country accountability framework: assessment* zambia · national health sector plan and m&e...

COUNTRY ACCOUNTABILITY FRAMEWORK: Assessment* Zambia

Policy Context

Global strategy on women and children/

commitment

National Health Sector Plan and

M&E Plan

Country team present at the National Accountability Workshop, 25-27 July 2012

MINISTRY OF HEALTH

- Vichael Silavwe, Chief IMCI Officer

[email protected]

- Ruth Bweupe, Family Planning Officer

[email protected]

- Chipalo Kaliki, Dep. Director M&E

[email protected]

- Avanthi Desilva, MPH Practicum Student

[email protected]

- Elisa Ahn,

MPH Practicum Student [email protected]

- Trust Mufune, Ag. Programme M&E Officer

[email protected]

- Pamela Kauseni, Principal Planner

[email protected]

- Calvin Kalombo, Snr. M&E Officer

[email protected]

- Desmond Banda,Senior Planner

[email protected]

MINISTRY OF COMMUNITY DEVELOPMENT,

MOTHER & CHILD HEALTH

- Stella Kangwa,Planner

[email protected]

- Lois Munthali, Chief SMH Officer

[email protected]

MINISTRY OF HOME AFFAIRS (MHA)

Xolani Akapelwa, Principal Planner M&E

[email protected]

MINISTRY OF LOCAL GOVERNMENT & HOUSING

Rhodah Habweele, Senior Planner

[email protected]

WHO

- Patricia Kamanga, WHO Zambia

[email protected]

- Solomon Kagulula, WHO Zambia

[email protected]

- Mary Katepa Bwalya, WHO Zambia

[email protected]

- Mwiche Nachizya, WHO Zambia

[email protected]

- B. Nganda, WHO IST ESA,

[email protected]

- Theresa N. Nzomo, WHO IST ESA

[email protected]

-Dag Roll Hansen, WHO headquarters

[email protected]

CLINTON HEALTH ACCESS INITIATIVE (CHAI)

- Tom Pellins, Sr. Research Associate

[email protected]

- Emily Henegham, Sr. Program Officer

[email protected]

- Yekoyesew Worku, Tech. Advisor

[email protected]

Situation Analysis

Zambia commits to: increase national budgetary expenditure on health from 11% to 15% by 2015 with a focus on women and children’s health; and

to strengthen access to family planning - increasing contraceptive prevalence from 33% to 58% in order to reduce unwanted pregnancies and

abortions, especially among adolescent girls. Zambia will scale-up implementation of integrated community case management of common diseases

for women and children, to bring health services closer to families and communities to ensure prompt care and treatment.

Zambia has recently revised its National Health Strategic Plan 2011-2015 (NHSP 2011-2015) and developed the Maternal Newborn and Child Health

roadmap for the period 2007-2014

Zambia is a member of the International Health Partnership+ (2009)

* This final version has been reviewed and validated through a national accountabilty workshop involving a broader stakeholder group. /14

Country team present at the National Accountability Workshop, 25-27 July 2012 (cont'd)

CHURCHES HEALTH ASSOCIATION OF ZAMBIA (CHAZ)

Rosemary Kabwe, Health Programs Manager

[email protected]

CENTER FOR HEALTH, SCIENCE & SOCIAL RESEARCH

(CHESSORE)

T.J Ngulube, Executive Director

[email protected]

CHILD FUND ZAMBIA

Lydia Jumbe, FP Coordinator

[email protected]

CANADIAN INTERNATIONAL DEVELOPMENT AGENCY

(CIDA)

Madani Thiam, Head of Cooperation

[email protected]

CENTRAL STATISTICAL OFFICE

Palver Sikanjiji, S. Demographer

[email protected]

ELISABETH GLASER PEDIATRIC AIDS FOUNDATION

(EGPAF)

- Makando Kabila, Lead Developer

[email protected]

- Lauren Smith, Technical Advisor SI&E

[email protected]

- Vincent Ahonsi, Director SI&E

[email protected]

HEALTH PROFESSIONS COUNCIL OF ZAMBIA (HPCZ)

Mary M. Zulu, Registrar

[email protected]

LONDON SCHOOL OF ECONOMICS AND POLITICAL

SCIENCE (LSE)

