PERCENT OF POPULATION WITH ACCESS TO PRIMARY HEALTH CARE FACILITIES

PERCENT OF POPULATION WITH ACCESS TO PRIMARY HEALTH CARE FACILITIES
Social	Health	Healthcare Delivery

1. INDICATOR

(a) Name: Percentage of Population with Access to Primary Health Care Facilities.

(b) Brief Definition: Proportion of population with access to primary health care facilities.

2. Policy Relevance

(a) Purpose: To monitor progress in the access of the population to primary health care.

(b) Relevance to Sustainable/Unsustainable Development (theme/sub-theme): Accessibility of health services, going beyond just physical access, and including economic, social and cultural accessibility and acceptability, is of fundamental significance to reflect on health system progress, equity and sustainable development. It should, however, be supplemented by indicators of utilization of services, or actual coverage, and quality of care. In addition, accessibility is an instrumental goal, a means to an end, to achieving the final intrinsic goals of the system. The more accessible a system is, the more people should utilize it to improve their health.

(c) International Conventions and Agreements: World Health Assembly Resolution WHA34.36, Global Strategy for Health for All by the Year 2000.

(d) International Targets/Recommended Standards: International targets have been outlined in the Global Strategy for Health for All and more recently in the Ninth General Programme of Work. In addition, many countries have established national targets.

(e) Linkage to Other Indicators: This indicator is associated with other socioeconomic indicators on the proportion of people covered by other essential elements of primary health care. It should also, as indicated above, be linked with indicators of utilization of services and quality of care.

3. Methodological Description

(a) Underlying Definitions and Concepts:

(i) Primary health care: is essential health care made accessible at a cost the country and community can afford, with methods that are practical, scientifically sound and socially acceptable.

(ii) Population covered: All the population living in the service area of the health facility.

(iii) Access: Definition of accessibility may vary between countries, for different parts of the country and for different types of services.

(b) Measurement Methods: The numerator - the number of persons living within a convenient distance to primary care facilities; the denominator - the total population.

(c) Limitations of the Indicator: The existence of a facility within reasonable distance is often used as a proxy for availability of health care. If the existing primary care facility, however, is not properly functioning, provides care of inadequate quality, is economically not affordable, and socially or culturally not acceptable, physical access has very little value as this facility is bypassed and not utilized. Therefore, other factors, as mentioned in 3(e) have to be taken into account.

(d) Status of the Methodology: Not Available.

(e) Alternative Definitions/Indicators: In the light of 3(c) the indicator must be supplemented by indicators of availability of services, quality of services, acceptability of services, affordability of services, or utilization of services.

4. Assessment of Data

(a) Data Needed to Compile the Indicator: The number of people with access to primary health care facilities, total population in service areas of health facilities.

(b) National and International Data Availability and Sources: No routinely available data. Information has to be acquired through surveys. Data Sources include Ministries of Health and National Statistical Offices.

5. Agencies Involved in the Development of the Indicator

(a) Lead Agency: The lead agency is the World Health Organization (WHO). The contact point is the Director, Department of Organization of Health Services Delivery, fax: 41 22 791 4747.

(b) Other Contributing Organizations: None.

6. REFERENCES

(a) Readings:

HIS Development Strategy and Catalogue of Health Indicators, Geneva 2000 (EIP/OSD/00.12)

WHO, The World Health Report 2000; Health Systems: Improving Performance, Geneva, 2000.

El-Bindari-Hammad, Smith, DL, Primary Health Care Reviews, Guidelines and Methods, WHO, Geneva, 1992.

WHO, Development of Indicators for Monitoring Progress towards Health for All by the Year 2000, Geneva, 1981.

WHO, Evaluating the Implementation of the Strategy for Health for All by the Year 2000, Common Framework: Third Evaluation, Geneva, 1996.

WHO, Health Centres: the 80/20 Imbalance; Burden of Work Vs Resources, Geneva, 1999.

(b) Internet site: World Health Organization. http://www.who.org

(b) Brief Definition: The percent of the eligible population that have been immunized according to national immunization policies. The definition includes three components: (i) the proportion of children immunized against diphtheria, tetanus, pertussis, measles, poliomyelitis, tuberculosis and hepatitis B before their first birthday; (ii) the proportion of children immunized against yellow fever in affected countries of Africa; and (iii) the proportion of women of child-bearing age immunized against tetanus.

(a) Purpose: This indicator monitors the implementation of immunization programs.

(b) Relevance to Sustainable/Unsustainable Development (theme/sub-theme): Health and sustainable development are intimately interconnected. Both insufficient and inappropriate development can lead to severe health problems in both developing and developed countries. Addressing primary health needs is integral to the achievement of sustainable development. Particularly relevant is the provision of preventative programmes aimed at controlling communicable diseases and protecting vulnerable groups. Good management of immunization programmes, essential to the reduction of morbidity and mortality from major childhood infectious diseases, is a basic measure of government commitment to preventative health services.

(d) International Targets/Recommended Standards: In the Global Strategy for Health and the Ninth General Programme at Work, all children and 90% of children respectively, should be immunized against diphtheria, tetanus, pertussis, measles, poliomyelitis, tuberculosis and hepatitis B (see section 6 below). The 1992 World Health Assembly agreed that all children should be immunized against hepatitis B as part of expanded national programmes of immunization. In addition, all children in affected countries of Africa should be immunized against yellow fever. At the World Summit for Children it was resolved that all pregnant women should be immunized against tetanus.

(e) Linkages to Other Indicators: This indicator is linked to other health indicators, particularly those associated with the young, such as infant mortality and life expectancy. It is influenced by such indicators as health expenditure and the proportion of population in urban areas.

(a) Underlying Definitions and Concepts: A child is considered adequately immunized against a disease when he or she has received the following number of doses: tuberculosis (1 dose); diphtheria, tetanus and pertussis (DTP) (2 or 3 doses according to the immunization scheme adopted in the country); poliomyelitis (3 doses of live or killed vaccine); measles (1 dose); hepatitis B (3 doses); and yellow fever (1 dose). A pregnant woman is considered adequately immunized against tetanus if she has received at least 2 doses of tetanus toxoid during pregnancy or was already previously immunized.

i) Infant population: The numerator is the number of infants fully immunized with the specified vaccines x 100, while the denominator is the number of infants surviving to age one. For immunizations against tuberculosis the denominator is the number of live births. If the national schedule provides for immunization in a different age group, such as measles in the second year of age, the value should be the percentage of children immunized in the target age group. For the proper management of immunization programmes, it is however essential to be able to break down the data in such a way as to show the percentage covered in the first year of life (or second year for measles immunization).

ii) Women of child-bearing age: The numerator is the number of women immunized with two or more doses of tetanus toxoid during pregnancy x 100, while the denominator is the number of live births.

