#ewecisme - who4 review annual review of data (discussion and use): – government and...

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16-17 November 2015, Geneva

#EWECisME

RESULTS: Driving accountability for the

Global Strategy Working groups

Stakeholder ConsultationGeneva, 16-17 November 2015

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MONITOR Primary objective is country reporting for country use

Gaps and priorities, incl.

– Quality of care, including women/user experiences

– Safety of health care workers in humanitarian crises

– Transparency of health and resource data; meaningful engagement with non-governmental actors (IHP+)

– Qualitative as well as quantitative data

– Disaggregation, incl. subnational, sex, age etc.

– Linking social accountability data and national data for accountability

– Opportunity of technology

Fewer number of core indicators that are sensitive and specific

Who decides on indicators? Ownership is important

Link with broader health sector data system, no silos

Health worker motivation & capacities to collect & use data (e.g. EPI)

Transparency of data essential

What monitoring and by whom in humanitarian settings?

Build on existing monitoring mechanisms (e.g., APR, GFF)

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REVIEW Annual review of data (discussion and use):

– Government and non-governmental data review in each country to identify gaps and successes;

– Engage wider stakeholders in the review of the data (e.g.,MoF, communities, civil society, parliamentarians, youth, private sector);

– Build on existing review processes (e.g., annual health sector reviews) where they exist to reach out to a broader set of stakeholders;

– For countries with decentralized governments, pursue review at subnationallevels

– Build capacities for cross-checking, challenging and using data

Don’t over homogenise – e.g. scorecards, need to be context specific

Consider independent reviews at country level also

Citizen hearings at local, national and global levels? Feed into IAP report?

How can these mechanisms build trust between the consumer and provider?

Learn from evidence of what works best for multi-stakeholder reviews

IAP report needs non-health sector (Thrive, Transform)

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ACT Engage key stakeholders (e.g., Ministries of Health and Finance, health

care professionals, civil society) in the process in meaningful ways…in the full process from the start.

Accessible summaries of reports (incl. IAP) in simple & compelling language, with graphics, and translated into local languages

Widespread dissemination - Put the report into the hands of people and groups who will act, including the media, parliamentarians, civil society, & young people

Hold dialogues on the reports with key stakeholders including CSOs, private sector, health care professionals, youth, affected populations, etc.

Institutionalise mechanisms & processes for change

Holding to account! This can be very political, but is critical. Need to determine how to do this… Not just government, all stakeholders

Accountability includes reward & remedial actions (e.g., sanctions?)

Accountability for both development and humanitarian settings

Bridging health inequities through

disaggregated data

Nina Schwalbe, Acting Chief of

Health and Associate Director of

Programme Divisoin

17 November 2015

151023_UNICEF Health Strategy_core strategy content.pptx 7

Operational

Framework:

9 ingredients for

action

Global Stragegy Operational Framework:

ingredients for action


Understanding (in)equity and its

drivers


Scorecards


District level Child Survival Score Card

Period : Baseline (December 2013)

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Masaka 63% 50% 63% 75% 95% 72% 65% 36% 34% 95% 59% 28% 15% 100% 20% 6% 0% 78%54.3

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Wakiso 62% 15% 38% 77% 8% 72% 54% 54% 27% 99% 48% 42% 18% 90% 26% 36% 6% 54%42.6

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Arua 75% 56% 31% 75% 0% 72% 55% 59% 42% 79% 42% 46% 6% 81% 23% 24% 0% 55%41.0

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Apac 100% 67% 83% 100% 0% 72% 57% 22% 17% 84% 50% 12% 3% 74% 27% 2% 0% 22%38.5

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Masindi 77% 39% 69% 100% 0% 72% 64% 46% 28% 64% 55% 31% 10% 40% 36% 9% 0% 35%38.4

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Maracha 50% 25% 13% 25% 0% 72% 69% 36% 24% 66% 58% 25% 0% 97% 43% 12% 0% 64%36.3

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High-quality disaggregated data enable more effective programming to tackle inequities