Alice Evans, Lecturer

[email protected]

PARLIAMENT

Brian Chituwo, Chair, Health Committee

PSMD ZAMBIA

Daniel K. Kalebaila

[email protected]

SWEDISH EMBASSY

Audrey Mwendapole Muchemwa, Health Advisor [email protected]

UNITED NATIONS POPULATION FUND (UNFPA)

- Sarai B Malumo, NPO/RH

[email protected]

- Sibeso Mululuma, Assistant Representative

[email protected]

UNICEF

Nilda Lambo, Chief, Health Nutrition Program

[email protected]

Alemach Kahsay, Specialist HIV/AIDS

[email protected]

UNIVERSITY OF ZAMBIA

Lutangu Ingombe, Lecturer

[email protected]


Context Possible actions

Assessment 2Plan 2Coordinating Mechanism 1Commitment 2Hospital reporting 2Community reporting 1Vital statistics 1Local studies

1

COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard* Zambia

Civil registration & vital

statistics systems

An assessment of the status and practices of civil

registration and vital statistics (CRVS) is in process. Sample

Vital Registration with Verbal Autopsy (SAVVY) and verbal

autopsy are done.With regards to hospital reporting,

recording of cause of death is done, but there is no

reporting and obtaining of death certificates. Community

reporting of births and deaths and verbal autopsy are

carried out in sampled areas only. Local studies exist in

pilot form, but these studies are not representative.

1. Need for LG to be placed at institution to provide death certificates,

automation of reporting relooking at the law

2. Strengthen community reporting of birth and death through village

registers, community health workers, test new approaches, and also

Neighborhood watch e.g. cell phones, develop/strengthen use of VA by

community workers, test new approaches.

3. Strengthen sensitisation during antenatal, birth registration at birth

and collection of birth certificates during under five programs.

4. Design a form which can capture all the required information for

patients so that it`s easier to capture information which is needed by

both the Department of National Registration and and MoH.

5. Engage the Ministry of Community Development and Maternal Health

at community level for birth and death registration.

6. Involve the Neighbourhood Health Committees and Tradional Birth

Attendants in birth and death registration.

7. Create linkages between smartcare and birth registration




National M&E Plan 1M&E Coordination 2Health Surveys 3Facility data (HMIS) 1Data sharing 2Analytical capacity 1Equity 3MNCH indicators

2


Notification 0Capacity to review and act 1Hospitals / facilities 2Quality of care 2Community reporting & feedback 0Review of the system

0

Monitoring of results

1. Make maternal death notifiable, health committee to look into

legislation to support MDR notification

2. Further training for MDSR at all levels

3. Ensure dissemination of report

4. Learn lessons from pilot, strengthen community reporting

5. Strengthen system of reviewing MDR at national and sub-national

levels; strengthen reporting from the sub-national to national level

While Zambia has recently revised its National Health

Strategic Plan 2011-2015 (NHSP 2011-2015) and developed

the Maternal Newborn and Child Health roadmap for the

period 2007-2014, the M&E plan of the NHSP (2011-2015)

does not capture all the 11 MNCH indicators. Currently it is

observed that the M&E plan does not adequately specifiy

the roles and responsibilities of key actors in the area of

data collection, compiliation, analysis and dissemination. At

facility level there is still need to have a well functioning

facility data reporting system (HMIS) that provides annual

statistics on the core MNCH indicators. It is also observed

that not all facilities are preparing facilitiy data quality

reports on a yearly basis. The Service Readiness

Availability Mapping (SAM) is still in its infancy and has not

yet been scaled up. At present only 8 of the 11 MNCH

indicators are utilised in most recent annual health sector

performance assessment reports.

1. Revise monitoring and evaluation (M&E) plans related to MNCH to

capture all remaining recommended MNCH indicators and include

performance measurement framework;

2. Strengthen M&E plans to specify roles and responsibilities of key

actors in data collection, compiliation, analysis and dissemination;

3. Need to establish a well functioning, integrated data reporting system

at facility level that aligns current reporting requirements

4. Strengthen analysis and interpretation of routine health information

data at all levels

5. Need for facilities to start preparing data quality reports on a yearly

basis;

6. The Performance Assessment system should include an assessment of

data quality reported at the facility level;

7.. Need to institutionalize Service Readiness Availability Mapping (SAM)

8. Facilitate open access to data for stakeholders and the general public

through the use of CHIP

Maternal death

surveillance & response

There is no current national policy requiring notification of

all maternal deaths. Reporting of causes of death using ICD

is being piloted in one province, but is not yet in the routine

system. Quality of care assessments are done as part of

general performance assessments biannually. There is no

separate comprehensive MNCH assessment. There are no

formal multi-stakeholder reviews of the maternal death

surveillance and response system, but reports are received

at the national level.




Policy 1Infrastructure 2Services 2Standards 1Governance 1Protection

0


National health accounts 0Compact and coordination 1Production capacities 1Data use

0

eHealth services are effective, but only for immunization.

There are multiple systems running vertically and systems

shared. Currently no standards for eHealth services and

application exist, but there are plans to develop this in the

National Health Strategic Plan (NHSP). The Ministry of

Health (MoH) has an existing mHealth committee, which

works primarily with EID. The new health policy includes

data protection clauses.

1. Revise the ICT strategy to encompass eHealth

2. Facilitate broadband connectivity

3. Continue strengthening eHealth, improve infrastructure (more

computers, savers, etc), migrate to web-based which will need training of

staff, interface multiple systems of smart care, and DHIS

4. Develop ICT standards

5. Expand terms of reference for MoH led mHealth committee on EID to

include broader representation, IDENTIFY other stakeholders to be part

of the committee

6. Introduce a motion to ensure legislation on eHealth is tabled to be

passed as a Bill

Monitoring of resources

Innovation and eHealth

The National Health Accounts (NHA) framework is based on

the International Classification for Health Accounts (ICHA)

and is in the process of migrating to System of national

accounts (SHA 2011). There are two people in charge of

producing health accounts’ key indicators, one primary and

one secondary. Health account specific indicators were

produced for HIV/AIDS, TB, and Malaria in the last NHA for

2005-2006, but not for maternal, newborn, child health

(MNCH) although this has been planned for the current

NHA. There is an MoU (not called a compact) which came

to an end in 2010 thus providing the opportunity to sign a

compact when this is renewed. All stakeholders are

involved in this process. A general NHA series is produced

and published available, but it is not produced annually and

it does not include RH and CH sub-accounts. The NHA is an

input to the budget process, but not for the RMNCH

budget.

1. Review and sign the compact/MoU

2. Institutionalize of the NHA and RMNCH subaccount




Annual reviews 2Synthesis informs reviews 1From review to planning 2Compacts or equivalent

2

Accountability processes

Collaboration between Partners , Civil Society and

Government is Zambia is guided under the health sector

coordination framework (SWAPs) which is guided through a

SWAP calendar. The SWAP calendar includes the following

health sector coordination Meetings: (1) MoH/CP Monthly

Policy Meetings (2) Sector Advisory Working Group

Meetings(SAG), (3) Joint Annual Reviews (JAR), (4) M&E sub-

committee and various Techincal Working Groups. There is

an intergrated coordinating committee for Maternal

Newborn and Child Health ( ICC for MNCH) and there are

annual consultative meetings. Despite the existence of this

committee since 2009, health sector coordination still

requires strengthening. This situation is being addressed

through the revision of the memorandum of understanding

(MoU) between government , partners and civil society.

Despite Zambia being a signatory to the Global IHP+

Compact, at country level, Zambia has not signed the IHP+

Compact. The revision of the MoU between governmet,

partners and civil society offers this opportunity. In

addition, in order for the sector coordiation mechanisms to

be adequately informed, there is need for a strong M&E

system supported by a robust Health management

Information System (HMIS). Unfortunately, at present the

HMIS is not linked between the various ministries

responsible for vital registration in the country, namely ;

Ministry of Community Development and Mother and Child

Health; Ministry of Health, Central Statistical Office, and

the Ministry of Home Affairs. The recent review of the

Ministry of Health HMIS system exposes a lot of gaps

relating to management, lack of adequate human resources

as well as inadequate infrastructure.

