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Table 6 Measurement concepts along with the initial candidate list of indicators presented by domain. Assessments of quality and measurement concept alignments are also presented for each indicator and domain

From: Towards a global monitoring system for implementing the Rio Political Declaration on Social Determinants of Health: developing a core set of indicators for government action on the social determinants of health to improve health equity

Measurement concept Candidate indicator Tier Quality assessment
Domain 1: Governance
 1.1 Level of intersectoral collaboration for health and health equity 1.1.1 National or subnational policy addressing the reduction of health inequities established and documented. Tier II 1. Measurement concept match ating (3/7).
This indicator does not align well with the measurement concept.
2. Technical quality rating: (2/8).
This indicator seeks to measure national policies aimed at reducing health inequities. However, this indicator only meets two of the technical quality criteria.
Data are currently available for this indicator.
1.1.2 Whether a national policy exists that addresses at least two priority determinants of health amongst target populations Tier II 1. Measurement concept match rating (3/7).
This indicator does not align well with the measurement concept.
2. Technical quality rating: (4/8).
This indicator seeks to measure national policies aimed at reducing health inequities. However, this indicator only meets two of the technical quality criteria. This indicator is also a binary indicator.
Data are available for this indicator.
No candidate indicator captures the measurement concept well, is technically feasible, and has data availability. The opportunity might exist for leveraging off the WHO Regional Office for Europe and the Pan American Health Organization indicators. Investment in the development of a new indicator may be beneficial (e.g., a standard indicator for intersectoral action for health).
 1.2 Level of implementation of health equity impact assessment for relevant government policies 1.2.1 Proportion of seats held by women in (a) regional parliaments and (b) local governments Sustainable Development Goals (SDG)
(a) Tier I, (b) Tier III
1. Measurement concept match rating (4/7).
This indicator does not align well with the measurement concept.
2. Technical quality rating: (5/8).
This indicator seeks to measure proportion of seats held by women on key decision-making bodies. Whereas this indicator meets most of the technical quality criteria, the unavailability of data at the local government level makes it challenging to recommend this for inclusion.
Only the first aspect of this indicator has data readily available.
The candidate indicator does not capture the measurement concept and does not meet the minimum mark to be included in the monitoring system. Therefore, we recommend that a new indicator be developed.
 1.3 Level of public social protection 1.4.1 Percentage Parity index (female or male) for the percentage of the population covered by social protection floors or systems SDG
Tier I
1. Measurement concept match rating (6/7).
This indicator captures the measurement concept.
2. Technical quality rating: (6/8).
This indicator aligns with the SDGs and is highly accepted in various countries.
Data are readily available for this indicator.
The candidate indicator captures the measurement concept, if technically feasible, and has data availability. It is suitable for inclusion in the monitoring system. The indicator could be further refined (e.g., could limit it to only the population living in poverty).
 1.4 Gender equity in level of public social protection 1.4.1 Parity index (female or male) for the percentage of the population covered by social protection floors or systems   1. Measurement concept match rating (6/7).
This indicator captures the measurement concept.
2. Technical quality rating: (6/8).
This indicator aligns with the SDGs and is highly accepted in various countries. Data are readily available for this indicator, and the parity index can be computed.
The candidate indicator captures the measurement concept, if technically feasible, and has data availability. It is a suitable for inclusion in the monitoring system. The indicator could be further refined (e.g., could limit it to only the population living in poverty).
 1.5 Level of public provision of early childhood education 1.5.1 Participation rate in organized learning (one year before the official primary entry age) SDG
Tier I
1. All three indicators are aMeasurement concept match rating (6/7).
This indicator captures the measurement concept.
2. All three indicators are aTechnical quality rating: (6/8).
This is an SGD indicator and is accepted in various countries.
Data are readily available for this indicator.
1.5.2 Proportion of schools with access to: (a) electricity; (b) the Internet for pedagogical purposes; (c) computers for pedagogical purposes; (d) adapted infrastructure and materials for students with disabilities; (e) basic drinking water; (f) single-sex basic sanitation facilities; and (g) basic hand washing facilities (as per the WASH indicator definitions) SDG
Tier II
1. Measurement concept match rating (5/7).
This indicator captures the measurement concept.