(c) Limitations of the Indicator: It is useful to have a composite indicator of adequate coverage by immunization. However, it is easier to collect data on the global coverage of a population against one disease than on the immunization of each child against all target diseases at the same time. This is why in most countries only the former data are easily available and collected.

The percent of pregnant women immunized with two or more doses of tetanus toxoid during pregnancy is rather easy to monitor through routine data collection in the health services. However, it underestimates the percent of pregnant women actually immunized against tetanus. It does not tale into account women who are already adequately immunized when becoming pregnant and therefore do not require new doses of tetanus toxoid during pregnancy. Women in this category are not numerous in countries where neonatal tetanus is still an issue and where, accordingly, this indicator is mainly used. But in some countries in transition, with long-standing child immunization programmes, the percent of pregnant women receiving tetanus toxoid is misleading as a significant number of them may be already immunized at the moment of pregnancy.

The indicator does not reflect other health preventative measures, such as education, diet, and pollution prevention. The international targets are not very meaningful for many countries.

(a) Data Needed to Compile the Indicator: The number of infants fully immunized against: DTP; poliomyelitis; measles; the number of infants surviving to age one year; against tuberculosis; the number of births; the number of infants living in African countries exposed to yellow fever; the number of pregnant women immunized against tetanus; and the number of live births.

(b) National and International Data Availability and Sources: Data is readily available from national immunization programmes of most countries, at least at the national level. Reporting of vaccinations performed annually or nation-wide surveys are the most common data sources.

(a) Lead Agency: The lead agency is the World Health Organization (WHO). The contact point is the Director, Office of Global and Integrated Environmental Health, WHO; fax no. (41 22) 791 4123.

(b) Other Contributing Organizations: The United Nations Children’s Fund is a cooperating agency.

WHO. Ninth General Programme of Work Covering the Period 1996-2001. Geneva, WHO, 1994.

WHO. WHO-Recommended Standards for Surveillance of Selected Vaccine-Preventable Diseases. WHO/EPI/GEN/99.012,1999.

(b) Brief Definition: This indicator is generally defined as the percent of women or reproductive age using any method of contraception. It is usually calculated for married women of reproductive age, but sometimes for other base population, such as all women of reproductive age, or for men of a specified age group.

(a) Purpose: The measure indicates the extent of people's conscious efforts to control their fertility. It does not capture all actions taken to control fertility, since induced abortion is common in many countries.

(b) Relevance to Sustainable/Unsustainable Development (theme/sub-theme): Increased contraceptive prevalence, is, in general, the single most important proximate determinant of inter-country differences in fertility, and of ongoing fertility declines in developing countries. Contraceptive prevalence can also be regarded as an indirect indicator of progress in providing access to reproductive health services including family planning, one of the eight elements of primary health care. Agenda 21 discusses reproductive health programmes, which include family planning, as among the programmes that promote changes in demographic trends and factors towards sustainability.

Health benefits include the ability to prevent pregnancies that are too early, too closely spaced, too late, or too many. Current contraceptive practice depends not only on people's fertility desires, but also on availability and quality of family planning services; social traditions that affect the acceptability of contraceptive use; and other factors, such as marriage patterns and traditional birth-spacing practices, that independently influence the supply of children.

(c) International Conventions and Agreements: Family planning is discussed in the broader context of reproductive, sexual health, and reproductive rights by Chapter VII of the Programme of Action, International Conference on Population and Development (ICPD); and Strategic Objective C of the Platform for Action adopted at the Fourth World Conference on Women.

(d) International Targets/Recommended Standards: International agreements do not establish specific national or global targets for contraceptive prevalence. Recent international conferences have strongly affirmed the right of couples and individuals to choose the number, spacing and timing of their children, and to have access to the information and means to do so. The ICPD Programme of Action states that "Governmental goals for family planning should be defined in terms of unmet needs for information and services. Demographic goals, while legitimately the subject of government development strategies, should not be imposed on family-planning providers in the form of targets or quotas for the recruitment of clients" (paragraph 7.12).

(e) Linkages to Other Indicators: The level of contraceptive use has a strong, direct effect on the total fertility rate (TFR) and, through the TFR, on the rate of population growth. Use of contraception to prevent pregnancies that are too early, too closely spaced, too late, or too many has benefits for maternal and child health. This indicator is also closely linked to access to primary health care services particularly those pertaining to reproductive health care. Furthermore, it has broader and predictive implications for many other sustainable development indicators and issues, such as rate of change of school-age population, woman's participation in the labour force, and natural resource use.

3. Methodological Description

(a) Underlying Definitions and Concepts: The standard indicator is the percentage currently using any method of contraception among married women aged 15-49 or 15-44. In this context, the married group usually includes those in consensual or common-law unions in societies where such unions are common. Contraceptive prevalence is also frequently reported for all women of reproductive age, and statistics are sometimes presented for men instead of, or in addition to, women.

Users of contraception are defined as women who are practising, or whose male partners are practising, any form of contraception. These include female and male sterilization, injectable and oral contraceptives, intrauterine devices, diaphragms, spermicide, condoms, rhythm, withdrawal and abstinence, among others.

For this indicator, too early is defined as under age 15. Such adolescents are 5 to 7 times more likely to die in pregnancy and childbirth than women in the lowest risk group of 20-24 years. Too closely spaced means women who become pregnant less than two years after a previous birth. Greater adverse consequences to women and their children are experienced under such circumstances. Women who have had five or more pregnancies (too many) or who are over 35 (too late), also face a substantially higher risk than the 20-24 year old group.

When presenting information about contraceptive use, it is useful to show the data according to specific type of contraception; by social characteristics such as rural/urban or region of residence, education, marital status; by 5-year age group, including specific attention to adolescents aged under 18 years; and by family size.

