country accountability framework: assessment* solomon … · strengthen analytical capacity,...

COUNTRY ACCOUNTABILITY FRAMEWORK: Assessment*

Policy Context

Global strategy on women and children/

commitment

National Health Sector Plan and

M&E Plan

Situation Analysis

The health sector and health-related sectors will improve the health status of the age and gender population groups, especially women and

children, considered to be the highest priorities.

Child Health includes: Expanded Programme on Immunization (EPI); Integrated Management of Childhood Illness Programme (IMCI) and the

Nutrition Programme. The safe motherhood component in Reproductive Health covers family planning (FP), antenatal care, clean, safe delivery

and essential obstetric care, postnatal care, family planning, sexually transmitted infections/reproductive tract infections and HIV control.

Strategy: Do Better EPI operations

• Improve the coverage of EPI operations & services

• Revise the supportive supervision check-list

• Supervisory follow-up in priority Area Health Centres by the Provincial EPI Coordinator

• Update cold chain inventory annually

• Improve & monitor stock management at provincial & AHC levels

• By 2015 average coverage of all vaccinations is at or close to 90% (MDG 4.3). By 2015 average coverage of all vaccinations is above 90% and

above 80% for low performing provinces

• $ 8.8 million or total funding support for EPI to increase to about 1.5% by 2015

Strategy: Do better reproductive health

• Provide expanded family planning & other services, particularly for adolescents

• Procure & deliver contraceptives & other supplies

• Train staff in counselling

• Provide & monitor clients

• Expand essential obstetric care

• 20% increase in Contraceptive Prevalence Rate (CPR) by 2015 to 41.5

• Maternal mortality reduced by 75 % from 1990 (550) to 2015 (100/100,000 in 2009; MDG 5.1 is already achieved)

• Increase % of births attended by skilled health personnel from 86% in 2009 to 92% by 2015 (MDG 5.2)

• $17 million or 3% budget to increase to 4% by 2015

Strategy: Do More & Better Gender Based violence prevention & enforcement and child protection

• Reduce domestic violence and improve child protection

• Define up-dated protocols & carry out staff training

• Work with justice system to reform practices

• Social Welfare Officers, police and health care workers will follow operational procedures 90% of the time at minimum ensuring immediate and

professional handling of child protection.

Solomon Islands

* This final version has been reviewed and validated through a broad consultation with the major stakeholders in-country. /14

Situation analysis (strengths,

weaknesses/gaps)Possible actions

Assessment & Plan 1Coordinating Mechanism 2 Conduct full CRVS assessment and develop improvement plan

Hospital reporting2

Establish / strengthen interagency coordinating committee involving all key stakeholders

Community reporting 1 Improve hospital reporting, use electronic reporting system

Vital statistics 2

Training of doctors in ICD 10; regular quality control of certification; improve coding

practices

Local studies for mortality1

Strengthen community reporting of births and deaths, implement innovative approaches

Strengthen community reporting through use of VA by community workers

Strengthen the analytical capacity of vital statistics office, including data quality

assessment

Develop/expand the HDSS system



M&E Plan2

Strengthen the M&E component of the NHS, including alignment of the MNCH component

M&E Coordination 2 Strengthen RMNCH and HSSP plans , including alignment of RMNCH components

Health Surveys 2 Establish/strengthen M&E coordinating body

Facility data (HMIS) 2 Develop 10 year health survey plan

Analytical capacity 2 Plan for a national coverage survey 2012-13

Equity1

Strengthen analytical capacity, annual compilation of statistics from facilities with data

quality assessment

Data sharing 2 Conduct annual facility survey for data verification and service readiness

Strengthen analytical capacity, involve key institutions; review contents, analyses and

presentation

Strengthen equity analyses for reviews

Develop/strengthen national data repository with all relevant data and reports

Civil registration & vital statistics

systems

There has not been either a rapid or full assesment of CRVS in the

Solomon Islands. There is a committee however there is no proper

schedule implemented regarding when this committee should meet.

Meeting occurs irregularly. Both completeness and accurrateness of

hospital death reporting may be inaccurate. There is no electronic

reporting system currently. There are some people trained in the use of

ICD-10; however even those who are trained do not use it regularly when

classifying a death. Some deaths that occur in the community may not be

reported at all. In many situations, if they are reported it is not in a timely

manner. Births are reported more frequently then deaths, but this is also

not complete. For many of the deaths that do occur in the community,

their is no follow-up investigation. Vital statistics are collected yearly from

all health centres through paper forms. This information, however, is not

always published yearly or readily accessible. Local studies for mortality

statistics do not currently exist.

Solomon IslandsCOUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard*

Monitoring of results

This is a work in progress, however the plan has not been finalized or

implemented yet. There is a committee established however the roles

within the committee are not well defined. Some members are only

present at committee meetings when they have a need to address. There

is no health survey plan. There is a plan to to an MNCH survey however it

is not fully developed currently. The HMIS needs significant strenthenging.

They currently use a centralized data entry system using paper-based

forms. The data that is entered is not correctly verified annually or at any

other period. There is an annual analytical report but it is not published in

a timely manner. Dissaggregated data is available in some cases, however

this is not used in reviews. There is no data sharing between services or

sectors. Some data is publicly available, however it is only upon request.

This service is not well advertised or utilized frequently.





Notification 2 Advocate/ develop national policy on maternal death notification

Capacity to review and act 2 Strengthen national capacity through training in MDSR

Hospitals / facilities 2 Strengthen district capacity through training in MDSR

Quality of care 2

Improve reporting by hospitals; Training in ICD certification and coding (links with CRVS)

Community reporting & feedback 2 Strengthen hospital capacity and practices, including private sector

Review of the system1

Support a regular system of QoC assessments, with good dissemination of results for policy

and planning

Develop / strengthen community reporting

Develop / strengthen a system of maternal death reporting and response initiation by

electronic devices

Develop / strengthen VA for maternal deaths in communities

Develop system of involving communities in review and response

Support and strengthen review system including dissemination and use of the report



Policy1

Develop national eHealth strategy (and policy) with country leadership and broad buy in

Infrastructure 1 Enhance the connectivity of districts

Services1

Assess/map currrent systems and develop plan to strengthen the use of eHealth services

to improve information sharing

Standards 1 Enhancing interoperability through eHealth services, supported by one policy

Governance 1

Develop / strengthen a system of coordination of standards to ensure interoperability

Protection 1 Develop and support a strong effective coordination mechanism

Develop / strengthen data protection, legislation and regulatory framework for sharing

health information

Enforce compliance to data protection policies

Notification of maternal death from all health facilities is done, however it

is not clear whether this is done as a requirement under the national

policy. Also timeframe for maternal death notification is also not clear.

Also not too sure whether there is a current national policy for maternal

death notification or not. Review of MDSR is only performed at the

national level, however more capacity is necessary to perform these

reviews competently and expand to the district level. Hospital reporting of

maternal deaths is nearly complete, however it is not always timely within

24 hrs and ICD-10 is rarely used for classification. Review of maternal

deaths is only done at the National Referral hospital. Regarding quality of

care, supervisory tours occur when finances are available. Midwives are

well trained at maternal care, however nurse skills are lacking. The

capability to perform a supervisory visit varies greatly from province to

province. Community maternal deaths may not be reported at all. If they

are reported it can be upwards of a month before this occurs. There is no

electronic devices used within the community currently to relay

information and create a response currently. Verbal autopsies are

conducted when maternal health workers are informed of the death, but

the capacity to perform these varies greatly between each province. In

cases where the death is reported, feedback occurs in the form of an

awareness workshop. This also greatly varies from province to province

however, and regardless of province many of the distant communities are

not reached. MDSR is not reviewed annually at this time.

A national eHealth strategy or policy is currently not present. In urban

areas access to health information over the internet is very intermittent.

In rural areas, access does not curently exist. This is a work in progress

and priority for the MHMS. All reported data is recorded by hand. There is

no sharing of data between facilities currently. As there are no eHealth

applications that run consistently, there are also no standards. There is no

national coordination mechanism currently. Data is stored on a

centralized server however there is currently no protection policy in place.

Innovation and eHealth

Maternal death surveillance &

response





National health accounts 1 Develop NHA framework

Compact 1

Organize a meeting with decision makers and technical staff to develop instituational

arrangements and team

Coordination1

Organize a meeting using IHP+ approach to engage government and development partners

and work towards "compact"

Production1

Set up a steering committee, officially approved, with institutional support, and

functioning using results-based management methods

Analysis 1 Ensure inclusion of all key stakeholders in resource tracking /NHA

Data

Use1

Train staff on system of health accounts 2011; train district and regional staff

Map government codes to NHA codes and develop IT conversion tool for NHA

Develop /strengthen database for production of NHA

Strengthen analytical capacity in government and other institutions

Produce and disseminate report

Meet with policy makers, identify their needs, and work with them to systematically

integrate NHA data into the policy process.



