Number of outpatient department visits per 10,000 population per year
The number of outpatient visits to health facilities during one year relative to the total population of the same geographical area. Health facilities include all public, private, non-governmental and community-based health facilities in which general health services are offered.
This indicator is calculated as:
(Number of visits to health facilities for ambulant care (not including immunization) / Total population for the same geographical area)
The ratio can be adjusted to per 10,000 population by multiplying the numerator and denominator by the same factor required for the denominator to equal 10,000.
This indicator is selected from the list of core indicators in the WHO Health System Strengthening (HSS) Handbook. For more background on the process and criteria used in developing the WHO Handbook of indicators for HSS and for details on this and related indicators, see WHO (2010)USAID (2009) and The Global Fund (2009).
Data can be collected from health facility records, health information systems (HIS), and population-based surveys. A comprehensive facility survey instrument called the Service Provision Assessment (SPA) has been developed by USAID and Macro International Inc. to be used with nationally representative samples of health facilities to provide information on the characteristics of health services, inclu(ding their quality, infrastructure, utilization and availability MEASURE DHS, 2011; WHO, 2010). The accuracy and completeness of reporting need to be consistent over time and between populations to allow assessment of trends and comparisons. Data can be disaggregated by type of facility, districts,age group and sex.
If targeting and/or linking to inequity, disaggregate by relevant demographic and socioeconomic factors related to poverty-related inequities such as location (poor/not poor, urban/rural) and income.
Facility records, HIS; population-based surveys; facility sample surveys, such as the SPA.
This standardized indicator shows the levels of utilization of outpatient healthcare services and can be employed to examine trends and variations in use of services by type of facility and healthcare service, geographic districts and urban/rural locations, and will allow comparisons between countries and programs. These data can assist in planning, advocacy, and data from multiple time points will allow for monitoring progress in scaling-up health services and overall HSS (WHO, 2010). The primary aim of HSS is to improve access, quality, and utilization, and growing evidence shows that health systems capable of delivering services equitably, efficiently, and in a coordinated manner are essential for achieving improved health outcomes.
There has been a shift in the global health agenda from focusing on disease-specific approaches to emphasizing HSS to improve the effectiveness of national and district-level health ministries and programs. Strengthening outpatient service delivery and increasing utilization are fundamental to the achievement of the health-related Millennium Development Goals, which include: #4 reduce child mortality; #5 improve maternal health; and # 6 combat HIV/AIDS, tuberculosis and malaria.
The number of outpatient visits does not measure actual numbers of people utilizing services since individuals may make repeated visits. The volumes of visits at outpatient facilities do not serve as a coverage indicator because the population in need is not well defined. However, low rates are indicative of poor availability and quality of services. For example, several countries have demonstrated that outpatient department rates go up when barriers to using health services are removed, such as by bringing services closer to the people or reducing user fees (WHO, 2010). On the other hand, “higher than normal” rates of outpatient visits may signify problems such as lack of available hospital beds or lack of trained staff or available commodities for providing appropriate care and treatment for clients who should actually be receiving inpatient care.
access, health system strengthening (HSS)
The Global Fund, 2009, Monitoring and Evaluation Toolkit: HIV, Tuberculosis and Malaria and Health Systems Strengthening, http://www.hivpolicy.org/Library/HPP000485.pdf
MEASURE DHS. 2011, Service Provision Assessments (SPA) Survey Overview, DHS Website http://www.measuredhs.com/What-We-Do/Survey-Types/SPA.cfm
USAID, 2009, Measuring the Impact of Health Systems Strengthening, A Review of the Literature, Washington, DC: USAID. https://www.researchgate.net/publication/274064201_Measuring_the_Impact_of_Health_Systems_Strengthening_A_Review_of_the_Literature
WHO, 2010, Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies, Geneva: WHO. http://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf