Progress towards and lessons learned in achieving the Commission on Information and

Accountability recommendations, including analysis of the results of country self-

assessments

3rd Stakeholder Meeting

WHO, Geneva, 19-20 November 2012

Commission on Information & Accountability and the follow up: a few milestones

S O N D J F M A M J J A S O N D J F M A M J J A S O N D

2010 2011 2012

Global Strategy launched

Commission

Report with 10 recommendations

WHA + UNGA

Stakeholder meeting 1

Geneva

Stakeholder meeting 2

Ottawa

Stakeholder meeting 3

Geneva

>200 commitments in context of Global Strategy

$40M Pledged

1st funds received

Multi-stakeholder workplan

1st iERG report

Bamako Dar es Salaam

Manila Ouagadougou

Bangkok Harare Cairo

Bishkek Antigua

Accountability

Monitor

Action

Review

From Commission Recommendations to Action

Recommendations 1-3: Better information for better results

Recommendations 4-6: Better tracking of resources for women's and children's health

Recommendations 7-10: Better oversight of results and resources: nationally and globally

Strategic workplan

75 countries in Commission Report

10 multi-country workshops Over 700 participants 71 self assessments completed

National meetings 21 roadmaps completed 19 nearly completed

Roadmap catalytic funding disbursed (16 countries)

Country Accountability Framework Self-Assessment and Roadmaps

• Multi-country workshops to orient country teams and facilitate the development of roadmaps

• Standard tool developed for assessing country situation and develop roadmap with priority actions

– 50 items: absent, needs a lot of strengthening, needs some strengthening, adequate

• National multi-stakeholder workshops: finalization and endorsement of roadmaps

– Mapping of current investments

Country Accountability Framework

06 March 2012

A tool for assessing and planning implementation of

the country accountability framework for health

with a focus on women's and children's health

Action

Monitor Review

Advocacy for accountability (Recommendation 7 and 8)

National oversight: By 2012, all countries have established accountability mechanisms that are transparent …

Advocacy & Accountability Country situation & proposed actions

58%: parliament has not established accountability mechanisms

43%: have no media engagement AT ALL in accountability processes

57%: have no functioning civil society coalition

A handful of countries have ever done a Country Countdown Event

Priority country actions Strengthen the role of civil society in accountability processes Strengthen the role of the media Organize a national Countdown event

21 countries rated themselves as

poor on all three: parliament, CSO, media

Afghanistan, Myanmar, Pakistan

Somalia, South Sudan, Iraq, Egypt, Morocco, Yemen

Comoros, Swaziland, Madagascar, DR Congo, Côte d'Ivoire, Liberia, Nigeria, Central African Republic

Papua New Guinea, Solomon Islands

Bangladesh, Nepal

Advocacy & Accountability Progress

Working with Parliaments

Oct 2011: Pan African Parliament speakers' Resolution on MNCH

Apr 2012: Inter-Parliamentary Union (IPU) Resolution on MNCH

Nov 2012: Manila declaration on MNCH with 18 countries

Media

Launch of "Born to soon", very good media coverage

Civil society

Africa MNCH coalition holds CSO seat on AU's MNCH task force

Mapping of RMNCH advocacy capacity in 10 countries (PMNCH)

National Countdown to 2015 events planned in at least 12 countries

Civil registration and vital statistics systems (CRVS)

(Recommendation 1)

By 2015, all countries have taken significant steps to establish a system for registration of births, deaths and causes …

CRVS country situation & proposed actions

26% are making progress towards full CRVS assessment & plan

49% indicate hospital reporting of causes of death needs lots of

strengthening

Only 3% have adequate reporting of community births and deaths

Priority country actions Complete assessments and develop comprehensive improvement plan Strengthen hospital reporting and use of ICD-10 for causes of death Develop / test innovative ways for community birth and death reporting

CRVS Strongest and weakest country systems

Good systems in place: Brazil, (Azerbaijan)

No system and limited action at time of assessment:

– LAC: Bolivia and Haiti

– West & Central Africa: 17 / 23 countries

– Middle East & Central Asia: Afghanistan, South Sudan, Sudan, Yemen

– Asia: Indonesia, Lao, Myanmar, Nepal, Papua New Guinea, VietNam

– Eastern & Southern Africa: Comoros, Lesotho, Madagascar

Civil Registration & Vital Statistics Systems Progress

Regional developments: Africa, Asia, Middle East Regional partnerships: UN Regional Commissions (UNECA, UNESCAP): one regional

plan with strong health sector drive (WHO, HMN, UQ, UNICEF, UNFPA); Political mobilization:

Ministers responsible for registration (Sep 2012, Durban: 2nd Ministers meeting ==> CRVS declaration)

Government statisticians Arab League of States Statistical Committee

Global developments UN Human Rights Council adopted a resolution on birth registration as a human

right (April 2012) Tools: WHO/UQ/HMN resource kit on strengthening CRVS; regional tools HMN: moving from a health-led partnership to a development partnership, linked

to the post Busan agenda

Maternal Death Surveillance and Response (MDSR)

(Recommendations 1,2, 3)

Countries monitor quality of care provided in health services and take steps to make improvements …

MDSR Country situation & proposed actions

Two-thirds have some policy for notification of maternal deaths but most

require strengthening of implementation

59%: national capacity to review and act needs lots of strengthening (and

70% of district capacity)

33%: conduct quality of care assessments

One in 5 countries have a MDSR system that is reviewed annually

Priority country actions Develop national system to report, review and address maternal deaths Conduct quality of care assessment Use innovative ways to improve community reporting and feedback

Top in MDSR

Well-functioning systems:

‒ Brazil, South Africa

Well on the way towards well functioning systems:

‒ Mongolia

‒ Azerbaijan

‒ China

‒ Rwanda

‒ Peru

Maternal Death Surveillance & Response Progress

Capacity building for MDSR in 47 countries through workshops

Guidelines developed by WHO, CDC and partners in MDSR Working Group

Concept of MDSR - maternal deaths notification, review and action is well-received by countries; major emphasis on quality of care dimension

eHealth & Innovation (Recommendation 3)

By 2012, all countries are implementing national e-Health strategies and web-based systems to report data ...

eHealth & Innovation Country situation & proposed actions

73% still need to develop an effective national eHealth strategy

60% indicated that connectivity for health reporting needs lots of strengthening

84% said that effective data sharing between systems needs lots of

strengthening

8% use electronic devices for community reporting of maternal deaths

Priority country actions Develop national eHealth strategy and establish coordination mechanism Address interoperability issue to improve data sharing and analyses Use of innovative ways to redesign report and feedback systems using IT

Highest scores in eHealth

Brazil

Azerbaijan

Ghana

eHealth & Innovation Progress

Country assessment based on eHealth Toolkit completed

30 countries for fast-track actions identified

Efforts to better coordinate multiple initiatives and experiences initiated (eHealth Data Standards Forum, Geneva, 3-4 December 2012)

Web-based reporting of health facility data now operational in over 30 countries, and increasing (Univ. of Oslo – DHIS 2.0 leadership)

Tracking Resources (Recommendations 4, 5 and 9)

By 2015, all 75 countries track and report health and RMNCH expenditure by at least two indicators.

By 2012, development partners request the OECD-DAC to agree on how to improve the Creditor Reporting System

Tracking Resources Country situation & proposed actions

52% have a functioning NHA framework

86% need a lot of human capacity strengthening to produce NHA tables

85% have no database for automated production of standard NHA tables

Half of countries have a formal agreement for resource tracking between

government and partners

Priority country actions leading to institutionalization Strengthen local capacity for NHA production Automation of data conversion and table production processes Annual production of NHA summaries, used in annual reviews

Tracking resources Top and bottom countries

Top – Ethiopia, Rwanda, China

Very low scores – Bolivia

– Azerbaijan, Turkmenistan

– CAR, Chad, Congo, Gambia, Guinea, Mali, Sao Tome & Principe

– Djibouti, Somalia, South Sudan

– Comoros, Eritrea, Lesotho, Swaziland

– Cambodia, Lao, Mongolia

Tracking Resources Progress

9 regional workshops on methods on resource tracking (System of Health Accounts 2011) with participation from 70 countries

26 countries to set up systems to report annually on total health and RMNCH expenditures by June 2013; second wave countries start mid-2013.

10 countries to enhance use of expenditure information in annual health sector reviews, joint work with Results Monitoring group

Guidance for countries in analysis and use of health and RMNCH expenditure data (early 2013)

Agreement on new marker for RMNCH resource tracking by OECD-DAC members; to be used for tracking of 2013 commitments and financial flows, reported in 2014.