1.To invest in infrastructure and human resources for M&E to capture

VRS as well as MNCH indicators across all four ministries (Ministry of

Finance [CSO], Ministry of Home Affairs, Ministry of Community

Development and Mother and Child Health, Ministry of Health) and other

relevant authorities.

2. Need to revise and sign the new SWAP MoU among partners,

government and civil society.




Parliament active in RMNCH 1Active RMNCH civil society 1RMNCH progress report/review 2Media role 1National Countdown meeting

1

Advocacy & outreach

1. Identify RMNCH specialist to provide technical support for

parliamentary committee and ZAPPD on RMNCH. By engaging with these

groups, we will seek to mobilise enhanced political support for RMNCH.

2. Advocate for formation of a sub-committee on RMNCH issues

3. The liason person at the MOH should liase with civil society to amplify

advocacy efforts for increased budget allocation to health and RMNCH in

particular 4. Engage communities through

participatory sensitisation, in order to improve bottom-up accountability

on quality provision of RMNCH, as well as to raise demand for RMNCH

services.

5. Provide regular technical updates to various stakeholders on RMNCH

for public consumption.

6. Plan for countdown between 2012 - 2014, Plan to engage stakeholders

in preparation for the next countdown

A parliamentary committee on health exists, but there is no

sub-committee for reproductive, maternal, newborn, and

child health (RMNCH). However, this health committee is

currently focusing on RMNCH and will continue to follow-

up RMNCH issues until goals and objectives are met. Public

participation is poor in public hearings concerning RMNCH

issues. RMNCH is part of the Joint Annual Review process. A

countdown event for RMNCH was planned for 2011 but did

not take place because of inadequate funds. A 2008

countdown report is available.


PRIORITY ACTIONS (2012-15)

including first year actions

(2012- 2013)

Resource

requirements

Lead in Government/prime

responsibility

Potential

partners

2012 2013 2014 2015 Funding

needs

(est.)

Catalytic

funding

request

12/13

Funding

sources

1. Conduct Situational Analysis on

CVR in Zambia, including study

visits, field visits, consultative

meetings, mapping exercise.

TA, Funds, MHA Partners: MOH, WHO, CAF,

CSO, Local Govt.,

EU,MCTA,UNICEF,UNECA,

MCDMC,CDC

X X $110,000 $60,000 WHO,

UNICEF,

CDC

2. Strengthen CVR reporting

through the key Ministries

MLGH,MHA ,MoH,MCDMC and

MCTA (Legislative, Administrative,

Capacity Building)

Tools, Funds MHA MOH, WHO, CAF, CSO, Local

Govt.,


MCDMC,CDC

X X X X $60,000 WHO,

UNICEF,

CDC

3. Birth and death registration

strengthened (Legislative,

Administrative, Capacity Building)

TA, Funds MHA Partners: MOH, WHO, CAF,

CSO, Local Govt.,


MCDMC,CDC

X X X $400,000 WHO,

UNICEF,

UNFPA,

GRZ, CDC

4. Production of Vital Statistics TA, Funds CSO Partners: MOH, WHO, CAF,

CSO, Local Govt.,


MCDMC,CDC, Statistics Norway

X X X $150,000 WHO,

UNICEF,

UNFPA,

GRZ, CDC

COUNTRY ACCOUNTABILITY FRAMEWORK: Roadmap* Zambia

CIVIL REGISTRATION AND VITAL STATISTICS SYSTEMS (CRVS)




(2012- 2013)

Resource

requirements


responsibility

Potential

partners

2012 2013 2014 2015 Funding

needs

(est.)

