the global context · multi-country workshop to develop accountability frameworks in the afr 2...

Multi-country Workshop to Develop Accountability Frameworks in the AFR

Harare, Zimbabwe 1-3 October 2012 1 |

The Global Context

Overview of the Commission on Information and Accountability Recommendations

and Opportunities for Strengthening Accountability

MULTI-COUNTRY WORKSHOP TO STRENGTHEN RESULTS AND ACCOUNTABILITY FOR WOMEN'S AND CHILDREN'S HEALTH AND

THE HEALTH SECTOR AS A WHOLE Harare, Zimbabwe, 1-3 October 2012

Dr. Thierry Lambrechts

Maternal Newborn Child and Adolescent Health Department (WHO/MCA)



Global Context

Goal: Accelerate progress towards MDGs 4 and 5 in the world's poorer countries

Multiple partners and country commitments estimated at US$ 40 billions. These commitments need to be honored, efforts harmonized, and progress tracked.

In September 2010, the Secretary-General of the United Nations launched the

Global Strategy for Women's and Children's Health



• In November 2010, establishment of the Commission on Information and Accountability

- objective: to develop framework for accountability for women's and children's health

• Recommendations discussed in high level meetings including

- World Health Assembly - resolution WHA 64.12: May 2011

- G8 meeting: July 2011

• Report officially released by Dr Ban Ki-Moon,

September 20, 2011 - Recommendations - Priority areas for actions at country and global levels

Global Context



• Vital events: By 2015, all countries have taken significant steps to establish a system for registration of births, deaths and causes of deaths and have well-functioning health information systems that combine data from facilities, administrative sources and surveys.

• Health indicators: By 2012, the same 11 indicators across the continuum of care: reproductive, maternal, newborn and child health, disaggregated for gender and other equity considerations, are being used …

Commission' Recommendations on Monitoring Results



Health indicators: By 2012, the same 11 indicators across the continuum of care: reproductive, maternal, newborn and child health …

Three tracer indicators:

– maternal mortality ratio

– under-5 child mortality (with the proportion of newborn deaths)

– children under 5 who are stunted

Eight coverage indicators:

– met need for contraception

– antenatal care coverage

– antiretroviral prophylaxis among HIV positive pregnant women to prevent mother-to-child transmission of HIV

– skilled attendant at birth

– postnatal care (within 48 hours of childbirth) for mother and child

– breastfeeding exclusively for 6 months

– three doses of the combined diphtheria, pertussis and tetanus vaccine

– children with suspected pneumonia receiving antibiotics.

Commission' Recommendations on Monitoring Results (details on indicators)



• Vital events: By 2015, all countries have taken significant steps to establish a system for registration of births, deaths and causes of deaths, and have well functioning health information systems that combine data from facilities, administrative sources and surveys

• Health indicators: By 2012, the same 11 indicators across the continuum of care: reproductive, maternal, newborn and child health, including HIV …

• Innovation: By 2015, all countries have integrated the use of Information and Communication Technologies in their national health information systems and health infrastructure

Commission' Recommendations on Monitoring Results



● Resource tracking: By 2015, all 75 countries where 98% of maternal and child deaths take place are tracking and reporting, at a minimum, two 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.

● Country Compacts: By 2012, in order to facilitate resource tracking, “compacts” between country governments and all major development partners are in place and include reporting on externally funded expenditures and predictable commitments

Reaching women and children: By 2015, all governments have the capacity to regularly review health spending (including on RMNCH) and to relate spending to commitments, human rights, gender and other equity considerations

Commission' Recommendations on Tracking Resources



National oversight: By 2012, all countries have established national accountability mechanisms that are transparent, that are inclusive of all stakeholders, and that recommend remedial action, as required.

Transparency: By 2013, all stakeholders are publicly sharing information on commitments, resources provided and results achieved annually, at both national and international levels.