2. Technical quality rating: (6/8).
This indicator aligns with the SDGs and is highly accepted in various countries.
Data are readily available for this indicator.
The candidate indicator 6.1 is prioritized over 6.2, because it is a better fit with the measurement concept and has full data availability. The prioritized indicator is fit for purpose and does not require further development.
 1.6 Income equity in level of early childhood education 1.6.1 Parity index (bottom or top wealth quintile) for participation rate in organized learning (one year before the official primary entry age) SDG
Tier I
1. All three indicators are aMeasurement concept match rating (6/7).
This indicator does capture the measurement concept.
2. All three indicators are aTechnical quality rating: (7/8).
This indicator aligns with the SGDs and is highly accepted in various countries.
Data are readily available for this indicator and the parity index can be computed on the basis of the data.
The candidate indicator captures the measurement concept, if technically feasible, and has data availability. The indicator is fit for purpose and does not require further development.
 1.7 Provision of public laws ensuring human rights 1.7.1 Whether laws and regulations are in place that guarantee women and adolescents access to sexual and reproductive health services, information and education (official records) SDG
Tier III
1. All three indicators are aMeasurement concept match rating (6/7).
This indicator captures the measurement concept.
2. All three indicators are aTechnical quality rating: (5/8).
This indicator aligns with the SDGs and is highly accepted in various countries. However, this indicator is a binary indicator, but data are not readily available for this indicator.
1.7.2 Whether a legal framework (including customary law) is in place that guarantees women’s equal rights to land ownership or control SDG
Tier III
1. Measurement concept match rating (6/7).
This indicator captures the measurement concept.
2. Technical quality rating: (5/8).
This indicator aligns with the SDGs and is highly accepted in various countries. However, this indicator is a binary indicator, but data are not readily available for this indicator.
1.7.3 Whether legal frameworks are in place to promote equality and non-discrimination on the basis of sex SDG
Tier III
1. Measurement concept match rating (6/7).
This indicator captures the measurement concept.
2. Technical quality rating: (5/8).
This indicator aligns with the SDGs and is highly accepted in various countries. However, this indicator is a binary indicator, but data are not readily available for this indicator.
All three indicators are a good match with measurement concepts, but have data availability over the long term only.
  OVERALL ASSESSMENT DOMAIN 1:
Multiple indicators in this domain tap into the prioritized measurement concepts. Most indicators in this domain are also SDG indicators that are collected in different countries. The underlying level of measurement for some indicators in this domain is binary. Efforts should be made to obtain other quantitative indicators. The proposed prioritized indicators capture the measurement concepts moderately well.
Domain 2: Participation
 2.1 Level of transparency in policymaking 2.1.1 Whether the country has adopted and implemented constitutional, statutory or policy guarantees for public access to information SDG
Tier II
1. Measurement concept match rating (6/7):
Public access to information is an integral part of transparency in policymaking. For this reason, the measurement concept – indicator match rating was considered moderate to high. This indicator is also well-aligned with Domain 5 (monitoring and accountability).
2. Technical quality rating (5/8):
This indicator refers to a specific, measurable government action (criteria 1 and 6) that is applicable across diverse country contexts (criterion 7). Given that the indicator is aligned with the SDGs (criterion 2), it will likely have high acceptability (criterion 8). As Tier II, the data is not readily available (criteria 3 and 4). Further work could be done to transform this binary regional indicator into a national-level indicator (criterion 5).
2.1.2 Whether the country has systems to track and make public allocations for gender equality and women’s empowerment SDG
Tier III
1. Measurement concept match rating (5/7):
This indicator aligns with tracking and sharing information regarding funding for initiatives that address gender equity but this indicator is more specific than 2.1.1.
