Progress on Implementing the Accountability Recommendations · Budget multi-stakeholder workplan...

Translating Recommendations into Action

Progress on

Implementing the

Accountability RecommendationsJuly 2012 – January 2014

2011 2012 2013 2014 2015

UNSG

Global

Strategy

WCH

293 commitments

Commission on

Information and

Accountability

10 recommendations

ACCOUNTABILITY: TIMELINE OF EVENTS

Commission Recommendations

Recommendations 1-3:

Better information for

better results


Better tracking of resources

for women's and children's

health


Better oversight of results

and resources: nationally

and globally

Monitor

Action

Review

2011 2012 2013 2014 2015

UNSG

Global

Strategy

WCH

200 commitments

Commission on

Information and

Accountability

10 recommendations

Multi-stakeholder

WorkplanBudget

OpPlan1

Ottawa

Rev/plan3

Geneva

Rev/plan2

Geneva


From Commission Recommendations to Action


Better information for

better results


Better tracking of resources

for women's and children's

health


Better oversight of results

and resources: nationally

and globally

Advocacy for Accountability(Recommendations 7 and 8)

Strategic workplan

Civil Registration and Vital

Statistics System (CRVS)(Recommendation 1)

Maternal Death Surveillance

and Response (MDSR)(Recommendations 1, 2, 3)

eHealth and Innovation(Recommendation 3)

Tracking Resources(Recommendations 4 and 9)

Monitoring Results(Recommendations 1 and 2)

Review Processes(Recommendations 6 and 7)

Budget multi-stakeholder workplan

• Budget $91M after second review/planning meeting; includes

iERG

– Countries: $250k as tranche 1 (2013-14), $600k as tranche 2

(2014-2015), based on performance

– Country funding is intended to be catalytic

– Many other investments in enhancing accountability in

countries: Global Fund, GAVI, bilaterals (USG, DFID, etc.),

WB, UN agencies and others

• Received (pledged) $40M from Canada: ($20M), Norway

($15M), UK/DFID ($4.7M), Germany($0.9M)

– Distributed of available funds (after PSC): 83% ($30M)

Countries, 11.7,

45%

Partners, 3.5, 14%

WHO/HQ, 9.4,

36%

WHO/Regions,

1.2, 5%

25.8 Million of Funds Distributed for Technical Activities

Distribution of funding

2011 2012 2013 2014 2015

UNSG

Global

Strategy

WCH

Commission on

Information and

Accountability

10 recommendations

Multi-stakeholder

Workplan


iERG

PMNCH

reports on

Commitments

Countdown

reports on 11

indicators

WHO progress

Report workplan

WHO progress

Report workplanWHO

iERG recommendations

2012 and 2013

2012

• Global investment framework for

WCH

• Strengthen human rights tools and

frameworks for WCH accountability

• Strengthen global governance

framework for WCH

• Set country-specific strategic

priorities for implementing the

Global Strategy

• Accelerate uptake e/mHealth

technologies

• Research in support of accountability

2013

• Advocate for a independent global

accountability mechanism for WCH

post-2015

• Prioritize quality to reinforce the

value of a human rights based

approach to WCH

• Strengthen country accountability:

better oversight mechanisms

• Focus on adolescents

• Expanded and skilled health

workforce for WCH

• Universal birth and death

registration (effective CRVS)

iERG 2012 recommendations

Human rights work intensified

1. UN Human Rights Council (HRC) resolutions on children’s right

to health, under-five mortality, birth registration

2. WHO study on under-five mortality as human rights concern

for HRC; WHO study on impact of evidence of a human rights-

based approach to improving women’s and children’s health

3. Technical Guidance on application of human rights-based

approach to reduce under-five mortality and morbidity under

preparation by OHCHR, WHO, as requested by HRC

4. General Comment on children’s right to health adopted by UN

Committee on the Rights of the Child, following lead support

from WHO, UNICEF, Save the Children and World Vision

5. OHCHR, WHO, UNFPA and PMNCH assisting 4 African countries

in conducting human rights assessments of RMNCH laws,

policies and programs

2011 2012 2013 2014 2015

UNSG

Global

Strategy

WCH

Commission on

Information and

Accountability

10 recommendations

Multi-stakeholder

Workplan


iERG

PMNCH

reports on

Commitments

Countdown

reports on 11

indicators

WHO progress

Report workplan

WHO progress

Report workplanWHO

Multiple New Initiatives

in support of RMNCH / Global Strategy

Born Too Soon;

Newborn Action Plan;

A Promise Renewed;

Pneumonia & Diarrhea Action Plan;

FP 2020;

Commission on Life Saving Commodities;

Nutrition for Growth;

Global Vaccine Action Plan;

etc.

Multiple new global initiatives

• Positive for accountability framework implementation:

– Advocacy for WCH

– Increased funding for WCH

– Emphasis on results

• Risks for accountability framework implementation

– Confusion in countries

– Funding flows may become complex and inefficient

– Fragmentation and lack of country system support

– Increased reporting requirements for countries

Global Health Agency Leaders

Reducing country reporting burden

• Sep 2013 meeting: agreement on need to reduce reporting

burden countries

• Working group with 19 agency representatives, chaired by DG

WHO

• Initial round of agencies reveals good intentions and actions

• Country situation more complicated: review of indicators and

reporting in countries ongoing

• Report back in April

A few additional highlights

of global progress

� Discourse: accountability framework used in many international meetings, fora,

commissions etc.

� Global investment framework for RMNCH

� Civil Registration & Vital Statistics Systems (CRVS):

� Calls for Action: Global Call for Action (BKK), regional ‘Decade for CRVS’

� Health Ministers endorse CRVS as priority in Pacific and in Eastern Mediterranean;

multi-partner approaches emerging in regions;

� "Role of the Health Sector in Strengthening CRVS Dec 2013": WHO in collaboration

with World Bank, UNICEF, USAID and Canada

� RMNCH financial tracking

• 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

• OECD working on integrating RMNCH into the database

2011 2012 2013 2014 2015

UNSG

Global

Strategy

WCH

Multi-stakeholder

Workplan


Multi-country

workshops

Development country roadmaps &

budget

Disbursement funds

Country implementation

75

priority countries

10 multi-country workshops

74 self assessments completed

55 funding submissions

50 disbursed

5 in progress

68 national stakeholder consultations

56 accountability roadmaps completed

12 in progress

CRVS

20%

MDSR

26%

Advocacy

9%

Resource

Tracking

12%

Reviews

5%

eHealth

6%

Monitoring

Results

23%

How are countries prioritizing their catalytic funds US$(N = 55 countries)

Countries with advanced implementation rate% expenditures > 70%

Civil registration and vital statistics systemsBy 2015, all countries have taken significant steps to establish a system for registration

of births, deaths and causes …

Progress and Achievements (Dec 2013)

�Emerging systemic Improvements: Mozambique (national mortality), Uganda

(health for registration), Philippines (annual registration week), and many more

�30 countries with comprehensive assessments complete or underway; up from 12

in May 2013.

Challenges

- Effective use of innovations and speed

- Engagement of multiple sectors

- Maintaining focus on the broad value of CRVS as a system – births, deaths and

causes of death

Proposed Strategies

• Maintain support for regional approaches

• Ensure that health sector investments & innovations are made in a way that

strengthens CRVS

Maternal death surveillance and responseCountries monitor quality of care provided in health services and take steps to make improvements..

Progress and Achievements

�All 75 countries oriented to the MDSR approach

�Technical guidance developed by WHO, UNFPA, CDC and other partners

�Global and regional workshops for experts to harmonize technical assistance for

MDSR implementation

�Consensus built for a core set of indicators for quality of care in health facilities

Challenges

- Capacity to implement MDSR at scale

Proposed Strategies

- Roster of MDSR experts developed

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

.


�Quality and transparency: regular routine monitoring of core indicators improved through use

of web based reporting (DHIS) in 30+ countries; systematic data quality monitoring in 15

countries (30+ by end 2014)

�Regular monitoring of readiness to provide quality RMNCAH services, including essential life

saving commodities in 12 countries (30+ by end 2014)

�Enhanced capacity to conduct analytical performance assessments & reports to inform

national reviews in 10+ countries (collaboration with Global Fund, GAVI)

Challenges

• Work with all partners towards one country platform for information & accountability

• Strengthening of country institutional capacity, while meeting immediate needs for results

Proposed Strategies

• Multi-partner collaboration to strengthen national (institutional) capacities in data quality,

analysis and use of results

• Support development and implementation of comprehensive M&E plans of the national

health strategy

eHealth and InnovationBy 2015, all countries are implementing national e-Health strategies and web-based

systems to report data ...


� Survey completed in 65 countries to help set priorities for developing and

strengthening national eHealth plans

� 38 countries trained in eHealth strategy development process

� 27 countries with national eHealth strategies including a focus on RMNCH

� Multiple RMNCH mHealth solutions developed / implemented across 18

countries for scale-up and institutionalization

Challenges

• Effective multi-stakeholder collaboration

• Transition from short-term project cycles into medium-term planning approach

• Effective governance mechanisms for adoption, integration and sustainability of

eHealth

Proposed Strategies

• Synthesize evidence on role of mHealth ICT innovations for RMNCH (mTERG)

Tracking ResourcesBy 2015, 50 countries are tracking and reporting, at a minimum, 2 aggregate resource indicators:

Total health expenditure by financing source, per capita; and

Total reproductive, maternal, newborn and child health expenditure by financing source, per capita


�Multi-partner support in standard framework for resource tracking (based on the

SHA 2011), including RMNCH and other disease-specific expenditure flows

�25 countries now with 1-2 years of data

�Capacity building of country teams (MOH + civil society, parliamentarians and the

media for women’s and children’s health) with multi-partner support

�Has harmonized resource tracking of health expenditure at the global and country

level (such as Decade of Vaccines, FP2020, Clinton Health Access Initiative)

Challenges

- Sustained investment in country resource tracking platform

CompactsBy 2012, in order to facilitate resource tracking, compacts between country governments and all

major development partners ...