Catalytic

funding

request

12/13

Funding

sources



1. Revise monitoring and

evaluation (M&E) plans related to

MNCH to capture all remaining

recommended MNCH indicators

and include performance

measurement framework;

TA and Financial

resources

Ministry of Health Home Affairs, WHO, CAF, CSO,

Local Govt., EU

$25,000 $25,000 GRZ, CDC,

CAF, EU

2. Strengthen M&E plans to specify

roles and responsibilities of key

actors in data collection,

compiliation, analysis and

dissemination;

TA and Financial

resources

Ministry of Health WHO X X $25,000 $25,000 UNFPA,

UNICEF,

EU

3. Need to establish a well

functioning data reporting system

at facility level that aligns current

reporting requirements ;

TA and Financial

resources

Ministry of Health X X TBD WHO, EU

4. Strengthen analysis and

interpretation of routine health

information data at all levels

TA and Financial

resources

Ministry of Health X X $50,000 EU

5. The Performance Assessment

system should include an

assessment of data quality at the

facility level;

TA Ministry of Health X X $10,000

6. Facilitate open access to data for

stakeholders and the general public

through the use of Country Health

Policy Process (CHIP)

Political will Ministry of Health X X $15,000 $15,000

7. Need to institutionalize Service

Readiness Availability (SARA).

Consider to include Lot Quality

assurance surveys.

TA and Financial

resources

Ministry of Health X X $300,000 CAF

MONITORING OF RESULTS




(2012- 2013)

Resource

requirements


responsibility

Potential

partners

2012 2013 2014 2015 Funding

needs

(est.)

Catalytic

funding

request

12/13

Funding

sources



1. Further training for MDSR at all

levels (three days training for all the

10 provinces including one TOT)

TA, tools,

financial

resources

MoH; MCDMCH Home Affairs, WHO, CAF, CSO,

Local Govt., EU, UNFPA,

UNICEF, World Bank

x x $240,000 $45,000

2. Strengthen system of reviewing

MDSR at all levels

Leadership, TA,

tools, financial

resources

MoH; MCDMCH Central level govenrment,

provincial administration, local

governmenet, WHO, CDC

x x x x $150,000

3. Implement national policy

following printing & dissemination

of document and national trainings

collaboration, TA, MoH; MCDMCH UNFPA, UNICEF, World Bank,

CDC

x x x x $150,000

4. Work to improve reporting

through HMIS, especially at

community level (through

community health assistants

reporting deaths within the

community to parent health

facilities)

tools,

collaboration,

MoH; MCDMCH Local Government, UNFPA,

UNICEF, World Bank, CDC

x x x $50,000

5. Make zonal (parent) facility

responsible for following up on

maternal deaths (may require

increased resources)

MoH; MCDMCH Local Government, UNFPA,


x x x x $60,000

MATERNAL DEATH SURVEILLANCE AND RESPONSE




(2012- 2013)

Resource

requirements


responsibility

Potential

partners

2012 2013 2014 2015 Funding

needs

(est.)

Catalytic

funding

request

12/13

Funding

sources



1. Develop/finalize national ICT

policy/strategy /STANDARDS,

ensuring that it broadly includes

ehealth

TA; money MoH; MCDMCH Home Affairs, WHO, CAF, CSO,

Local Govt., EU, UNFPA,


x x $20,000

2. Continue strengthening Ehealth,

including mhealth, infrastructure

and promote activities in this area

through partnership

TA, money,

infrastructure

development

MoH; MCDMCH x x x x $100,000

3) Work to augment mHealth

systems

TA, money,

infrastructure

development

MoH; MCDMCH CHAI, NMCC, MSL, Private

Sector (telecoms; ZOONA),

UNFPA, UNICEF, World Bank,

CDC

$0

Expand EID mHealth committee

(rewrite TOR) to other activities and

focus areas (malaria and CHA

activities have already, but should

be included in committee)

TA; consultation

of other

stakeholders

MoH; MCDMCH UNFPA, UNICEF, World Bank,

CDC

x x $10,000

Explore public-private partnerships

to develop/expand reach of ehealth

programs; possible platforms

(encourage CSR efforts of private

sector)

TA, collaboration,

infrastructure

development

MoF, MoH, Private Sector/

Foundations


CDC

x x $0

Work to improve mobile and

internet infrastructure for health.

Find solutions to push the limits of

connectivity.

money/infrastruc

ture

development

MoH JICA, Swedish Embassy,


CDC

x x x x $400,000

INNOVATION AND E-HEALTH




(2012- 2013)

Resource

requirements


responsibility

Potential

partners

2012 2013 2014 2015 Funding

needs

(est.)