(b) Measurement Methods: Measurements of contraceptive prevalence come almost entirely from representative sample surveys of women or men of reproductive age. Current use of contraception is usually assessed through a series of questions about knowledge and use of particular methods.

(c) Limitations of the Indicator: For surveys, under-reporting can occur when specific methods are not mentioned by the interviewer. This can be the case with the use of traditional methods such as rhythm and withdrawal, and use of contraceptive surgical sterilization. The list of specific methods is not completely uniform in practice, but in most cases is sufficiently consistent to permit meaningful comparison. "Current" use is often specified in surveys to mean "within the last month", but sometimes the time reference is left vague, and occasionally longer reference periods are specified. With statistics from family planning programmes, the accuracy of the assumptions is often difficult to assess. The derived estimates obviously omit contraceptive users who do not use the programme's services, and thus tend to underestimate the overall level of use.

Service statistics maintained by family planning programmes are also sometimes used to derive estimates of contraceptive prevalence. In such cases it is necessary to apply assumptions in order to derive estimates of numbers of current users from the records of numbers of family planning clients. Base population statistics (numbers of women or of married women) are in this case usually derived from census counts, adjusted to the reference date by the Population Division of the Department of Economic and Social Affairs (DESA), as part of its preparations of the official United Nations population estimates and projections.

(d) Status of the Methodology: The methodology is widely used in both developed and developing countries.

(e) Alternative Definitions/Indicators: None.

4. Assessment of Data

(a) Data Needed to Compile the Indicator: Number of women of childbearing age using family planning methods. Number of women of childbearing age. Both data sets are frequently limited to married women.

(b) National and International Data Availability and Sources: The most recent United Nations review of contraceptive prevalence includes statistics for 119 countries and areas with information dating from 1975 or later. These countries include 90 per cent of world population. This review includes contraceptive prevalence measures for all women of reproductive age in 64 countries and areas and for samples of men in 27 countries and areas.

Contraceptive prevalence is one of the few topics for which data coverage is more complete and more current for developing than for developed countries. Most surveys provide estimates for major regions within countries as well as at the national level. Less frequently the sample design permits examining prevalence at the state, provincial, or lower administrative levels. In addition to those with national or near-national coverage, surveys covering this topic are sometimes available for particular geographic areas. Data are much less widely available for population groups other than married women, although such information has increased in recent years.

(c) Data References: Executing agencies for surveys covering this topic vary. National statistical offices and ministries of health are the most common source, but other governmental offices, non-governmental voluntary or commercial organizations are frequently involved. Many surveys are conducted in collaboration with international survey programmes. The Population Division, DESA regularly compiles information about contraceptive prevalence and publishes it in the annual World Population Monitoring report.

5. Agencies Involved in the Development of the Indicator

(a) Lead Agency: The lead agency is the World Health Organization (WHO). The contact point is the Director, Office of Global and Integrated Environmental Health, fax no. (41 22) 791 4123.

(b) Other Contributing Organizations: The United Nations Department of Economic and Social Affairs (DESA), with the contact point as the Director, Population Division, fax no. (1 212) 963 2147.

6. REFERENCES

(a) Readings:

Levels and Trends of Contraceptive Use as Assessed in 1988 (United Nations, Sales No. E.89.XIII.4).

Levels and Trends of Contraceptive Use as Assessed in 1994 (United Nations, ST/ESA/SER.A/146, forthcoming).

Programme of Action of the International Conference on Population and Development, Report of the International Conference on Population and Development, Cairo, Egypt, September 5-13, 1994. (United Nations Document - A/CONF. 171/13).

World Population Monitoring, 1993 (Sales No. E.95.XIII.8, New York).

World Population Monitoring, 1996 (ESA/P/WP.131).

(b) Internet site: World Health Organization. http://www.who.org

(b) Brief Definition: The estimated proportion of the population entering primary school who reach grade 5.

(a) Purpose: This indicator provides an estimate of the proportion of children entering primary school who reach grade 5 of primary education and thereby acquire basic literacy.

(b) Relevance to Sustainable/Unsustainable Development (theme/sub-theme): Education is a process by which human beings and societies reach their fullest potential. Education is critical for promoting sustainable development and improving the capacity of people to address environment and development issues. It is also critical for achieving environmental and ethical awareness, values, and skills consistent with sustainable development and effective public participation in decision-making.

Policy-makers concerned with children’s retention in schools and their eventual acquisition of basic literacy and numeracy skills would find this indicator particularly useful as it indicates the functioning, or internal efficiency of the education system and its ability to turn out literate people.

Appropriate policies and measures could then be adopted to address problems of grade repetition and drop-out as well as bottlenecks with regard to retention in school. Indirectly, this indicator reflects the quality and performance of schools.

(d) International Targets/Recommended Standards: With values that can vary form 0 to 100%, the general target would be 100%. This implies complete retention of children in school to grade 5 (or zero drop-out).

(e) Linkages to Other Indicators: Literacy is closely linked to indicators reflecting basic needs such as education, capacity-building, information and communications, and the role of major groups. Besides assessing the functioning of the education system, this indicator is often used together with enrolment ratios to depict respectively the complementary aspects of participation and retention in education. It can be cross-referenced with adult literacy which reflects the cumulative output of the education system over the years.

(a) Underlying Definitions and Concepts: Efforts to extend literacy depend on the ability of the education system to ensure full participation of school-age children and their successful progression to reach at least grade 5, which is the stage when they are believed to have firmly acquired literacy and numeracy. By estimating the percentage survival to grade 5, this indicator measures the proportion of the population entering primary school who eventually reach grade 5.

(b) Measurement Methods: This indicator can be derived using the reconstructed cohort student flow method, which is analogous to that used in demography to determine survival rates from one age to the next. This method first derives the grade promotion, repetition and drop-out rates based on available data on enrolment and repeaters by grade for two consecutive years using Markov chain calculations. It then applies these rates to a cohort of 1,000 students in grade 1 to reconstruct their passage through the education system assuming that these student flow rates by grade remain unchanged throughout the life-time of the cohort. From the reconstructed cohort student flow, the percentage survival to grade 5 can be derived.

If pi, ri and di represent respectively promotion rate, repetition rate and drop-out rate at grade i of primary education, they can be derived but the following condition on the flow rates have to be satisfied:

When these conditions are not satisfied, the method used to derive survival is no longer valid since it is not possible to isolate the original cohort and any inferences made will be of a dubious nature.

A fundamental assumption is that the probability of the cohort entering primary school, irrespective of the age of the pupils not reaching grade 5 is the same as that of the entrance age population for this level of education. That is, the drop-out rate is the same for all pupils regardless of the age at which they enter school.

(c) Limitations of the Indicator: The measurement method described in 4b above is rather a cumbersome one to administer. In addition, in some countries such as Germany and Austria, the concept of grade 5 does not exist in primary education. Moreover, data on enrolment and repetition by grade may not be available for consecutive years for some countries and certain regions or schools within a country. The reconstructed cohort student flow method assumes that promotion rates, repetition rates and drop-out rates do not change from year to year. When applying this method to sub-national and school levels, the derived drop-out rates by grade may sometimes present a negative value due to transfers between schools. A suggested solution to this problem is to collect data on transferred students by grade, and to deduct them from the corresponding enrolment figures before applying the reconstructed cohort method.

(d) Status of the methodology: This indicator has the status of a recommendation since the basic data elements to derive it are included in the Revised Recommendation Concerning the International Standardization of Education Statistics adopted by the UNESCO General Conference at its twentieth session, Paris, 1978.

(e) Alternative Definitions: In the absence of data on repeaters, the methodology outlined in section 4 (b) above may be adjusted by assuming that the repetition rate is 0. However, this assumption, in addition to those described in 4 (b), presupposes that the repetition rates are quite low and that their magnitude does not vary much between grades.

An alternative indicator for education effectiveness would be school drop-out rates, grade by grade.

(a) Data Needed to Compile the Indicator: Basic data required to derive this indicator include: enrolment and repeaters by grade for at least two consecutive years.

(b) National and International Data Availability and Sources: Data on enrolment and repeaters by grade in primary school are generally available in most countries and also at sub-national and school levels. For sound measurement, this indicator must be supported by consistent data for gender and area (such as rural/urban zones).

(a) Lead Agency: The lead agency is the United Nations Educational, Scientific and Cultural Organization (UNESCO). The contact point is the Director, UNESCO Institute of Statistics, UNESCO, fax: (33 1) 45 68 55 20.

6. REFERENCES

(a) Readings:

World Education Report (UNESCO), 1995, 1998.

Education for All: Year 2000 Assessment (UNESCO)

International Standard Classification of Education Manuals

Statistical Information System in Education

(b) Internet site: http://www.unesco.org/statistics

ADULT SECONDARY EDUCATION ACHIEVEMENT LEVEL
Social	Education	Education level

1. INDICATOR

(a) Name: Adult Secondary Education Achievement Level.

(b) Brief Definition: The proportion of the population of working age (25-64 years) which has completed at least (upper) secondary education.

(d) Placement in the CSD Indicator Set: Social/Education/Education Level.

2. POLICY RELEVANCE

(a) Purpose: This indicator provides a measure of the quality of the human capital stock within the adult population of approximately working age. Those who have completed secondary education can be expected either to have an adequate set of skills relevant to the labour market or to have demonstrated the ability to acquire such skills. The indicator can be made more dynamic by presenting the results in 10-year age bands (25-34, 35-44, 45-54, 55–64) in order to give an indication of changes over time in actual secondary education completion rates.

(b) Relevance to Sustainable/Unsustainable Development: Education is a process by which human beings reach their fullest potential. It is critical for promoting and communicating sustainable development and improving the capacity of people to address environment and development issues. It facilitates the achievement of environmental and ethical awareness, values, and skills consistent with sustainable development and effective public participation in decision-making.

(d) International Targets/Recommended Standards: International agreements do not establish specific national or global targets for this indicator.

(e) Linkages to Other Indicators: Education is closely linked to indicators reflecting basic needs such as literacy, capacity-building, information and communications and the role of major groups. This indicator also is a broad measure of the quality of the human capital stock within countries (and hence, an indication of the potential for future sustained development).

3. METHODOLOGICAL DESCRIPTION

(a) Underlying Definitions and Concepts: The International Standard Classification of Education (1997) defines levels of education (pre-primary, primary, secondary etc) in an internationally comparable manner.

(b) Measurement Methods: To calculate the adult secondary education achievement level, divide the number of adults aged 25-64 years who have completed secondary or tertiary education by the corresponding total population aged 25-64 years and multiply by 100.

Educational achievement levels are mostly based on self-declaration or declaration of the head of household, which may give rise to concerns about data reliability and consequently comparability, especially for females in many developing countries. Some countries determine completion of secondary education by making inference using data on the number of years of schooling received rather than qualifications obtained. In some cases, the available data only indicate whether an individual has studied at secondary level as opposed to having completed secondary education.

(d) Status of the methodology:

This indicator has the status of an international recommendation since the basic data elements to derive it are included in the Revised Recommendation concerning the International Standardization of Education Statistics adopted by the UNESCO General Conference at its twentieth session, Paris, 1978. In the latest revised Principles and Recommendations for Population and Housing Censuses in 1999, the concerned UN agencies co-operated with international experts in upgrading the methodology used in collecting statistics on literacy and educational characteristics.

(e) Alternative Definitions:

Where relatively small numbers of the population have completed secondary education, alternative indicators are either the Adult Primary Education Achievement Level (although this may be closely correlated with the Adult Literacy Rate) or the Adult Lower Secondary Education Achievement Level.

4. ASSESSMENT OF DATA

(a) Data Needed to Compile the Indicator: Data on the number of people of the relevant age (recommended to be 25-64) who have completed at least secondary education and the corresponding population of the same age.

(b) National and International Data Availability and Sources: Data are usually collected during national population censuses, or during household surveys such as Labour Force Surveys. Official statistics exist for many countries in the world but are often out-of-date due to censuses taking place every ten years and late census data release. For sound measurement, the ratio must be supported by consistent data by gender and age-group.

5. AGENCIES INVOLVED IN THE DEVELOPMENT OF THE INDICATOR

(a) Lead Agency: The lead agency is the United Nations Educational, Scientific and Cultural Organization (UNESCO). The contact point is the Director, UNESCO Institute for Statistics, UNESCO; e-mail: uis@unesco.org and fax (33-1) 45 68 55 20.