Monitoring Results (Recommendations 1 and 2)

By 2015, countries have well-functioning health information systems that combine data from facilities, administrative sources and surveys

By 2012, the same 11 indicators on reproductive, maternal and child health, disaggregated … being used

Monitoring Results Country situation & proposed actions

50%: national M&E plan needs lots of strengthening

Two-thirds: quality of analytical work for reviews needs lot of strengthening (and 73% note the lack of equity analyses)

33%: will conduct a MNCH-related survey in 2013-2014

ALL: national health sector strategic plans have MNCH indicators prominently

present

NONE: of the plans have all 11 indicators; changes in the indicators mid-way

the health sector strategic plan are usually not made

Priority country actions

Strengthen analytical work in preparation for reviews, including equity Improve health facility data availability and quality for annual monitoring Strengthen M&E plan and coordination

Countries with very low score Monitoring of Results

West & Central Africa: Benin, Chad, Central Africa Republic, Congo, DR Congo, Gambia, Mali, Niger, Sao Tome & Principe, Senegal

Middle East and Central Asia: Afghanistan, Djibouti, Pakistan, Somalia, South Sudan, Yemen

Western Pacific: Solomon Islands, Papua New Guinea

Monitoring Results Progress

Capacity strengthening: 15+ countries (WHO, Africa Pop Hlth Res Centre, Stats Norway, Univ. Oslo, others)

Tools and guidance:

Facility DQ (report card, verification, SARA) WHO with USAID & CDC, GAVI

Countdown 2015, WHO and HMN published 11 indicator guidance

Partner commitment to M&E platform

Global Fund: moving towards investing in country M&E platform

GAVI: support to annual DQ assessment for facility data; evaluation study

Surveys strengthening

UNICEF committed to another round of MICS in dozens of countries:

Gates Foundation committed $8M support, funding gap still $8M

Data for monitoring

Countdown 2015: produced annual report for iERG on the 11 indicators

Review Processes (recommendations 6 and 7)

National oversight: By 2012, all countries have established accountability mechanisms that are transparent …

By 2012, compacts between country governments and all major development partners ...

Review Processes Country situation & proposed actions

65% conduct multi-stakeholder annual health reviews (55% for RMNCH)

44% do not have adequate mechanisms in place to proceed from review

results to planning and resource allocation

56% has a country compact or similar mechanism with good adherence

Priority country actions Strengthen preparation for annual reviews Strengthen use of review results in planning processes Ensure alignment of MNCH program review with health sector review

Highest and lowest scoring countries on Reviews

Top Three

Brazil (100%!)

Eritrea

Kyrgyzstan and Rwanda

Bottom Three

(nothing in place)

Haiti

Somalia

Sao Tome and Principe

Review Processes Progress

Renewed global focus on IHP+ approach: Global Health Leaders meeting in New York (World Bank, WHO and others)

31 countries and 25 development partners have signed up to the International Health Partnership (IHP+)

64% of development partners with country representation signed compacts (where they existed) (IHP+ Results 2012 report)

Several countries are planning a mid term review of the 2008-2015 MNCH acceleration plans in 2013; linking with country Countdowns & Mid term Health Sector Strategic Plan reviews

Summary and discussion points

• Accountability framework well-received, especially by countries and several partners

• Massive out reach effort to countries successful with involvement of: – Multiple constituencies: RMNCH, health

systems, eHealth, measurement of resources and results/statistics

– Many partners: UN agencies, Global Health Partnerships, bilaterals, civil society, parliamentarians and others

• About 30 roadmaps ready by the end of 2012

• Likely that over 60 countries will develop developed roadmaps and implement

• Diverse set of activities, building upon current investments, gaps identified by the self-assessment and country priorities

Broadening of involvement in countries • Highest political levels • Strengthening civil society • Further global partner

mobilization, links with global health partnerships and initiatives, with IHP+ approach

Country implementation • Challenging implementation

(multiple organizations involved)

• Resources are catalytic and relative small to see impact

• Additional resources in future?

Summary and discussion points

• Major differences between countries: – West & Central Africa – Conflict or politically unstable

countries (Middle East & Central Asia)

– Small population countries

• The >200 commitments are currently not a driving force for accountability or for implementation of the Global Strategy

Monitoring the Global Strategy implementation • GS Commitments too variable

to use as progress monitoring basis, but should receive more attention

• Mid term reviews of RMNCH acceleration plans possible entry point, linked with health sector reviews

Country focus • Greatest need in countries that

often received little attention

• But the size of disadvantaged populations in better performing countries is often larger – equity focus