1.1 What is monitoring?
Policies are created with the intent of improving the status quo. When there is a
condition in a population that needs to be improved, a policy or programme is
created to address it. However, it is sometimes difficult to judge whether policies
and programmes accomplish the goals they set out to achieve.
Monitoring is a process that can help to determine the impact of policies, programmes
and practices, and subsequently, to indicate whether change is needed. Generally
speaking, monitoring is the process of repeatedly answering a given study question
over time. In the world of policy, the study question usually pertains to the measurement
of a condition that a policy seeks to impact. In this context, monitoring is useful and
necessary as it has the ability to track policy outcomes over time and provides a
means of evaluating the need for policy change. Once a policy has been changed,
subsequent monitoring is necessary to evaluate the outcomes of the new policy, and
thus monitoring should be an iterative and cyclical process that operates continuously.
While monitoring can help policy-makers identify success or problem areas, monitoring
alone cannot typically explain the cause of troublesome trends. Rather, monitoring
may be thought of as a warning system. In the case of health, monitoring picks up
trends in health and allows policy-makers to target further research in those areas to
determine the root cause of problems. Ongoing monitoring may identify subpopulations
that are experiencing adverse trends in health. Thus, monitoring activities can both
inform and direct research in a given area. While this handbook is primarily focused
on one type of monitoring – health inequality monitoring – a general knowledge of
monitoring can be applied to any field where a study question can be repeatedly
asked and answered.
1.2 What is involved in health monitoring?
Cycle of health monitoring
Health monitoring is the process of tracking the health of a population and the health
system that serves that population. In general, health monitoring is a cyclical process,
as shown in Figure 1.1. The process begins by identifying health indicators that are
relevant to the study question at hand, and then continues with the task of obtaining
data about those health indicators. Data are then analysed to generate information,
evidence and knowledge. Depending on the question at hand, the process of analysing health data can be as simple as creating overall summary statistics about
the population’s health, or it can involve more complex statistical analyses. Following
analysis, it is essential to report and disseminate the results so that they can be used
to inform policy. Reporting can come in many forms, ranging from internal memos to
press releases, technical reports and academic publications, each including various
methods of presenting data (such as tables, graphs, maps or text). The goal should
be to ensure that the results of the monitoring process are communicated effectively,
and can be used to inform policies, programmes and practice. Selecting the most
salient data to be presented in their clearest form is paramount in achieving this goal.
Based on monitoring results, changes may be implemented that will impact and
improve the health of the population. (This final stage will not be covered extensively
in the handbook, but will be discussed briefly later in this section.) In order to monitor
the effects of these changes, more data must be collected that describe the ongoing
health of the population; thus, the cycle of monitoring is continuous.
Health indicators
In health monitoring, the general concept of health can be construed broadly to
encompass indicators of all measurable aspects of health and the health sector.
The World Heath Organization’s monitoring, evaluation and review framework organizes
health indicators into four components: inputs and processes, outputs, outcomes
and impact (Figure 1.2).
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