(b) Other Organizations: The International Labour Organization (ILO) also collects statistics on educational attainment from national Labour Force Surveys and the Organisation for Economic Co-operation and Development (OECD) publishes such data.

6. REFERENCES

(a) Readings:

UNESCO, World Education Report, 1995, 1998.

UNESCO, Statistics of Education in Developing Countries: an Introduction to their Collection and Analysis, 1983.

(b) Internet site: http://www.unesco.org/statistics

(b) Brief Definition: The proportion of the adult population aged 15 years and over that is literate.

2. POLICY RELEVANCE

(a) Purpose: This indicator provides a measure of the stock of literate persons within the adult population who are capable of using written words in daily life and to continue to learn. It reflects the accumulated accomplishment of education in spreading literacy. Any shortfall in literacy would provide indications of efforts required in the future to extend literacy to the remaining adult illiterate population.

(b) Relevance to Sustainable/Unsustainable Development (theme/sub-theme): Literacy is critical for promoting and communicating sustainable development and improving the capacity of people to address environment and development issues. It facilitates the achievement of environmental and ethical awareness, values, and skills consistent with sustainable development and effective public participation in decision-making.

(c) International Conventions and Agreements: The World Declaration and The Dakar Framework for Action on Education for All.

(d) International Targets/Recommended Standards: The general target is full literacy, i.e., 100% adult literacy rate. This is the goal of most national efforts and international campaigns to eradicate illiteracy.

(e) Linkages to Other Indicators: Literacy is closely linked to indicators reflecting basic needs such as education, capacity building, information and communication, and the role of major groups. The literacy rate indicates the status, or stock of literates at a given point in time. It is often linked to school enrolment ratios and population reaching grade 5 of primary education, both of which influence the accumulation of the stock of literates.

3. METHODOLOGICAL DESCRIPTION

(a) Underlying Definitions and Concepts: The Revised Recommendation concerning the International Standardization of Educational Statistics suggests the following definitions for statistical purposes:

(i) A person is literate who can with understanding both read and write a short simple statement related to his/her everyday life.

(ii) A person is functionally literate who can engage in all those activities in which literacy is required for effective functioning of his/her group and community and also for enabling him/her to continue to use reading, writing and calculation for his/her own and the community’s development.

Persons who do not fulfill (i) or (ii) are termed illiterates or functional illiterates respectively. Adult literacy, in international practice, applies only to the population aged 15 years and over, classified by sex, by five-year age-groups, and by urban/rural zones.

(b) Measurement Methods: To calculate the adult literacy rate, divide the number of literates aged 15 years and over by the corresponding total population aged 15 years and over and multiplied by 100.

(c) Limitations of the Indicator: As literacy is a relative concept, no single measure can separate the literate from the illiterate. A cut-off point is not totally appropriate because there are many different forms and degrees of literacy. A person might be literate in numeric terms, but have difficulty with text comprehension. Literacy can be defined in terms of work, school, home, and social spheres. Each area of life requires different types of literacy skills.

Literacy status is mostly based on self-declaration or declaration of the head of household, which gives rise to concerns about data reliability and consequently comparability, especially for females in many developing countries. Some countries estimate literacy rates by making inference using data on educational attainment, such as by equating persons with no formal schooling as illiterates in the absence of theoretical and empirical basis. Increasingly, literacy should be determined by actual test measurement of reading, writing and numeracy abilities of each person within a social context. It may, however, be time-consuming, costly and operationally complex to organize such measurements during national population censuses.

(d) Status of the methodology: This indicator has the status of an international recommendation since the basic data elements to derive it are included in the Revised Recommendation concerning the International Standardization of Education Statistics adopted by the UNESCO General Conference at its twentieth session, Paris, 1978. In the latest revised Principles and Recommendations for Population and Housing Censuses in 1999, the concerned UN agencies co-operated with international experts in upgrading the methodology used in collecting statistics on literacy and educational characteristics. Further development of easy-to-use, robust and low-cost literacy test methodologies and their use in spreading the practice of literacy test measurement shall help to improve the quality of international statistics on literacy in the future.

(e) Alternative Definitions: To meet the limitations discussed in 4c above, the definition and measurement of functional literacy represents an alternative indicator. This is usually measured for four or five components of literacy such as "prose", "document", and "quantitative" domains. The aim is to measure the degree of functionality, rather than the dichotomy literate vs. illiterate.

4. ASSESSMENT OF DATA

(a) Data Needed to Compile the Indicator: Data on the number of literates or illiterates and the corresponding population aged 15 years and over.

(b) National and International Data Availability and Sources: Data are usually collected during national population censuses, or during household surveys or literacy surveys. Official statistics exist for most countries in the world but are often out-of-date due to census taking every ten years and late census data release. The United Nations Educational, Scientific and Cultural Organization (UNESCO) carries out periodic estimations and projections to fill data gaps. In principle, literacy data are available at both the national and sub-national levels. For sound measurement, the ratio must be supported by consistent data by gender, age-group and area (such as rural/urban zones). The primary data sources are national population censuses and household surveys. International data sources include the Statistics Division of the United Nations Department of Economic and Social Affairs (DESA); and the UNESCO Institute for Statistics.

(c) Data References: The UNESCO Statistics WEB site http://unescostat.unesco.org/; UNESCO Statistical Yearbook 1999; UNDP Human Development Reports; World Bank World Development Reports.

5. AGENCIES INVOLVED IN THE DEVELOPMENT OF THE INDICATOR

(b) Other Contributing Organizations: The Statistics Division of the United Nations DESA also collects and publishes statistics on literacy from national population censuses, besides providing the data to UNESCO for processing and dissemination.

6. REFERENCES

(a) Readings: UNESCO Statistical Yearbook (annual editions); Compendium of Statistics on Illiteracy: 1995 Edition, UNESCO, Paris. 1995.

(b) Internet site: http://unescostat.unesco.org/

FLOOR AREA PER PERSON
Social	Housing	Living Conditions

(a) Purpose: This is a key indicator of housing quality, which measures the adequacy of living space in dwellings. A low value for the indicator is a sign of overcrowding.