Catalytic

funding

request

12/13

Funding

sources



1. Need to migrate to system of

health accounts 2011(SHA 2011)

and produce NHAs at regular

intervals eg every after two years

TA and Financial

resources

Ministry of Health Home Affairs, WHO, CAF, CSO,

Local Govt., EU

X $60,000 CAF/GRZ

2. Need to review and sign the

compact including government,

partners and civil society

Financial

resources

Ministry of Health All Cooperating Partners and

CSOs

X X $20,000 CAF, GRZ,

WHO

3. Institutionalization of the NHA

and RMNCH subaccount

TA and Financial

resources

Ministry of Health All Cooperating Partners and

CSOs

X X $60,000 $50,000 CAF, GRZ

1. Need to revise and sign the new

Sector Wide Approach SWAp) MoU

among partners, government and

civil society.

TA Ministry of Health CSHF, CSO-SUN Alliance,

UNFPA, UNICEF, WHO, DFID,

CIDA, SIDA, USAID, JICA

X

2. To invest in infrastructure and

human resources for M&E to

capture Vital statistics as well as

MNCH indicators across all four

ministries (Ministry of Finance

[CSO], Ministry of Home Affairs,

Ministry of Community

Development and Mother and Child

Health, Ministry of Health) and

other relevant authorities.

TA, financial

resources and

tools

MCDMCH, WHO, CSO, Local

Govt., EU, CIDA, SIDA, USAID,

World Bank, JICA

X x x x $1,906,000 GRZ,

Partners

MONITORING OF RESOURCES

ACCOUNTABILITY PROCESSES




(2012- 2013)

Resource

requirements


responsibility

Potential

partners

2012 2013 2014 2015 Funding

needs

(est.)

Catalytic

funding

request

12/13

Funding

sources



1. Plan for two countdown events

between 2012 - 2014, Plan to

engage stakeholders in preparation

for the next countdown

TA, financial

resources and

tools


Development and Mother and

Mother and Child Health

MCDMCH, WHO, UNICEF,

USAID, CIDA, SIDA, USAID,

X $400,000 GRZ,

Partners

2. Identify RMNCH specialists to

provide technical support for

parliamentary committee and

ZAPPD on RMNCH. By engaging

with these groups, we will seek to

mobilise enhanced political support

for RMNCH.

TA Ministry of Health MCDMCH,WHO, UNICEF,

MLGH, CSO, Local Govt., EU

X

3. Advocate for formation of a sub-

committee on RMNCH issues

TA Ministry of Community


Health

MOH, CSHF, CSO-SUN Alliance,

CIDA, SIDA, UNFPA, UNICEF,

WHO

X

4. The liaison person at the MOH

should liaise with civil society to

amplify advocacy efforts for

increased budget allocation to

health and RMNCH in particular

TA Prime responsibility: Ministry of

Health

CSHF, CSO-SUN Alliance,

UNFPA, UNICEF, WHO

X x x x

5. Engage communities through

participatory sensitisation, in order

to improve bottom-up

accountability on quality provision

of RMNCH, as well as to raise

demand for RMNCH services.

TA, financial

resources and

tools



Health

MOE, CSHF, CSO-SUN

Alliance,UNFPA, UNICEF, WHO

X x x x $700,000

6. Provide regular technical updates

to various stakeholders on RMNCH

for public consumption.

TA, financial

resources and

tools

Ministry of Health Partners: MCDMCH, CSHF,

UNFPA, CSO-SUN Alliance,

UNICEF, WHO, Media

X x x x $30,000 $30,000

TOTALS 5,501,000 250,000 -

ADVOCACY & ACCOUNTABILITY




(2012- 2013)

Resource

requirements


responsibility

Potential

partners

2012 2013 2014 2015 Funding

needs

(est.)

Catalytic

funding

request

12/13

Funding

sources


CIVIL REGISTRATION AND VITAL STATISTICS SYSTEMS (CRVS)Needs Catalytic request

CRVS $720,000 $60,000

Monitoring of results $425,000 $65,000

MDSR $650,000 $45,000

eHealth & Innovation $530,000 $0

Monitoring of resources $140,000 $50,000

Reviews $1,906,000 $0

Advocacy $1,130,000 $30,000

TOTAL $5,501,000 $250,000


country accountability framework: assessment* zambia · national health sector plan and m&e...

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