Reviews 3 Advocate for annual reviews that are based on the goals, targets

Synthesis of information & policy context

2Ensure greater involvement of all stakeholders, including CSOs and women's groups

perform a stakeholder analysis; calendar of events for preparation of review

From review to planning2

Ensure that the RMNCH reviews are held and that findings feed into the health sector

reviews

Compacts or equivalent mechanisms 4 Strengthen the capacity to prepare analytical reports prior to the reviews

Develop/strengthen mechanism to compile all policy / qualitative information to inform

annual reviews

Strengthen the use of review results for planning purposes

Ensure greater involvement of all stakeholders

Develop/strengthen "Compacts" or similar mechanisms that allow management of

partners, increase partner buy-in

Increase partner buy-in, ensure review results are used

Review processes

There is currently no NHA framework in place. There is a discussion

regarding moving towards an NHA, however it is not progressing

smoothly. A major question asked is who will maintain the responsibility

for the NHA? For the monitoring resources category, nothing related to

the NHA is in place.

Both the National Health Conference and Joint Annual Performance

Review (JAPR) meetings bring together multiple stakeholders and

evaluate goals and targets. Development Partners work closely with the

MHMS in preparing/executing reviews, however women's organizations

and women in general from the Solomon Islands are largely under-

represented. There is a RMNCH review in place and it is performed

annually. Some of the available data is used to inform health sector

performance reviews, however not all relevant data, either qualitative or

quantitative, is used. Mechanisms are in place however these need a little

more strengthening in order to be most effective. MHMS does its best to

ensure annual operational planning meets are occurring, however it is

sometimes difficult to interact with Development Partners. Alignment

here is not completely present. These occur through means of the JAPR,

Donor Partner Co-Ordination Group, and through SWAp partnerships.

Plans are in place to develop a Technical co-operation framework to

further this idea.

Monitoring of resources





Parliament active on RMNCH issues1

Parliamentarians are mobilized to engage in RMNCH accountability, especially on financing

Civil Society Coalition1

Facilitate the organization of public hearings/forums for sharing of information on RMNCH

Media role 1 Establish / support /strengthen coalition

Countdown event for RMNCH1

Support capacity of civil society to synthesize evidence and disseminate messages

Work with the media to strengthen their capacity to report on RMNCH related issues

Work with the media to strengthen their capacity to report on the monitoring the

implementation of the Global Strategy

Improve information flows to media

Countdown Coordinating Committee, UN agencies (H5), and other partners

encourage/support national stakeholders to plan national Countdown

Prepare Countdown report / profile using all evidence

KEY:

1

2

3

5

Advocacy & outreach

Not present, needs to be developed

Needs a lot of strengthening

Needs some strengthening

Already present/no action needed

There is currently no parliament mobilization. Civil society coalitions do

not exist. Often the public is not given vital information for political

reasons. There is little to no media coverage in RMNCH. The media is not

pro-actively engaged, they will only report if somone from the MHMS

contacts them with an appropriate story. There is generally no sharing of

information with media to spread to the public. As indicated earlier, this

can be for political reasons (though other factors play a part). There is

currently no countdown even planned at this time, however the MHMS is

very interested in performing an event like this. As there is no countdown,

no report/profile is produced.


Lead government/

national institutePartners 2012 2013 2014 2015

Conduct full CRVS assessment and develop

improvement plan

1 Apply full assessment tool and

develop improvement plan

Civil Registration Office $30,000 MHMS/SWAp

Establish / strengthen interagency

coordinating committee involving all key

stakeholders

1 Develop and enforce committee

meeting schedule

Civil Registration Office

and MHMS

MHMS/SWAp

Improve hospital reporting, use electronic

reporting system

1 Invest in strengthening HMIS MHMS, Provincial

Health Services, NRH

MHMS/SWAp

Training of doctors in ICD 10; regular quality

control of certification; improve coding

practices

1 Train national facilitators, apply

electronic tools

MHMS, Provincial

Health Services, NRH

MHMS/SWAp

Strengthen community reporting of births

and deaths, implement innovative

approaches

1 These activities can be combined with

the community reporting regarding

MDSR activities below

MHMS and Provincial

Health Services

Church MHMS/SWAp

Strengthen community reporting through use

of VA by community workers

1 These activities can be combined with

the community reporting regarding

MDSR activities below

NRH and Provincial

Health Services

Church MHMS/SWAp

Strengthen the analytical capacity of vital

statistics office, including data quality

assessment

1 Analytical training relevant staff Provincial Health

Services

$25,000 MHMS/SWAp

Develop/expand the HDSS system 1 Assess and invest in HDSS MHMS and Provincial

Health Services

MHMS/SWAp

Solomon IslandsCOUNTRY ACCOUNTABILITY FRAMEWORK: Roadmap*

Total

Estimated

Cost per

action

Catalytic

funding

request

2012/2013

Unfunded

balance

Potential

sources for

funding unmet

balance

Suggested approach/methodsActions Priority

CIVIL REGISTRATION AND VITAL STATISTICS SYSTEMS (CRVS)