(b) Relevance to Sustainable/Unsustainable Development (theme/sub-theme): This is a key indicator measuring the adequacy of the basic human need for shelter. Human settlement conditions in many parts of the world are deteriorating mainly as a result of a low level of investment, although such investment has been shown to generate considerable public and private sector investment. Housing policies, particularly in urban areas, greatly affect the living conditions of people. In low income settlements, reduced space per person can be associated with certain categories of health risks.

(c) International Conventions and Agreements: This indicator is one of ten "key" housing indicators approved by the Commission on Human Settlements (Resolution 14/13), to be collected in all countries and in a number of cities in each country, to measure progress towards meeting the objectives of the Global Shelter Strategy. Countries are to use the indicators to provide the basis for their country reports to the Second United Nations Conference on Human Settlements. Also, the Habitat Agenda, endorsed at the Second United Nations Conference on Human Settlements (Habitat II), explicitly mentions ‘provision of sufficient living space and avoidance of overcrowding’, as part of the commitments of UN member states, to be measured by this indicator. This indicator has also been selected for the Common Country Assessment (CCA) indicators’ framework prepared by the UNDG for evaluation, advocacy and policy dialogue at the country level.

(d) International Targets/Recommended Standards: No targets have been developed for this indicator.

(e) Linkages to Other Indicators: This indicator is closely linked to several other socio-economic indicators with which it should be considered, including population density, rate of growth of urban population, area and population of informal settlements, and infrastructure expenditure per capita.

(a) Underlying Definitions and Concepts: The floor area should include all living space, along with bathrooms, internal corridors and closets. Covered semi‑private spaces such as corridors, inner courtyards or verandas should be included in the calculation if used by the household for cooking, eating, sleeping, or other domestic activities. Floor area refers to a housing unit, defined as a separate and independent place of abode intended for habitation by one household at the time of the census or other inquiry.

(b) Measurement Methods: The median floor area of a unit should be divided by the average household size. If data from household surveys or from a recent census are available, these can be used. In the absence of better data, the floor area of the median priced dwelling may be used as an approximation, although this may not be an accurate estimate. If the median cannot be estimated, then the average should be provided.

(c) Limitations of the Indicator: Results for this indicator may vary considerably if collected at the city, national, urban/rural levels, given the variations in land availability and types of human settlements and activities. Informal settlements in particular are likely to have much less space per person, as are disadvantaged groups. Various levels of data collection are necessary to provide a full picture of this specific housing outcome. Housing size and housing quality are usually but not necessarily linked, and floor area per person may not give a complete picture of living conditions. Cultural values affect sensitivity to crowding. For these reasons, interpretation of this indicator is difficult, and should be completed in conjunction with related indicators.

(e) Alternative Definitions: Alternative measures of crowding have been the subject of data collection and reporting in international statistical compendia. The two most common are persons per room and households per dwelling unit, each of which was included among data collected during the first phase of the Housing Indicators Programme (UNCHS, World Bank, 1992). Surveys have shown that floor area per person is more precise and policy‑sensitive than the other two indicators. Habitat, the United Nations Centre for Human Settlements (UNCHS) has developed and tested a series of crowding indicators in low‑income settlements. They include, among others, percentage of housing units with more than one household, in‑house living area per person, percentage of housing units with more than three persons per room, number of households per building and per housing unit, number of persons per building.

(a) Data Needed to Compile the Indicator: Median floor area of housing units; average number of persons per household.

(b) National and International Data Availability and Sources: The data are generally available at the country level. This indicator was collected in 52 countries (one city per country) by the Shelter Sector Performance Indicators Programme in 1992 (UNCHS, World Bank). It has been collected worldwide by the UNCHS Indicators Programme in preparation for the Habitat II Conference (1996). Results are available from the following Habitat website: www.urbanobservatory.org/indicators.

(c) Data References: Primary data sources include censuses or household surveys. The indicator is reported in the Housing Indicators Programme report listed in section 6 below.

(a) Lead Agency: The lead agency is the United Nations Centre for Human Settlements (Habitat). The contact point is the Head, Urban Secretariat, UNCHS (Habitat); fax no. (254 2) 623080.

World Bank. Housing: Enabling Markets to Work. The World Bank, Washington D.C., 1993 (A World Bank Policy Paper).

UNCHS (Habitat), World Bank. The Housing Indicators Programme. Report of the Executive Director (Volume I). UNCHS, Nairobi, 1993.

UNCHS (Habitat). Monitoring the Shelter Sector. Housing Indicators Review. UNCHS, Nairobi, 1995.

UNCHS (Habitat). Human Settlement, Interventions Addressing Crowding and Health Issues, UNCHS, Nairobi, 1995.

UNCHS (Habitat) home page: http://www.urbanobservatory.org/indicators/database

1. INDICATOR

(a) Name: Number of Recorded Crimes per 100,000 Population.

(b) Brief Definition: Total crimes recorded in criminal (police) statistics, regardless of type.

(d) Placement in the CSD Indicator Set: Social/Security/Crime.

2. POLICY RELEVANCE

(a) Purpose: The Economic and Social Council, in its resolution 1984/48 of 25 May 1984, requested the Secretary-General to maintain and develop a United Nations crime-related database by continuing to conduct surveys of crime trends and operations of criminal justice systems. The major goal of the United Nations Surveys on Crime Trends and the Operations of Criminal Justice Systems is to collect data on the incidence of recorded crime and the operations of criminal justice systems with a view to improving the analysis and dissemination of that information globally.

(b) Relevance to Sustainable/Unsustainable Development (theme/sub-theme): It is widely recognized that crime is not merely a problem of illegal behaviour and law enforcement but also a phenomenon closely associated with economic and social development. The phenomenon of crime, through its impact on society, can hamper the overall development of nations. It can undermine people’s spiritual and material well-being, compromise human dignity and create a climate of fear and violence that endangers personal security and erodes the quality of life. If development is to be sustainable, it should be able to provide living conditions that would enable people to lead peaceful and secure lives.

On the other hand, imbalanced or inadequately planned development can worsen social conditions that contribute to a rise in criminality especially where the fruits of development are not equitably distributed among the people.

(c) International Conventions and Agreements: The United Nations Congress on the Prevention of Crime and Treatment of Offenders formulated a non-binding plan of action (e.g., Milan Plan of Action of 1985) and recommendations (The Caracas Declaration of 1980) on the subject.

