Indicadores para la gestión de los servicios de salud pública

Objectives: To define a set of indicators for the management of the various services of an agency responsible for comprehensive public health in a defined area and population. Methods: We analyzed the agency's activity and held discussions with those responsible for the distinct services to define indicators whose estimation is viable and which optimally describe three aspects: the services' activity, coverage, quality or effectiveness, and cost. Results: Quantitative indicators were defined for all the productive public health services inventoried in the agency's services portfolio, but not all three aspects could be covered in all areas. In addition, for coordination and liaison services, the indicators were often less quantitative and less sensitive to change. Costs were estimated for the main areas of productive activity and for the 47 services or products, with indirect costs being estimated as 14% of expenditure. Conclusions: We defined a system of indicators for management control, allowing comparisons over time and with other geographical areas, and with activity indicators covering all production areas. Defining indicators reflecting coverage, quality or impact for all services is more difficult. Cost can be estimated by unit of production for some services, but less successfully for others. The yearly cost by population is always a good synthetic indicator of the cost of public health services.