SCI-SUD

Index

Within United Nations Sustainable Development Goals, Health Target 3.5 calls to “strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol” with an indicators 3.5.1 on “coverage of treatment interventions (pharmacological, psychosocial and rehabilitation and aftercare services) for SUD”. While there is a need to further improve the global reporting on treatment contact coverage for substance use disorders, a complementary measure was developed to assess the capacity of health care systems and the availability of services for people with SUD.

Service Capacity Index for Substance Use Disorders (SCI-SUD) reflects the capacity of national health systems to provide treatment for substance (alcohol, drugs and other psychoactive substances) use disorders, in terms of the proportion (%) of available health system elements in a given country from a theoretical maximum.

Disaggregation is possible to present separate indices for alcohol and drug use disorders, SCI-AUD and SCI-DUD

Proportion of available service elements in a given country from a theoretical maximum of service elements for treatment of substance use disorders. The values of the SCI-SUD range from 0 to 1 (convertible to percentage points), with higher values indicating higher overall development of services.

For countries that provide data to the WHO Global Survey on Progress with SDG Health Target 3.5, direct calculation of the SCI-SUD is performed: the country reported value of a given variable is divided by the theoretical maximum value on that variable, leading to the proportion from maximum for each variable. Then, the proportions from maximum for each of the variables are averaged at the country level. The 95% confidence intervals are computed around the mean established via the basic method for constructing bootstrap confidence intervals, using 10,000 replicates. Missing values, when present, are treated as zeros and all variables are considered as having the same weight in the computation of the index.

For countries that did not provide data to the WHO Global Survey on Progress with SDG Health Target 3.5 or had very high levels of missingness, multiple imputation is employed according to the multivariate imputation by chained equations method to impute SCI-SUD under assumption of missing at random and using the predictive mean matching method. The imputed SCI-SUD values from imputation datasets are averaged and 95% CI around the mean is established via the basic method for constructing bootstrap confidence intervals, using 10,000 replicates.

To provide complementary indices specifically for alcohol use disorders and drug use disorders, alcohol and drug specific variables from WHO Global Survey on Progress with SDG Health Target 3.5 are used for computation of Service Capacity Index for Alcohol Use Disorders (SCI-AUD) and the Service Capacity Index for Drug Use Disorders (SCI-DUD), but without imputation of data for countries not providing data.

Based on direct and imputed SCI-SUD values, global and regional averages are calculated for the six WHO regions.

N/A

Every 4-5 years

Every 4-5 years

Comparable SCI-SUD estimates for all countries allow monitoring of the capacity of treatment systems to deliver services to people with these conditions. It is (1) based upon national data; (2) feasible for monitoring at global; regional and national levels; (3) produces data which are comparable across countries; and (4) can inform local actions for service strengthening.

Further details on methodology of SCI-SUD is available at: Krupchanka D, Formanek T, Shield K, Rehm J, Heymans MW, Fleischmann A et al. (2023). International monitoring of capacity of treatment systems for alcohol and drug use disorders: Methodology of the Service Capacity Index for Substance Use Disorders. Int J Methods Psychiatr Res. 32(3):e1950. https://doi.org/10.1002/mpr.1950

krupchankad@who.int

Dzmitry Krupchanka

While, the SCI-SUD offer new approach with several advantages, some limitations should be noted. First, from a conceptual point of view, since treatment of SUD is often distributed across different sectors, using the WHO Framework for Monitoring Health Systems might result in missing information from social care, criminal justice systems and others. Second, for the SCI-SUD values derived directly from country-level data, there might be issues with the quality of reported data, both because of human error and the imperfection of health information systems and imprecision of population-level statistics. Complementarily, it is impossible to rule out the possibility that the SCI-SUD captures not only the overall development of services related to SUD but also the quality of data reporting systems in a given country. Third, by treating missing values as zeroes, this step might introduce an underestimation of the true SCI-SUD for the affected countries. Fourth, for the imputed SCI-SUD, the approach relied on the use of external data sources, which, in most cases, are not direct estimates themselves. Fifth, while for the majority of countries the last available data is used, there are instances when the data were considerably older, which could have led to the introduction of imprecision in the SCI-SUD estimation. Finally, in the absence of gold standard metrics for capacity of system to provide treatment of substance use disorders, it is difficult to examine the performance of the index against external data. Given this, the external validity of the SCI-SUD requires further investigation that would allow more detailed collection of information on health system indicators in selected countries.