(d) International Targets/Recommended Standards: None.

(e) Linkages to Other Indicators: This indicator is linked to other indicators of poverty and income disparities (e.g., percent of population living below poverty line, unemployment rate, gini index of income inequality), population change (e.g., population growth rate, population of urban formal and informal settlements) as well as those on economic performance (e.g., GDP per capita). Rapid population growth is included among those indicators that are generally considered crime-generating.

3. METHODOLOGICAL DESCRIPTION

(a) Underlying Definitions and Concepts: Total recorded crimes regardless of type per year within a country as interpreted as such by the countries responding officials. These crimes refer to the number of penal code offences or their equivalent (i.e., various special law offences) but excluding minor road traffic and other petty offences, brought to the attention of the police or other law enforcement agencies and recorded by one of these agencies. It follows that this indicator refers only to police-reported crimes.

(b) Measurement Methods: Questionnaire sent to a single official statistical body officially representing the country. The indicator is computed as the number of total crimes reported to the police in a given year multiplied by 100,000 and divided by the total population of the country in the same year.

(c) Limitations of the Indicator: Definitions of what is or is not a crime may vary for different countries. So may readiness to report to the police, readiness to record by the police, methods of counting, accuracy and reliability of the recorded figures reported.

(d) Status of the methodology: While the indicator is used by many developed and developing countries, improvements are needed in the collection of the data/information needed to construct the indicator.

(e) Alternative Definitions: Results from ICVS (Percentage of pop, victimized by crime, regardless of police recording).

4. ASSESSMENT OF DATA

(a) Data Needed to Compile the Indicator: Midyear population figures per country; (Police) statistics on total recorded crimes.

(b) National and International Data Availability and Sources: Data are normally available from local and regional police agencies and are collated by a national agency, often a statistical division within the Ministry or Department of Justice.

(c) Data References: National Statistical Institutes; UN Survey of Crime Trends and Operations of Criminal Justice Systems; UN Statistical Year Book, World Bank.

5. AGENCIES INVOLVED IN THE DEVELOPMENT OF THE INDICATOR

(a) Lead Agency: The lead agency is the United Nations Office for Drug Control and Crime Prevention.

(b) Other Contributing Organizations: United Nations Interregional Crime and Justice Research Institute, Turin (Rome), Italy (UNICRI); European Institute for Crime Prevention and Control, Helsinki, Finland (HEUNI).

6. REFERENCES

(a) Readings:

International Crime Victim Survey (ICVS): International Conference on Surveying Crime – A Global Perspective, Conference Report, UNICRI, 1998.

Criminal Victimization in the Developing World, UNICRI, 1995.

United Nations Rules, Norms and Standards at website: http://www.uncjin.org/Standards/ standards.html.

(b) Internet sites:

http://www.uncjin.org

http://www.unicri.it/

http://www.vn.fi/om.heuni/

1. INDICATOR

(a) Name: Population Growth Rate.

(b) Brief Definition: The average annual rate of change of population size during a specified period.

(d) Placement in the CSD Indicator Set: Social/Population/Population change.

2. POLICY RELEVANCE

(a) Purpose: The population growth rate measures how fast the size of the population is changing.

(b) Relevance to Sustainable/Unsustainable Development (theme/sub-theme): Agenda 21 identifies population growth as one of the crucial elements affecting long-term sustainability (see especially paragraphs 5.3 and 5.16). Population growth, at both national and subnational levels, represents a fundamental indicator for national decision-makers. Its significance must be analyzed in relation to other factors affecting sustainability. However, rapid population growth can place strain on a country's capacity for handling a wide range of issues of economic, social, and environmental significance, particularly when rapid population growth occurs in conjunction with poverty and lack of access to resources, or unsustainable patterns of production and consumption, or in ecologically vulnerable zones (see paragraphs 3.14, 3.25 and 3.26 of the ICPD Programme of Action).

(d) International Targets/Recommended Standards: International agreements do not establish national or global targets. A number of national governments have adopted numerical targets for the rate of population growth. However, in 1998, 14 percent of governments considered their rates of population growth to be too low, 44 percent were satisfied with the rate, and 41 percent considered it to be too high.

(e) Linkages to Other Indicators: There are close linkages between this indicator and other demographic and social indicators, as well as all indicators expressed in per capita terms (for example, GDP per capita). Population growth usually has implications for indicators related to education, infrastructure, and employment. It is also related to human settlements and the use of natural resources, including sink capacities. Population growth can increase environmental degradation, although this is not always the case.

3. METHODOLOGICAL DESCRIPTION

The rate of population growth, r, between two times, t₁and t_2,is calculated as an exponential rate of growth, conventionally expressed in units of per cent per year:

r = 100 ln (P₂/P₁)/(t₂-t₁)

Where P₁ and P₂are the number of persons at times 1 and 2, respectively, and the time interval (t₂-t₁) is expressed in years.

For a country, the estimate is generally based on either (i) an intercensal population growth rate calculated from two censuses, each adjusted for incompleteness; or (ii) from the components of population growth (adjusted for incompleteness, when necessary) during a period; the components are numbers of births, deaths and migrants. Intercensal growth rates can also be calculated for subnational areas.

4. ASSESSMENT OF DATA

(a) Data Needed to Compile the Indicator: As indicated above, the population growth rate can be calculated either from census data or from registration data (births, deaths and migrants). The United Nations recommends that countries take censuses every 10 years, and these data can be used to calculate an intercensal population growth rate.

(b) National and International Data Availability and Sources: In recent decades, most countries have carried out censuses and is widely available. For example, 204 countries or areas carried out a census during the 1990 census decade (1985 to 1994). Data on births, deaths and migrants may come from national registration systems or from special questions in demographic surveys and censuses. National and sub-national census data, as well as data on births, deaths and migrants, are available for the large majority of countries from national sources and publications; as well as from questionnaires sent to national statistical offices from the Statistics Division, UN Department of Economic and Social Affairs (DESA). For all countries, census and registration data are evaluated and, if necessary, adjusted for incompleteness by the Population Division, DESA, as part of its preparations of the official United Nations population estimates and projections.

(c) Data References: Past, current and projected population growth rates are prepared for all countries by the Population Division, DESA, and appear in the United Nations publication, World Population Prospects: The 1998 Revision (see item 6, below).