2. Technical quality rating (4/8): This indicator is aligned with the SDGs (criterion 2), is acceptable (criterion 8), and is applicable across diverse country contexts (criterion 7) and well-defined government action (criteria 1). Given that this indicator is Tier III, information may not be available in the near future and could require data collection.
2.1.3 Whether country has met their commitments and obligations in transmitting information as required by each relevant agreement on hazardous waste and other chemicals SDG
Tier I
1. Measurement concept match rating (4/7):
This indicator addresses transparency in policymaking but it does not specifically measure transparency with the public, which is central for increasing participation as defined in the Rio pledge 2.
2. Technical quality rating (6/8): Given that this indicator is Tier I, data are readily available, routinely collected and used (criteria 2, 4 and 6). It will thus be low or no cost and have high acceptability (criteria 5, 7 and 8).
The candidate indicator 2.1.1 best captures the measurement concept, is technically feasible, and has some data availability. If data availability is limited, 2.1.3, which is immediately available, could be used as a placeholder indicator, until 2.1.1 becomes available.
Co-indicator for Domain 5: monitoring and accountability.
 2.2 Level of implementation of mechanisms for participation of civil society in policymaking 2.2.1 Percentage of local administrative units with established and operational policies and procedures for participation of local communities in water and sanitation management SDG
Tier III
1. Measurement concept match rating (4/7):
This indicator measures the implementation of mechanisms well, but it is specific to water and sanitation management.
2. Technical quality rating (4/8): This continuous indicator is aligned with the SDGs (criteria 5 and 2) which will increase acceptability across countries (criteria 7 and 8). However, given the data in Tier III are not yet available, technical quality is difficult to assess at this point.
2.2.2 Proportion of cities with a direct participation structure of civil society in urban planning and management that operate regularly and democratically SDG
Tier III
1. Measurement concept match rating (5/7):
This indicator measures the implementation of mechanisms in a broader sense that emphasizes participation in policymaking.
2. Technical quality rating (3/8): This regional indicator does not yet have data available (Tier III). However, it is aligned with the SDGs (criteria 2, 7 and 8).
Indicators align moderately well with the measurement concepts, but have data availability over the long term only.
 2.3 Level of between-country exchange of good practices around participation in policymaking 2.3.1 Whether country has communicated the establishment or operationalization of an integrated policy, strategy, or plan that increases its ability to adapt to the adverse impacts of climate change, and foster climate resilience and low greenhouse gas emissions development in a manner that does not threaten food production (including a national adaptation plan, nationally determined contribution, national communication, biennial update report or other) SDG
Tier III
1. Measurement concept match rating (1/7):
This indicator indirectly measures exchange of good practices. It does not address participation in policymaking.
2. Technical quality rating (3/8): This indicator is aligned with the SDGs and thus theoretically has high acceptability across countries. Data are not available.
2.3.2 Number of least developed countries and small island developing Member States that are receiving specialized support, and amount of support, including finance, technology and capacity-building, for mechanisms for raising capacities for effective climate change-related planning and management, including focusing on women, youth and local and marginalized communities SDG
Tier III
1. Measurement concept match rating (0/7):
This indicator does not align with the measurement concept.
2. Technical quality rating (3/8): This indicator is aligned with the SDGs and thus theoretically has high acceptability across countries. Data are not available.
Neither indicator is a good match with measurement concept nor are data available. Further work is needed to identify other potential indicators.
  OVERALL ASSESSMENT of DOMAIN 2
The only indicator recommended at this time is 2.1.1 (Whether country has adopted and implemented constitutional, statutory or policy guarantees for public access to information) because it aligns best with the measurement concept and has high-quality data available in the short-term. If data cannot be accessed in time, indicator 2.1.3 (Whether country has met its commitments and obligations in transmitting information as required by each relevant agreement on hazardous waste and other chemicals) whichever is more specific can be used as a proxy because data are available. For all other measurement concepts, no indicators aligned well with measurement concepts and had high-quality data available.