�40 countries have signed a compact or equivalent partnership agreement

�Signing of compacts by CSOs doubled from 36% pre 2010 to 70% post 2010.

�Accountability for commitments increasingly central to compact agreements (80%

of new compacts have indicators to track commitments, up from 64% before 2010)

�Compacts do help in aligning support for national health plans

Challenges

• Adherence to compact commitments

• Institutionalised tracking of commitments

Proposed Strategies

• Strengthen and use joint annual reviews (or other national mechanisms) to track

progress on commitments

National Oversight: Health ReviewsBy 2012, all countries have established national accountability mechanisms that are transparent,...


� 53 countries conducted reviews

� Annual review reports - most reviews (94%) covered RMNCAH issues (N=17)

� Global partners increasingly investing in national capacities for monitoring of results and

reviews of health sector strategic plan, and policy dialogue to use the results

� More emphasis on decentralized performance assessment – districts (Benin, Ghana, Uganda)

Challenges

• Country institutional capacity to conduct independent reviews of progress still limited

• Mechanisms for implementing recommendations based on reviews often lacking

• Capacity and involvement CSO, media, parliament needs strengthening to make reviews

participatory, inclusive and transparent

Proposed Strategies

• Enhanced multi-year support to countries in preparing for, conducting and implementing

recommendations from reviews

Transparency By 2013, all stakeholders are publicly sharing information on commitments, resources provided and

results achieved annually, at both national and international levels.

� Working with Parliaments: Increased capacity of parliaments to contribute to better health outcomes,

budgets, legislation and awareness raising and accountability

• IPU report and assembly workshop on accountability reached over 100 parliamentarians

• Bangladesh, Kenya, Malawi, Uganda, Zimbabwe and India participate in WHO, IPU and

Government of Bangladesh workshop on accountability processes and mechanisms

• MNCH Handbook guides parliamentary action

• Pan African Parliament Women Parliamentarians discuss their possible contributions to

eliminating early marriage

� Working with CSOs: CSO coordination for efficient advocacy, capacity building for engagement with

budgets including issues around transparency, increasing interest in social accountability

• Capacity building workshop for CSOs, parliaments and the media in Kenya, Liberia, Sierra Leone,

Tanzania and Uganda to engage in budget advocacy

• RMNCH CSO advocacy alliances in 10 countries develop joint advocacy workplans for improved

RMNCH outcomes

Challenges & Proposed Strategies

- Enhance engagement and capacity of key media institutions and networks

- Need systems to track transparency

Malawi

Targets Progress

CRVS assessment/plan

MDSR system in place

Core 11 indicators monitored

National eHealth strategy

Country reporting on expenditures

IHP+ compact

National health sector review

Political leaders engaged in

RMNCH, including parliamentarians

National Countdown event

Rights based law and policy

assessment completed for RMNCH

Effective data sharing

Some Highlights of Country Action

� National Registration Bureau strategic

plan & regulations submitted to Ministry of

Justice

� Community sensitization campaign for

birth registration - Over 14,000 new-borns

issued with hospital birth reports

� A national MDSR situation analysis was

conducted and guidelines developed;

MDSR implementation in progress

� 580 district coordinators trained in web-

based monitoring of facility data

� Capacity building in NHA production

� CSOs integral part of SWAP reviews at

national and zonal level

� RMNCH focused reviews are planned

Conclusions

� Countries

� Strong interest: 56 countries with Country Accountability Framework roadmap;

in general, fragile states progress slower

� Implementation progress for technical components (monitoring) greater >>

accountability process (e.g. involvement CSO, media; use for action)

� Link with existing national accountability mechanisms essential (HSSP – IHP+)

� Core resources are catalytic, other domestic and development partner

investments and influences are critical

� Global

� Several areas of progress:

� Stronger link with human rights agenda

� Harmonized resource tracking of health expenditure

� Greater partner investment in country-led platform for information and

accountability

� Accountability as key IHP+ behaviour

� But much more needs to be done to bring all together in support of single

country framework for accountability

Meeting agenda

• Country experiences

• iERG recommendations

• Alignment & harmonization in accountability: IHP+,

RMNCAH initiatives

• Way forward: approach, country support, collaboration,

post-2015

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