MONITORING OF RESULTS


Lead government/



Total

Estimated

Cost per

action

Catalytic

funding

request

2012/2013

Unfunded

balance

Potential

sources for

funding unmet

balance



Strengthen the M&E component of the NHS,

including alignment of the MNCH component

1 Review M&E component, revise

according to WHO/IHP+ guidance

MHMS WHO $30,000 MHMS/SWAp

Strengthen RMNCH and HSSP plans , including

alignment of RMNCH components

1 Review M&E plans and revise as

necessary using IHP+ approaches

MHMS WHO MHMS/SWAp

Establish/strengthen M&E coordinating body 1 Link with National Statistical Plan,

mapping all health surveys

MHMS WHO MHMS/SWAp

Develop 10 year health survey plan 1 Liaise with MICS, DHS, raise funding,

determine contents

MHMS WHO MHMS/SWAp

Plan for a national coverage survey 2012-13 1 Use WHO analytical approach

including data quality score card

analysis


Strengthen analytical capacity, annual

compilation of statistics from facilities with

data quality assessment

1 Plan sample survey of facility (about

100) prior to review using WHO

standard instrument


Conduct annual facility survey for data

verification and service readiness

1 Conduct analysis workshop/training

as part of review preparation; review

and improve existing practices,

including equity focus

MHMS WHO MHMS/SWAp

Strengthen analytical capacity, involve key

institutions; review contents, analyses and

presentation

1 Build upon current national and

regional observatory approaches,

WHO analysis and data quality tools

MHMS WHO MHMS/SWAp

Strengthen equity analyses for reviews 1 Develop policy/procedure in order to

integrate disaggregated data into

reviews

MHMS WHO MHMS/SWAp

Develop/strengthen national data repository

with all relevant data and reports

1 Invest in strengthening HMIS

database systems

MHMS WHO MHMS/SWAp

MONITORING OF RESULTS


Lead government/



Total

Estimated

Cost per

action

Catalytic

funding

request

2012/2013

Unfunded

balance

Potential

sources for

funding unmet

balance



Advocate/ develop national policy on

maternal death notification

1 Develop plan on maternal death

notification; incorporate plan into

overall death notification plan

MHMS WHO/UNICEF $30,000 MHMS/SWAp

Strengthen national capacity through training

in MDSR

1 Train relevant staff in MDSR MHMS WHO/UNICEF $30,000 MHMS/SWAp

Strengthen district capacity through training

in MDSR

1 Train relevant staff in MDSR MHMS WHO/UNICEF $45,000 MHMS/SWAp

Improve reporting by hospitals; Training in

ICD certification and coding (links with CRVS)

1 Develop and enforce guidelines for

the use of ICD-10 reporting. Train

relevant staff in the use of ICD-10.

MHMS WHO/UNICEF MHMS/SWAp

Strengthen hospital capacity and practices,

including private sector

1 Develop guidelines for reviewing

maternal deaths


Support a regular system of QoC

assessments, with good dissemination of

results for policy and planning

1 Develop framework for additional

supervisory tours and feedback to

health centre's.


Develop / strengthen community reporting 1 Community reporting, use of

electronic devices and verbal

autopsies are all initiated within the

community. These activities can be

combined.


Develop / strengthen a system of maternal

death reporting and response initiation by

electronic devices

1 Community reporting, use of





Develop / strengthen VA for maternal deaths

in communities

1 Community reporting, use of




combined.


Develop system of involving communities in

review and response

1 Develop guidelines for follow-up after

a community death is reported


Support and strengthen review system

including dissemination and use of the report

1 Review MDSR system; revise review

methods based on feedback from

initial review of the system


MATERNAL DEATH SURVEILLANCE AND RESPONSE


Lead government/



Total

Estimated

Cost per

action

Catalytic

funding

request

2012/2013

Unfunded

balance

Potential

sources for

funding unmet

balance



Develop national eHealth strategy (and

policy) with country leadership and broad

buy in

1 Funding for these activities comes

from other sources (mainly AusAID).