5. AGENCIES INVOLVED IN THE DEVELOPMENT OF THE INDICATOR

(a) Lead Agency: The lead agency is the United Nations Department of Economic and Social Affairs (DESA). The contact point is the Director, Population Division, DESA; fax no. (1 212) 963 2147.

(b) Other Contributing Organizations: None.

6. REFERENCES

(a) Readings:

Population Division, DESA, World Population Prospects: The 1998 Revision. Vol. I. Comprehensive Tables (United Nations publication Sales No. E.99.XIII.9, New York, 1999).

Population Division, DESA, World Population Prospects: The 1998 Revision. Vol. III. Analytical Report (United Nations. ESA/P/WP.156, New York, 1999).

Population Division, DESA, Manual X: Indirect Techniques for Demographic Estimation (United Nations Sales No. E.83.XIII.2, New York, 1983).

Population Division, DESA, World Urbanization Prospects: The 1998 Revision (United Nations publication, forthcoming).

Population Division, DESA, MORTPAK-LITE - The United Nations Software Package for Mortality Measurement (United Nations, New York, 1988).

Statistics Division/DESA, 1997 Demographic Yearbook, (United Nations Sales No. E/F.99.XIII.1, 1999).

For information about government policies regarding this indicator, see:

Population Division, DESA, National Population Policies (United Nations Sales No. E.99.XIII.3., New York, 1998).

Population Division, DESA, Results of the Eighth United Nations Population Inquiry Among Governments (forthcoming).

(b) Internet site: http://www.un.org/esa/population

(b) Brief Definition: Number of inhabitants living in urban formal and informal settlements.

(d) Placement in the CSD Indicator Set: Social/Population/Population Change.

(a) Purpose: The indicator measures the size of formal and informal urban settlements by their population. By focusing on the legality of human settlements, this indicator measures the marginality of human living conditions.

(b) Relevance to Sustainable/Unsustainable Development (theme/sub-theme): Settlements characterized by illegality of tenure and unauthorized shelter are generally marginal and precarious, and do not cater to basic human needs such as affordable housing. They affect sustainable human settlements development, human health, and socioeconomic development.

Illegal dwellers generally live in an unsafe and precarious environment, lack basic services, suffer from the absence of tenure security, and have no legal claim in case of eviction. Also, numerous illegal settlements are established on lands, which are predisposed to natural disasters. Informal settlements have usually a much higher population density than formal settlements and these living conditions constitute a threat to human health.

(d) International Targets/Recommended Standards: No international targets have been established for this indicator.

(e) Linkages to Other Indicators: This indicator is closely linked with several other socioeconomic and environmental indicators, such as rate of growth of urban population, human and economic losses due to natural disasters, access to adequate sanitation, primary health care, infant mortality, infrastructure expenditure, and land use.

(a) Underlying Definitions and Concepts: Informal settlements refer to: i) residential areas where a group of housing units has been constructed on land to which the occupant have no legal claim, or which they occupy illegally; ii) unplanned settlements and areas where housing is not in compliance with current planning and building regulations (unauthorized housing). Formal settlements refer to land zoned residential in city master plans or occupied by formal housing.

(b) Measurement Methods: The number of inhabitants in formal and informal settlements is generally measured in censuses. Informal settlements do not cover dwelling units which have been regularized, that is those units for which land titles, leases or occupancy permits have been granted. They should only include those units which presently occupy land illegally and/or housing units which are not in compliance with current regulation.

(c) Limitations of the Indicator: The ephemeral nature and lack of an acceptable operational definition for this indicator, limit its usefulness, especially for trend analysis. The legal framework for settlements on which this indicator is based varies from country to country. Informal housing is not registered in official statistics, any measure of informal settlements remains limited. Information may be obtained from specific research studies, but it difficult to obtain and may be of variable quality. Homelessness, which is one of the extreme symptoms of human settlements inadequacy, is not accounted for by this indicator and in fact the existence of illegal settlements may reduce the incidence of homelessness.

(e) Alternative Definitions/Indicators: Many concepts intended to measure marginality of human settlements have been formulated: unplanned, squatter, marginal settlements, unconventional, non permanent structures, housing in compliance, inadequate housing, slums, etc. "Unconventional dwellings" is one of the most common measures, defined by the number of housing units occupied by households, but considered inappropriate to human habitation. ‘Improvised housing units’ is another category used by the Census, defined as independent, makeshift shelters constructed of waste materials and without a predetermined plan for the purpose of habitation by one household. Included in this category are squatters’ huts, favelas, hongos, jhuggis, etc. The type of building (permanent, semi‑permanent, non permanent) which describe the building structures in which households live is another common measure, but the criteria widely vary from country to country.

(a) Data Needed to Compile the Indicator: Population of informal settlements.

(b) National and International Data Availability and Sources: These data are more likely to be available at the city level and are generally collected in large cities affected by informal settlements. Data sets at the national level will only occur sporadically.

(a) Lead Agency: The lead agency is the United Nation Centre for Human Settlements (Habitat). The contact point is the Head, Urban Secretariat, UNCHS (Habitat); fax no. (254 2) 623080.

World Bank. Housing: Enabling Markets to Work. A World Bank Policy Paper. The World Bank, Washington D.C., 1993.

UNCHS (Habitat) and The World Bank. The Housing Indicators Programme. Report of the Executive Director (Volume I). UNCHS, Nairobi, 1993.

UNCHS (Habitat). Monitoring the Shelter Sector. Housing Indicators Review. UNCHS, Nairobi, 1995.

POPULATION GROWTH RATE
Social	Population	Population change

POPULATION OF URBAN FORMAL AND INFORMAL SETTLEMENTS
Social	Population	Population Change

IMMUNIZATION AGAINST INFECTIOUS CHILDHOOD DISEASES
Social	Health	Healthcare Delivery

CONTRACEPTIVE PREVALENCE RATE
Social	Health	Healthcare Delivery

CHILDREN REACHING GRADE 5 OF PRIMARY EDUCATION
Social	Education	Education Level

NUMBER OF RECORDED CRIMES PER 100,000 POPULATION
Social	Security	Crime

ADULT LITERACY RATE
Social	Education	Literacy