This table provides metadata for the actual indicator available from United States statistics closest to the corresponding global SDG indicator. Please note that even when the global SDG indicator is fully available from American statistics, this table should be consulted for information on national methodology and other American-specific metadata information.

Method of computation

Number of people receiving the intervention / Number of people who need the intervention

Method of measurement

Universal health coverage means that people receive the services they need, without incurring financial hardship. Countries progressively realize UHC according to their level of development, epidemiological situation, health system and people’s expectations. The indicators ideally cover promotion, prevention, treatment, rehabilitation and palliation. There are a number of indicators that all countries implement such as immunization coverage or skilled attendance at birth that can be used for a summary measure of progress that can be used at lgobal and regional and country levels. Countries however will also create their own set of indicators to track progress towards UHC. The selection of indicators is based on the initial framework, and was applied in the global report published in 2015 by WHO and the World Bank. This provides a basis for further improvements working alongside countries.

Method of estimation

The indicators can be expressed as a summary measure. These can be weighted according to indicator, or intervention area. Work on incorporating an equity component in the summary measure is ongoing but is possible in a relatively simple manner.

This table provides information on metadata for SDG indicators as defined by the UN Statistical Commission. Complete global metadata is provided by the UN Statistics Division.

Indicator

Indicator 3.8.1: Coverage of essential health services

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
Organisation

World Health Organization (WHO)

Definition and concepts

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).

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 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 younger than 5 years with symptoms of acute respiratory infection (cough and fast or difficult breathing due to a problem in the chest and not due to a blocked nose only) in the 2 weeks preceding the survey for whom advice or treatment was sought from a health facility or provider

II. Infectious diseases

5. Tuberculosis: Percentage of incident TB cases that are detected and treated

6. HIV/AIDS: Percentage of adults and children 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, sanitation and hygiene: Percentage of population using at least basic sanitation services.

III. Noncommunicable diseases

9. Hypertension: Prevalence of treatment (taking medicine) for hypertension among adults aged 30-79 years with hypertension (age-standardized estimate) (%)

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 currently using any tobacco product (smoked and/or smokeless tobacco) on a daily or non-daily basis (SDG indicator 3.a.1, metadata available here)

IV. Service capacity and access

12. Hospital access: Hospital beds density, 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)

Unit of measure

The indicator is an index reported on a unitless scale of 0 to 100.
Data sources

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 providers

In most cases, Ministries of Health and National Statistical Offices oversee data collection and reporting for health service coverage indicators.

Comment and limitations

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

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 standardizing 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, conversion and/or rescaling is required to obtain appropriate values from 0 to 100, as follows:

Conversion

The prevalence of tobacco use is converted into prevalence of tobacco non-use, so that an increase means an improvement.

Rescaling

  • Rescaling based on a non-zero minimum to obtain finer resolution (this “stretches” the distribution across countries): prevalence of non-use of tobacco is rescaled using a minimum value of 30%, which indicate a realistic range of prevalence levels for the indicator.

r e s c a l e d   t o b a c c o   n o n u s e   =   ( X - 30 ) / ( 100 - 30 ) * 100

  • Rescaling for a continuous measure: mean fasting plasma glucose, which is a continuous measure (units of mmol/L), is converted to a scale of 0 to 100 using the minimum theoretical biological risk (5.1 mmol/L) and observed maximum across countries (7.4 mmol/L).

r e s c a l e d   v a l u e   =   ( 7 . 4   -   o r i g i n a l   v a l u e )   /   ( 7 . 4 - 5 . 1 )   *   100

  • Maximum thresholds for rate indicators: hospital bed density and health workforce density are both capped at maximum thresholds, and values above this threshold are held constant at 100. These thresholds are based on minimum values observed across OECD countries (2015 edition of OECD Health Statistics Database).

r e s c a l e d   h o s p i t a l   b e d s   p e r   10 , 000   =   m i n i m u m   ( 100 ,   o r i g i n a l   v a l u e   /   18 * 100 )

r e s c a l e d   p h y s i c i a n s   p e r   1 , 000   =   m i n i m u m   ( 100 ,   o r i g i n a l   v a l u e   /   0 . 9 * 100 )

r e s c a l e d   p s y c h i a t r i s t s   p e r   100 , 000   =   m i n i m u m   ( 100 ,   o r i g i n a l   v a l u e   /   1 * 100 )

r e s c a l e d   s u r g e o n s   p e r   100 , 000   =   m i n i m u m   ( 100 ,   o r i g i n a l   v a l u e   /   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 or beyond 100, it is set to 1 (out of 100) or 100 (out of 100) respectively 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.

Metadata update

2023-12-15
International organisations(s) responsible for global monitoring

World Health Organization (WHO)

Related indicators

The universal health coverage (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.

Indicator 3.8.1 should always be interpreted together with the other SDG UHC indicator, 3.8.2, which measures financial protection.
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