Under-five mortality rates in Brazil, 2013

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#EWECisME

Institutionalize, Resource and Measure: Meaningful Civil Society Engagement in global country and health policy, financing, measurement and accountability

http://chestrad-ngo.org/wp-content/uploads/2015/01/Key-Priorities-and-Action-Points-Mean-CS-Engage-June-2015-final.pdf

Amplifying Voices and Enabling Action: Key Messages and Action Points

http://chestrad-ngo.org/wp-content/uploads/2015/01/Amplifying-Voices-and-Enabling-Action-Key-msgs-and-action-points-final.pdf

Accountability: Complex and Interactive

An Imbalance

Supply:

Technical Process: Goals, Targets, Indicators, Measurements, Information Systems -Monitor, Analyze and Review)

Demand:

Political Process: Utilization, Action and Remedial – Dialogue, Reward, Incentive Systems, Sanctions, Whistle Blowing

COUNTDOWNS (UHC,NCD,RMNCH)

OTHERS

GAVI, GFTAM FRAMEWORK

UNAIDS ACCOUNTABILITY

COIA

IHP+

PHCPI

GLOBAL COLLABOR

ATIVE

CIVIL SOCIETY

Data Collaborative:An Opportunity

Harmonize, Align and improve the quality of a plethora of accountability platforms and processes at all operational levels

Balance the technical (monitoring, review) and demand (Act)

Country Voices: More and stronger

ENGAGE RELATECONTRIBUTE

CIVIL SOCIETY AND THE GLOBAL COLLABORATIVE ON PERFORMANCE MEASUREMENT AND ACCOUNTABILITY:

AN INSIDE-OUT APPROACH

Data Systems and QualityOpen Data Initiative Data Reviews and Utilization Capacity Enabling Institutional strengtheningMeaningful stakeholder Engagement

Political Will (Alignment, coordination,

contribution)Targeted Campaigns

(e.g. CRVS, Financing)Health and accountability

dialogue(Multi-stakeholder)

Citizen’s Engagement (Scorecard & Reports)Partnership Behaviour

(IHP+ Behaviours & Others)Peer Accountability

(Right bearers)Accountability demand

(Whistle Blowing & Remedial)

Costed and aligned M & E plansCountry Institutional CapacityPopulation surveysFacility, Community and Administrative information systemsDisease surveillance

MONITOR ACTREVIEW

2030: Every Woman, Every Child Every Adolescent In Every

Setting

Healthy, Secure and Accounted For

RESOURCES: Driving accountability for the



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Monitor

Discussion points

Monitoring commitments least valuable; disbursements better; real expenditure close to people better still

What is money used for?

Monitor external, domestic govt & private resources

Out of pocket payments

Hard to access data

Harmonise tracking: add adolescents

Link up sub-national to global levels

Recommendations

1/. Continue with OECD policy marker: add donors & adolescents.

2/. Manage expectations: takes few years to build up good quality data.

3/. Continue with financial monitoring done by iERGas valuable to see trends over time.

4/. National Health Accounts valuable: add adolescents

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Review

Discussion points

Enhance data quality, transparency, availability

Need national institutional review tailored to context

Continue WHO feedback on (National) Health Accounts & use data for planning / budgeting

Build open source & intelligent reporting systems, incl facility level

Recommendations

1/. Focus on country level: including state/county level

2/. Enhance Regional mechanisms for learning & peer review

3/. Funding & capacity building (for all) for accountability work

4/. Multi-stakeholder review groups where independent review is not possible.

5/. What’s in it for me? Make data collection useful to user

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Act

Discussion points

Think through incentives carefully

Enable Ministry to Ministry advocacy e.g. MoH to Finance

Develop tracking of private facilities

Action at all levels from facility to district to state to national to regional to global

Recommendations

1/. Capacity building for all incl. Parliamentarians

2/. Scorecards useful for different purposes: for management & for CSO / Parliamentary scrutiny

3/. Share what works MoH to MoH

4/. Encourage govt to govt peer pressure

5/. Empower & include CSOs

RIGHTS: Driving accountability for the



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MONITOR What? Identify key and core health-related human rights commitment

and targets - the realization or violation of which will most affect progress under the Strategy:

– Violence against women– Harmful gender norms– Respect of rights of health workers– Respectful birth– Etc.