Domain 3: Health system reorientation
 3.1 The level of comprehensive, [equitable] service coverage by health systems (including primary health care and the right to health)
ALTERNATIVE MEASUREMENT CONCEPT [Inequalities in the level of comprehensive service coverage by health systems]
3.1.1. [SDG 16.9.1] Proportion of children under 5 years of age whose births have been registered with a civil authority, by age
[Gender disaggregation is possible with this indicator; therefore, a parity index between females and male registration could be used to examine inequalities in comprehensive service coverage by health services
SDG
Tier I
1. Measurement concept match rating (4/7):
This indicator addresses an important vehicle for demanding the right to health services. Several complications exist, however, that need to be addressed in thinking through the match. These may arise from the formulation of the measurement concept. The first complication is whether equity should be included in the measurement concept or measured separately, making the measurement focus on comprehensive, implying the full spectrum of care (including addressing key food, water and other environmental determinants as identified as part of primary health care and the right to health).
For this reason, the measurement concept – indicator match rating was considered moderate.
2. Technical quality rating (4/8):
As Tier I, a suggested methodology exists that has been tested and is an international standard; therefore, it meets criterion 1 (SMART). It is feasible and acceptable given alignment with SDG indicators and the associated process used for international agreement. It would also therefore meet criteria 2,3,7, and 8. Some evidence regarding the usefulness of this indicator-concept in being associated with access to determinants for health equity is available but needs further documentation (criterion 6). The criterion about the indicator being continuous is fulfilled. Regular availability of data would be fulfilled as part of the SDGs (criterion 4).
3.1.2. [SDG 6.1.1] Percentage of population using safely managed drinking water services
[Regarding inequalities, as with the previous indicator of 3.1.1. parity indices by rural/urban and by lowest/highest wealth quintiles could be constructed on the basis of available data.]
SDG
Tier I
1. Measurement concept match rating (6/7):
A single rating process was adopted here because the right to drinking water, sanitation and safety from harmful exposures are included in the right to health and the policies for primary health care. For this reason, the measurement concept – indicator match rating was considered moderate to high.
2. Technical quality rating (6/8):
As Tier I, a recommended methodology exists that has been tested and is an international standard; therefore, indicators 3.1.2. and 3.2.3. meet criterion 1 (SMART). They are feasible and acceptable given alignment with SDG indicators and the associated process used for international agreement. They would also therefore meet criteria 2,3,7, and 8. Evidence regarding the usefulness of this indicator-concept in being associated with access to determinants for health equity is available but needs further documentation (criterion 6). The criterion about the indicator being continuous is fulfilled given the “coverage” nature of this indicator. Regular availability of data would be fulfilled as part of the SDGs (criterion 4).
An overall technical rating of 8/8 was given.
Other considerations: a hierarchy exists in the indicator concepts and their alignment with the measurement concept. If so, water may be prioritized, or a combined index could be created from individual level data (percentage of population with coverage in 1,2 and 3). This indicator has been tested previously and would require a limited data collection burden. One advantage would be to increase relevance in countries with high water provision rates because sanitation often lags behind water provision.
3.1.3. [SDG 6.2.1] Percentage of population using safely managed sanitation services including a hand washing facility with soap and water
[Regarding inequalities, as with the previous indicator of 3.1.1. parity indices by rural or urban and lowest or highest wealth quintile could be constructed on the basis of available data.]
SDG
Tier I
3.1.4. [SDG 6.3.1] Percentage of wastewater safely treated SDG
Tier III
1. Measurement concept match rating (5/7):
A link exists between the responsibility of public and private companies to maintain a safe and healthy environment and the health system actions for prevention and health promotion in light of Alma Ata Declaration and the right to health. In particular, unsafe water inequitably distributed resulted in deteriorated environments for more disadvantaged groups. For this reason, the measurement concept – indicator match rating was considered moderate to high.
2. Technical quality: (2/8)
Because of technical problems with data collection, this indicator should be excluded for now.