MHMS WHO/AusAID MHMS/AusAID

Enhance the connectivity of districts 1 Funding for these activities comes



Assess/map currrent systems and develop

plan to strengthen the use of eHealth services

to improve information sharing




Enhancing interoperability through eHealth

services, supported by one policy




Develop / strengthen a system of

coordination of standards to ensure

interoperability




Develop and support a strong effective

coordination mechanism




Develop / strengthen data protection,

legislation and regulatory framework for

sharing health information




Enforce compliance to data protection

policies




INNOVATION AND E-HEALTH


Lead government/



Total

Estimated

Cost per

action

Catalytic

funding

request

2012/2013

Unfunded

balance

Potential

sources for

funding unmet

balance



Develop NHA framework 1 Though there is discussion of an NHA

framework, this is currently not a

focus. Initial funding from CoIA will

not be used to establish an NHA.

MHMS WHO MHMS/SWAp

Organize a meeting with decision makers and

technical staff to develop instituational

arrangements and team

1 Though there is discussion of an NHA




MHMS WHO MHMS/SWAp

Organize a meeting using IHP+ approach to

engage government and development

partners and work towards "compact"





MHMS WHO MHMS/SWAp

Set up a steering committee, officially

approved, with institutional support, and

functioning using results-based management

methods





MHMS WHO MHMS/SWAp

Ensure inclusion of all key stakeholders in

resource tracking /NHA





MHMS WHO MHMS/SWAp

Train staff on system of health accounts 2011;

train district and regional staff





MHMS WHO MHMS/SWAp

Map government codes to NHA codes and

develop IT conversion tool for NHA





MHMS WHO MHMS/SWAp

Develop /strengthen database for production

of NHA





MHMS WHO MHMS/SWAp

MONITORING OF RESOURCES


Lead government/



Total

Estimated

Cost per

action

Catalytic

funding

request

2012/2013

Unfunded

balance

Potential

sources for

funding unmet

balance


CIVIL REGISTRATION AND VITAL STATISTICS SYSTEMS (CRVS)Strengthen analytical capacity in government

and other institutions





MHMS WHO MHMS/SWAp

Produce and disseminate report 4 Though there is discussion of an NHA




MHMS WHO MHMS/SWAp

Meet with policy makers, identify their needs,

and work with them to systematically

integrate NHA data into the policy process.





MHMS WHO MHMS/SWAp


Lead government/



Total

Estimated

Cost per

action

Catalytic

funding

request

2012/2013

Unfunded

balance

Potential

sources for

funding unmet

balance



4 Review processes are supported by

members of the SWAp. These include

DPCG, JAPR and NHC meetings as an

example.

MHMS SWAp Partners MHMS/SWAp

Ensure greater involvement of all

stakeholders, including CSOs and women's

groups perform a stakeholder analysis;

calendar of events for preparation of review




example.





example.


Strengthen the capacity to prepare analytical

reports prior to the reviews




example.


Develop/strengthen mechanism to compile

all policy / qualitative information to inform

annual reviews




example.


Strengthen the use of review results for

planning purposes




example.


Ensure greater involvement of all

stakeholders




example.





example.





example.


REVIEW PROCESSES


Lead government/



Total

Estimated

Cost per

action

Catalytic

funding

request

2012/2013

Unfunded

balance

Potential

sources for

funding unmet

balance



Parliamentarians are mobilized to engage in

RMNCH accountability, especially on

financing

1 This will not be an initial focus using

the CoIA funding at this time

MHMS WHO/AusAID MHMS/SWAp

Facilitate the organization of public

hearings/forums for sharing of information

on RMNCH




Establish / support /strengthen coalition 3 This will not be an initial focus using



Support capacity of civil society to synthesize

evidence and disseminate messages




Work with the media to strengthen their

capacity to report on RMNCH related issues




Work with the media to strengthen their

capacity to report on the monitoring the

implementation of the Global Strategy




Improve information flows to media 1 This will not be an initial focus using



Countdown Coordinating Committee, UN

agencies (H5), and other partners

encourage/support national stakeholders to

plan national Countdown




Prepare Countdown report / profile using all

evidence




TOTAL CATALYTIC FUNDING (ESTIMATED NEED) $250,000

ADVOCACY & OUTREACH


Lead government/



Total

Estimated

Cost per

action

Catalytic

funding

request

2012/2013

Unfunded

balance

Potential

sources for

funding unmet

balance



2012/13 Catalytic funding

estimated needs

CRVS $55,000

Monitoring of results $90,000

MDSR $105,000

eHealth & Innovation $0

Monitoring of resources $0

Reviews $0

Advocacy $0

TOTAL $250,000


country accountability framework: assessment* solomon … · strengthen analytical capacity,...

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