A characterisation and profiling of district health indicators in Zimbabwe: an application of principal component analysis in a data limited setting

The Ministry of Health and Child Care, Zimbabwe does not have a method for prioritization and equitable allocation of its share of the national health budget and other resources in the sector. Regional allocations especially at Provincial level are currently allocated equal resources regardless of the provinces' disease burden population size or needs. Currently there is no method or data available to show how the provinces eventually allocate these resources to the lower district levels. In a data limited country such a Zimbabwe such a Principal Component Analysis method can be used to identify a set of indicators that account for cross variation between different regions in Zimbabwe. This set of composite health indicators could then in future be used by planners in as reference indices for equitable allocation and prioritization of resources and health care interventions. The aim of the study was to construct a set of simple, feasible, reliable and valid public health system indices for use in characterising and profiling the different districts in Zimbabwe. This was a retrospective analysis of secondary data to derive composite indices for the 57 administrative health districts in Zimbabwe using retrospective secondary data. The data was extracted from the 2012 Zimbabwe Health information database, the 2012 National Census and the 2011 Prices, Income and Expenditure Survey. The analysis of the data resulted in the construction of 10 mutually exclusive principal composite indices, which included demographic, child related, disease related and health systems related indices. The resultant 10 composite indices (population, immunisation, child mortality, antenatal care, HIV/TB, malaria, non-communicable diseases, socioeconomic, health seeking behaviour and infrastructure) were tested for construct and content validity and all were found to be statistically robust, reliable and consistent with observed behaviour. The composite indices exhibited internal consistency and construct validity to be regarded as true representations of the cross variation of the 57 districts in Zimbabwe; hence these indices could be used to characterise the behaviour and assess the performance of these districts. There is also future potential use for these indices in the areas of resource allocation and prioritisation of health interventions.