  The SDH emphasis in universal coverage envisaged by the measurement concept relates to pledge 3.2 of the Rio Political Declaration. [Strengthen health systems towards the provision of equitable universal coverage and promote access to high-quality, promotive, preventive, curative and rehabilitative health services throughout the life-cycle, with particular focus on comprehensive, integrated primary health care.] A key feature of the pledge is the comprehensive nature of health systems – stretching along the care continuum, including primary health prevention and promotion services as described in the primary health care movement of the Alma Ata Declaration and in the right to health. Another key feature is equity. In view of this combined focus, the best possible combination of indicators to measure this construct would be two parity indices, one related to identify (gender parity) and one related to urban/rural parity for a combined coverage indicator of drinking water and sanitation. The question as to whether these indicators are sufficient to describe the full measurement concept needs some discussion.
 3.2 Level of integration of equity into health systems, policies and programs 3.2.1. Country Policy and Institutional Assessment (CPIA) policies for social inclusion or equity for gender equality, equity of public resource use, building human resources, social protection and labor, and policies and institutions for environmental sustainability (average from a 1 = low to 6 = high)
[The Country Policy and Institutional Assessment (CPIA) rates countries against a set of 16 criteria grouped in four clusters: (a) economic management; (b) structural policies; (c) policies for social inclusion and equity; and (d) public sector management and institutions.]
World Bank [see description] 1. Measurement concept match rating (2–4/7):
The measurement concept – indicator match rating was considered moderate. An assumption exists that the social and public health institutions will move in parallel. Some support might exist for this in institutional theory. However, further study of this indicator would be needed to assess how this indicator covers the private sector, and associated resource use.
It needs further assessment based on our criteria and more information on the exact focus and construction. The element of
Equity of Public Resource Use could be particularly interesting: “Criterion assessing the consistency of government spending with the poverty reduction priorities taking into account the extent to which: (a) individuals, groups, or localities that are poor, vulnerable, or have unequal access to services and opportunities are identified; (b) a national development strategy with explicit interventions to assist the groups identified in (a) has been adopted; and (c) the composition and incidence of public expenditures are tracked systematically and their results fed back into subsequent resource allocation decisions. The assessment of the revenue collection dimension takes into account the incidence of major taxes, e.g., whether they are progressive or regressive, and their alignment with the poverty reduction priorities.” A potential problem with this indicator is the inclusion of multiple sectors and being able to extract the health component. When relevant, expenditure and revenue collection trends at the national and subnational levels should be considered.
2. Technical quality: the indicator covers 95 countries dating back (not for all) to 2005. Further assessment regarding criteria is needed after establishing how the health sector component can be extracted.
 3.3 Level of knowledge exchange on equity-oriented policies and programs None available.   
OVERALL ASSESSMENT DOMAIN 3
Overall, weakness exists in the extent of indicators presented to cover reorientation of the health sector. In particular, two out of three measurement concepts do not appear to have feasible indicators with good conceptual matches.
No indicator has yet been identified for knowledge exchange regarding equity-oriented policies and programs. Consideration may be needed with regard to the latter concept; perhaps the WHO program budget indicator could be used on a temporary basis. It refers to: [Number of] Country [ies] that have implemented at least two WHO-supported activities to integrate gender, equity and human rights in their health policies and programs] and covers all WHO Member States.
Starting to monitor with so few indicators might be unacceptable, unless they are complemented by other governance indicators that relate to intersectorality to address the SDH equity.
Other options are to reconsider basic expenditure indicators (as a percentage of gross national product (public versus private (for-profit). National health accounts definitions need to be consulted. However, some empirical work has linked equity orientation with public health expenditure as a percentage of total health expenditure.
Domain 4: Global governance
 4.1 Level of implementation of the 1993 Vienna Declaration and Programme of Action 4.1.1 Percentage of countries where the legal framework (including customary law) guarantees women’s equal rights to land ownership or control
[SDG Indicator 5.a.2]
SDG
Tier II (FAO)
Tier III (World Bank)
1. Measurement concept match rating (4/7): This indicator is somewhat aligned with the Vienna Declaration and Programme of Action because it measures legislative action on women’s equal rights to land ownership or control.