Reporting international aid on women's and children's health: development partners and the OECD will develop mechanisms to capture and report all reproductive, maternal, newborn and child health spending by development partners

Global oversight: international Expert Review Group will report regularly to the UN Secretary-General (first report available)

Commission' Recommendations on Better Oversight



Monitor

Action

Review

National

Review

Mechanisms

What do we mean by accountability?

Key principles: - focus on national leadership and ownership of results; - strengthening countries’ capacity to monitor and evaluate; - aligning efforts with the systems countries use to monitor and evaluate their national health strategies and specific health programmes; - harmonizing existing international mechanisms to track progress on all commitments made. for better results



Health system performance monitoring

Malaria

Inputs Outputs Outcome Impact

RMNCH

HIV/AIDS

Tuberculosis

NCD & injuries

HSS

Nutrition

- aligning efforts with the systems countries use to monitor and evaluate their national health strategies and specific health programmes;

What do we mean by accountability?



Accountability Framework Summary

1. Vital Events—System for birth, death registration including cause of death; Health information system (HIS) combining administrative data, surveys by 2015

2. Health indicators–-Monitor Global Strategy using 11 RMCH indicators disaggregated by gender, other equity considerations by 2012

3. Innovation—Integrated information and communication technologies into country HIS by 2015

4. Resource tracking— Monitor per capita 1) total health expenditure by financing source 2) total RMCH expenditure by financing source by 2015

5. Country compacts between countries and major development partners for resource tracking

6. Reaching women and children—Systems to review health spending and relate to commitments, human rights and results by 2015

7. National oversight—Country level accountability mechanisms with remedial action by 2012

8. Transparency all stakeholders report commitments, resources and results by 2013

9. Reporting aid systems for women’s and children’s health by 2012

10.Global oversight expert review group report on implementation of these recommendations



July 2011: Multi partner consultation on the strategic workplan for implementing the recommendations, Geneva, Switzerland

Multi-stakeholder work-plan developed though consultative process (est. USD 88 m)

WHO coordination

Focus on country actions (49 countries in Global Strategy + additional 25 Countdown countries)

Roles and responsibilities for many partners (Bilateral donors global initiatives, CSOs, PMNCH, HMN, Countdown 2015, H4+, OECD)

From Recommendations to Actions



COMMISSION 10

RECOMMENDATIONS Birth and death registration

Monitoring of results

Maternal death surveillance & response & QoC

Tracking expenditures (NHA & RMNCH sub-accounts)

ehealth & innovation

Country review processes

Advocacy and action

Monitoring results

Tracking resources

Global review (iERG)

Country level

Global level

From Recommendations to Actions

Strategic workplan with priority actions

Accountability assessment &

Roadmap



• Conduct self-assessment using the country accountability framework tool

• Develop the first draft of a roadmap with priority activities for implementation of the country accountability framework

• National workshop with broader stakeholder group:

Requirements: information/orientation of key stakeholders prior to national workshop and mapping of activities and commitments

Objectives: finalize assessment, complete roadmap with priorities and budget (CoIA catalytic budget and other sources) and align with M&E plans for national health strategy

• Transparency: making data and information publicly available

• Monitor implementation

This workshop

From Recommendations to Actions: Process



Transparency: making information available

http://www.who.int/ woman_child_accountability/en/

http://www.who.int/woman_child_accountability/en/






Global (countries, partners, UN organizations) and multisectoral (government and several ministries, parliamentarians, partners in the country, civil society) initiative.

Focus on maternal, newborn, and child health but aligning on national health policy and monitoring and evaluation plans and building on existing country activities and accountability mechanisms.

Accountability is a fundamental component of a rights based approach to health

Regional workshops are only the first step in national processes to improve health results and accountability mechanisms

Accountability agenda provides opportunities to strengthen M&E and review mechanisms at country level

Translating the CoIA Recommendations into Actions: Conclusions



Thank You!

Monitor

Action

Review

the global context · multi-country workshop to develop accountability frameworks in the afr 2...

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