How? Draw on existing monitoring mechanisms to gather relevant data:– Human rights mechanisms (Charter-based bodies, UPR, Special

Procedures)– National Human Rights Institutions/civil society shadow reporting

Identify a set of critical markers against which to measure/evaluate well-functioning accountability frameworks

Cross-cutting: – Budget tracking of funds spent on human rights interventions. A

‘human rights marker’.– Monitoring integration across the different areas

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REVIEW

Innovate to better ‘cost’ human rights measures to understand their contribution and impact in terms of returns on investment.

Clarify the overlap between 1) SDG commitments; 2) international law commitments; 3) Global Strategy targets and indicators, and translate these overlapping commitments into laymen's terms to facilitate review.

Ensure the IAP includes members with expertise on human rights

Provide a briefing package for all IAP members on core relevant human rights tools, mechanisms and principles (UPR, CEDAW, ICESCR, CRC, ICPD, CSW)

Build a ‘pool’ of technical experts in the field of human rights who could provide specific support on human rights analysis including from OHCHR/WHO

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ACT Raise awareness of the specific contribution human rights to the

health agenda

Draw down to local level to create a space for inclusive national dialogue

Ensure commitments trickle down and that people ‘on the ground’ know their rights and duties – including through Patient Bill of Rights.

Ensure reviews of progress towards Global Strategy are listed as a formal standing item at key political and international fora:

– High Level Political Forum on Sustainable Development – WHO Executive Board/World Health Assembly/Regional

Committees– Human Rights Council– Inter-Parliamentary Union Annual General Assembly


#EWECisME

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Meeting Outcomes

Won’t repeat the many useful recommendations

from the meeting - recorded and disseminated

separately.

A few take-aways

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Meeting outcomes

CoIA: GS2 updates the priorities, but urgent

to define who does what and provide

resources. Risk of confusion and overlap.

“A job well done, but do more!” Dr Chan

Align with broader SDG processes. What

does this mean? Health? GS2? SDGs?

Human Rights? What is the “Unified

Accountability Framework? Who takes the

lead? Links with IAP?

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Meeting outcomes

Focus: Monitor – Review – Act

Bottom-up, person-centered approach

“Nothing for us, without us” Youth

Data: accessible and useful to end user,

focused on outcomes and key barrierse.g. inequality, corruption, human rights

Need to build strong country multi-

stakeholder institutional mechanisms. Lots of

good examples! Resource South-South

learning processes to build on them.

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Meeting outcomes

Accountability costs money, people and time!

Who pays? Donors can do so much but it

won’t be sustainable without country

leadership and resources.

“Black hole” of private sector

Openness of countries to support

accountability and use their own resources?

Need to explore financing options

Meaningful engagement with CSOs, youth,

independent reviews etc.

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Meeting outcomes

IAP: high quality, independent members

But IAP very high level. Is there a need for

country level consultations on the IAP

findings and recommendations?

Good Communications: The IAP report will

be just that without good communications to

policy makers, practitioners, the public.

“Move from abstract to concrete” Andrew

Jack

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Next Steps - IAP

Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep

2015 2016

Friday 20 Nov,

17h00 CET

Deadline for IAP

nominations

End Nov

Partnership’s

Working Group to

present shortlist of

15 candidates to

Mrs Machel

Dec

UNSG to appoint 9

IAP members

CHAIR

May

Women Deliver

PMNCH Board

World Health Assembly

Q1

Partnership to

create IAP

Secretariat

Q1

IAP to meet

Q1 – Q2

IAP to collect data, and

write First Interim State

of Women’s, Children’s

and Adolescents’

Health Report13-26 Sep

UN General

Assembly

& HLPF Meeting

Q3

PMNCH Board write

commentary on

ReportEarly Dec

Partnership to

provide shortlist

to UNSG

Q3

First State of Women’s,

Children’s and

Adolescents’ Health

Report published,

including PMNCH Board

commentary

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#ewecisme - who4 review annual review of data (discussion and use): – government and...

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