2. Technical quality rating (5/8): This indicator meets SMART criteria (1) and is aligned with the SDGs (2). This indicator is binary at the country level (yes or no), but continuous at the international level (5). Additionally, this indicator is applicable across countries (7), and is accepted by international organizations such as FAO, the World Bank, and UN Women (8). However, this indicator may be difficult to obtain (3), is not reported annually (4), and may have limited evidence of direct benefit to the SDH. Although FAO has proposed methodology for this indicator, it is not being reported; therefore, data availability is limited.
4.1.2 Proportion of countries with laws and regulations that guarantee women and adolescents access to sexual and reproductive health services, information and education (official records)
[SDG Indicator 5.6.2]
SDG
Tier III (UNFPA)
1. Measurement concept match rating (4/7): This indicator is somewhat aligned with the Vienna Declaration and Programme of Action; because it measures legislative action on women’s rights to access sexual and reproductive health services.
2. Technical quality rating (6/8): This indicator meets SMART criteria (1) and is aligned with the SDGs (2). This indicator is binary at the country level (yes/no), but continuous at the international level (5). Access to sexual and reproductive health may have direct benefit to the SDH. Additionally, this indicator is applicable across countries (7), and is accepted by international organizations such as UNFPA (8). However, this indicator may be difficult to obtain (3), and is not reported annually (4), Although UNFPA has proposed methodology for this indicator, it is not being reported; therefore, data are not available.
Both indicators are a good match with measurement concepts, but have data availability over the long term only.
 4.2 Level of implementation of international agreements that improve the SDH 4.2.1 Number of parties to international multilateral environmental agreements on hazardous waste, and other chemicals who meet their commitments and obligations in transmitting information as required by each relevant agreement
[SDG Indicator 12.4.1]
SDG
Tier I (UNEP)
1. Measurement concept match rating (6/7): This indicator is directly relevant to the implementation of international agreements that improve SDH, because it measures compliance with environmental agreements on hazardous waste and other chemicals.
2. Technical quality rating (7/8): This indicator meets SMART criteria (1), is aligned with the SDGs (2), is feasible or cost-effective to obtain (3) and can be reported annually (4). This indicator is binary at the country level (yes/no), but continuous at the international level (5). Additionally, this indicator is applicable across countries (7), and is accepted by such international organizations as UNEP (8). However, evidence might be limited that transmitting information about hazardous waste or other chemicals has direct benefit to the SDH (6). UNEP has established methodology for this indicator, and data are currently available.
4.2.2 Number of countries that have communicated the establishment or operationalization of an integrated policy, strategy, or plan which increases their ability to adapt to the adverse impacts of climate change, and foster climate resilience and low greenhouse gas emissions development in a manner that does not threaten food production (including a national adaptation plan, nationally determined contribution, national communication, biennial update report or other)
[SDG Indicator 13.2.1]
SDG
Tier III (UNFCCC)
1. Measurement concept match rating (4/7): This indicator is somewhat related to implementation of international agreements that improve SDH, as it measures the establishment and operationalization of an integrated policy, strategy, or plan to adapt to the adverse impacts of climate change.
2. Technical quality rating (5/8): This indicator is aligned with the SDGs (2), is applicable across countries (7) and is accepted by international organization such as the UNFCC (8). This indicator is binary at the country level (yes/no), but continuous at the international level (5). Additionally, establishment and operationalization of an integrated policy, strategy, or plan to adapt to the adverse impacts of climate change may directly benefit the SDH (6). However, this indicator may not be specific or measurable, because the establishment and operationalization of an integrated policy, strategy, or plan to adapt to the adverse impacts of climate change is somewhat subjective. This indicator may be difficult to obtain (3), is not annually reported (4), Although UNFCCC has established methodology for this indicator, it is not currently reported; data are not currently available.
