ and province‐level managers to focus supervision on health facilities reporting drug stock‐outs, prevent drug stock‐out situations and strengthen health systems to ensure uninterrupted drug supply |
| Data collection tool example | Health facility report – Annex 3 included in WHO (Available at http://www.who.int/cardiovascular_diseases/hearts/en/) |
| Core CVD/DM drugs are thiazide or thiazide‐like diuretics, long acting dihydropyridine calcium channel blocker (CCB; eg, amlodipine), long acting angiotensin converting enzyme inhibitor (ACE‐I), and angiotensin receptor blocker (ARB), statin, insulin, metformin, glibenclamide, beta‐blocker, aspirin. | |
| 4. Hypertension control in the population | |
| Definition | Proportion of all hypertensive people with controlled blood pressure in the population |
| Purpose | To measure population‐level hypertension control, including trends over time |
| Method of calculation | A = Number of respondents with SBP < 140 and DBP < 90 who are EITHER (being currently treated with medications for hypertension OR have been diagnosed with hypertensionB = Number of survey respondents with SBP ≥ 140 or DBP ≥ 90 OR who are currently treated with medicines for hypertension OR who report having been diagnosed with hypertension by a health professionalCalculation: A ÷ B |
| Source/Methodology | Population‐based sample survey (National or subnational health survey. |
| Disaggregated by | Age, sex, socio‐economic status |
| Frequency of reporting | Once in 3‐5 y |
| Users of data | National policy makers to measure progress toward universal health coverage, formulate national health policies, allocate programmatic budgetGlobal policy makers to compare progress in UHC across countries |
| Data collection tool example | http://www.who.int/ncds/surveillance/steps/en/ |
| 5. Proportion of eligible persons receiving drug therapy and counseling (including glycaemic control) to prevent heart attacks and strokes | |
| Definition | Percentage of eligible persons (defined as aged 40 y and older with a 10 y cardiovascular disease (CVD) risk ≥30%, including those with existing CVD) receiving drug therapy and counseling (including glycaemic control) to prevent heart attacks and strokes |
| Purpose | To measure change in population‐level CVD‐risk management |
| Method of calculationa | A = Number of eligible survey participants who are receiving drug therapy and counselingbB = Total number of eligible survey participants. (Defined as aged 40 y and older with a 10‐y cardiovascular risk ≥30%, including those with existing cardiovascular disease)Calculation: A ÷ B |
| Source/methodology | This is generated from population‐based surveys such as a population‐based sample survey (STEPS or similar survey) |
| Disaggregated by | Age, sex, socio‐economic status |
| Recommended target | 5% increase every year |
| Frequency of reporting | Once in 5 y |
| Users of data | National policy makers to measure progress towards NCD global action plan targetsGlobal policy makers to compare progress in NCD global action plan targets across countries |
| Data collection tool example | http://www.who.int/ncds/surveillance/steps/en/ |
| Users of data | National policy makers to measure progress towards NCD global action plan targetsGlobal policy makers to compare progress in NCD global action plan targets across countries |
| Data collection tool example | http://www.who.int/ncds/surveillance/steps/en/ |
| 6. Proportion of people with hypertension who are registered | |
| Definition | Proportion of people in the catchment area (clinical facility, municipality, district) who have been registered as hypertensive based on the best estimate of expected prevalence in the catchment area or larger geographical unit in a specific period of time (month, quarter, year) |
| Purpose | To measure the capacity and effectiveness of the program to recruit/diagnose and register all people with hypertension |
| Method of calculation | A = Number of adult patients who have been registered as diagnosed with hypertension (>140 mm Hg and >90 mm Hg or taking medications) in the catchment area in a specific period of time (month, quarter, year)B = Expected number of adults with hypertension based on best estimate of age‐adjusted prevalence of hypertension (based on physical measures surveys) in the catchment area in a specific period of time (month, quarter, year)Calculation: A ÷ B* 100 |
| Source of data | Health facility register for hypertension AND physical measures surveys |
| Key data elements | For numerator: Date of registration, number of people registered as hypertensive, sex, age group, (other demographic and socio‐economic dimensions, if available), period of time (month, quarter, year)For denominator: age adjusted number of people with hypertension in the region in a specified period of time |
| Frequency of reporting | Month, Quarterly, Year |
| Users of data | Facility managers: to understand what proportion of patients with hypertension based on the best estimate of expected prevalence at their facility are being recruited and registeredDistrict‐level manager: to assess the overall quality of hypertension programs and services, to identify poorly performing facilities and rectify problems at an early stageRegistry coverage is well aligned with at least 2 important concepts: 1. Territoriality or geographically based coverage as an important organizational characteristic of a health system based on primary health care, and 2. universal health care, both in access and coverage. Therefore, registry coverage is an actionable indicator to guide program implementation, as it is critical to improve control at population level and to reduce the burden of CVD. |
| Data collection tool | Hypertension facility registry – Annex 2 included in WHO module (Available at http://www.who.int/cardiovascular_diseases/hearts/en/) |
*The tables are identical to those in the HEARTs Module except for indicator 6, which is a PAHO‐WHL core indicator.
a
Feasible in settings that have a comprehensive population‐based survey with behavioral parameters along with physical and biochemical measurements.
b
More information on the indicator is available at http://www.who.int/nmh/ncd-tools/indicators/GMF_Indicator_Definitions_Version_NOV2014.pdf.
Use of the term “eligible persons” does not imply that others should not receive treatment. Jurisdictions may wish to consider analyses, which include persons at high risk as defined by the jurisdiction, and analyzing control of, rather than taking medicine for hypertension.