4.2.3 Number of least developed countries and small island developing Member States that are receiving specialized support, and amount of support, including finance, technology and capacity-building, for mechanisms for raising capacities for effective climate change-related planning and management, including focusing on women, youth and local and marginalized communities
[SDG Indicator 13.b.1]
SDG
Tier III (WMO)
1. Measurement concept match rating (3/7): This indicator is only tangentially relevant to the implementation of international agreements that improve SDH, because it measures number of least developed countries receiving support for climate change planning and management.
2. Technical quality rating (4/8): This indicator is aligned with the SDGs (2), and accepted by international organizations such as the WMO (8). This indicator is binary at the country level (yes or no), but continuous at the international level; amount of support received is continuous (5). Additionally, support for climate change management may directly benefit the SDH (6). However, this indicator may not be specific or measurable, because support for climate change management (aside from financial support) is somewhat subjective (1). This indicator may be difficult to obtain (3), is not reported annually (4), and is not broadly applicable to all countries (7). No established methodology exists for this indicator, and data are not available.
All three indicators capture the measurement concept. The candidate indicator 4.2.1. is prioritized, because it has immediate data availability. The prioritized indicator is fit for purpose and does not require further development.
  OVERALL ASSESSMENT of DOMAIN 4
Only one indicator (4.2.1 Number of parties to international multilateral environmental agreements on hazardous waste, and other chemicals that meet their commitments and obligations in transmitting information as required by each relevant agreement [SDG Indicator 12.4.1]) meets both measurement concept match and technical quality criteria, and can be measured with data that are currently available. Although three of the five remaining indicators meet a substantial amount of measurement concept match and technical quality criteria, data are not available for measuring these indicators. Further work is needed to generate data that will measure the indicators proposed in this domain; additionally, the proposed core indicator does not capture all measurement concepts in this domain.
Domain 5: Monitoring Progress
 5.1. The level (extent of) of development and analysis of database (s) containing disaggregated data relevant to health determinants and health equity 5.1.1[SDG 17.18.1] Proportion of sustainable development indicators produced at the national level with full disaggregation when relevant to the target, in accordance with the Fundamental Principles of Official Statistics SDG
Tier III
Measurement concept match rating (4/7):
It covers the idea of disaggregation of data for health determinants and health (goal III). However, it does not refer to the analysis component, which is arguably the equally important aspect. For this reason, the measurement concept – indicator match rating was reduced.
2. Technical quality rating (2/8):
As Tier III, methodology is recommended but it has not been tested and no international standard exists; therefore, it cannot be assessed for criterion 1 (SMART). It would also therefore not meet criteria 2,3,7, or 8. Evidence is quite good in relation to the availability of disaggregated data to stimulate action on SDH (criterion 6). Continuousness of indicator (criteria 5) should be fulfilled. Regular availability of data would be fulfilled if it is part of the SDGs (criterion 4).
 5.2. Promotion and investment in research and evaluations of SDH interventions to promote equity 5.2.1 [SDG 3.b.2] Total net official development assistance to the medical research and basic health sectors Tier I
c
1. Measurement concept match rating (3/7):
This indicator is being used under Goal III (health) of the SDGs to monitor the target related to “Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade-Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all.” It covers the idea of official development aid and other resource flows to countries and how they are used for medical research but the breakdown of basic health sectors is still problematic. In supporting the flow of investments from North to South it corresponds to some of the spirit of other Rio pledges related to improving equity between countries. However, the indicator does not measure national allocations to research and evaluations, which would be a much better fitting concept. Also, the Rio pledges it relates to refer to describe not only the production of evaluations but also systematically sharing evidence, as well as using these assessments for guiding policymaking. Because the indicator lacks covering these aspects, the measurement concept – indicator match rating was rated low. A further consideration, given its health sector and international focus, is that it may be considered more relevant to reorienting the health sector measurement domain or the global governance domain.
2. Technical quality (6/8)
As Tier I, the indicator has a well-established methodology that has been tested and an international standard (criterion 1, SMART). It is feasible and acceptable given alignment with SDG indicators and the associated process used for international agreement (criteria 2,3,7,8). Criterion 5 on continuous indicators is also met. Further work will be needed to assess how well the indicator meets criterion 6 related to impacts on health equity.
5.2.2 [SDG 17.16.1] Country reports progress in multi-stakeholder development effectiveness monitoring frameworks that support the achievement of the sustainable development goals Tier II 1. Measurement concept match rating (5/7)
The notion that multi-stakeholder action (across sectors and across government and civil society) is important in development frameworks is mentioned in the Rio Political Declaration. The indicator (modified to represent the indicator at the country level) tries to measure the effectiveness of these multi-stakeholder processes in relation to achieving SDGs. This could have relevance for health determinants as well although health is not specifically mentioned, given that health is impacted by so many goals, the evaluation of the effectiveness of the framework would need to assess the impacts across different areas of SDGs. On the basis of these assumptions, the measurement concept – indicator match rating was rated fairly high. However, more work needs to be done to review the methodology used for describing effectiveness.
2. Technical quality (5/8)
As Tier II in SDGs, an established methodology that has been tested and a fair degree of international agreement exists on the methodology (Organization for Economic Co-operation and Development for 80 African countries); therefore, criterion 1 (SMART) roughly meets [although the United Nations Development Programme is proposing another methodology to assess development effectiveness monitoring frameworks that support achievement of the sustainable development goals]. It is feasible given alignment with SDG indicators and the associated process used for international agreement (criteria 2,3, and 7). How acceptable it is might be queried (criterion 8). Further assessment of match to the technical criterion of “preference for continuous indicators (criterion 5)” (e.g., continuous) will need to be completed after obtaining more information on how the indicator is calculated at the national level. As an SDG indicator it would be available routinely (criteria 4). The linkages to health inequities is not yet established (therefore, failing criterion 6).
  Given the deficiencies of the two indicators, selecting between them is difficult. If measurement concept is the overriding consideration, preference must be for the second one SDG 17.16.1] [Number of] countries reporting progress in multi-stakeholder development effectiveness monitoring frameworks that support achievement of the sustainable development goals. However, we recommend that another indicator mighty be sought in relation to use of national research funds.
 5.3. (Level of) access to information as a key component of research, monitoring and evaluationsto ensure accountability and justice 5.3.1. [SDG 16.10.2] Country has adopted and implemented constitutional, statutory, or policy guarantees for public access to information Tier II 1. Measurement concept match rating: (5/7)
It relates to how public access to information produces positive impacts on health determinants; although the rule of law mentioned in the indicator provides for populations having access to information, no mention is made of recourse to justice, which is specified in the measurement concept, in cases where information enables them to address determinants affecting health and well-being. For this reason, the measurement concept–indicator match rating was reduced.
2. Technical quality rating: (5/8)
As Tier II, the indicator has a fairly well-established methodology that has been tested and is an international standard (criterion 1, SMART). It is feasible and acceptable given alignment with SDG indicators and the associated process used for international agreement (criteria 2,3,7, and 8). Evidence is emerging on role of information for SDH, and, in particular, for health service use (criterion 6). Further assessment of match to the technical criterion of “preference for continuous indicators (criterion 5)” (e.g., continuous) will need to be completed after obtaining more information on the SDG proposals for indices, which are being proposed as sourced from either the World Bank Road Infrastructure Development project or from United Nations Educational, Scientific and Cultural Organization. These may be composite indices, in which case the framing of the indicator wording will need to be changed.
  OVERALL ASSESSMENT DOMAIN 5
The only indicator in this domain that meets minimum standards (which need to be developed further but can be thought of at least 5/7 on measurement fit and 5/8) on technical criteria fit, is 5.3.1. [SDG 16.10.2] Country has adopted and implemented constitutional, statutory or policy guarantees for public access to information. Further work needs to be done to assess which other indicators from other data sources can be put forwards for this domain or may need to be developed. Also, it has to be evaluated whether the proposed core indicator is sufficient for an initial core set for monitoring Domain 5.
  1. Abbreviations: SDG Sustainable Development Goals, SDH social determinants of health, SMART specificity, measurability, assignability, realistic, and time-related