The Global Context The Commission on Information and Accountability

Recommendations and Actions

INTERCOUNTRY WORKSHOP FOR THE DEVELOPMENT OF THE ACCOUNTABILITY FRAMEWORK

EURO, Bishkek 8-10 October 2012

Dr. Mikael Ostergren Maternal Newborn Child and Adolescent Health Department (MCA)

The aspiration: to save

~16 million lives

We have the tools and resources and the political will

September 2010, the Secretary-General of the

United Nations launched the Global Strategy for

Women's and Children's Health.

Goal: track progress towards MDG 4 and 5 (child and mother health)

• Protect 120 million children from contracting pneumonia • Prevent 88 million children from stunting • Prevent 33 million unwanted pregnancies • Prevent 15 million deaths of children under the age of 5 • Prevent 570 thousand deaths of pregnancy related complications

Promises made: Status

as of September 2011

• More than 200 commitments from a range of constituencies

• US$ 40 billion mobilised: 49 countries engaged–

• 15 countries attracted more than 10 commitments

• 7 countries with only one commitment and 1 country with no commitment

Kyrgyzstan

• The Government of Kyrgyzstan commits to ensure that 100% of the

population of reproductive age have choice and access to modern

contraception with at least 3 modern methods of family planning ; 100%

free medical care for pregnant women and under-fives; ensure at least

80% of births take place at a health facilities and 90% of health facilities

have access to centralized water supply system. Kyrgyzstan will ensure

that 95% of health facilities with antenatal services provide both HIV

testing PMTCT; 35% family medicine centers provide the standard

package of youth-friendly health services; and that70% of children

receive evidence-based services within integrated management of

childhood illness.

Tajikistan

• Tajikistan commits to ensure that by 2015, 85% of

midwives are trained in provision of emergency

obstetric care; at least 85% of maternity facilities

apply the clinical protocols approved by the

ministry of health; youth friendly health services are

expanded from pilot to nationwide implementation;

and 50% of the needs of women of reproductive

age in modern contraceptives are covered from the

budget. Tajikistan will also develop an accreditation

policy for maternity institutions and ensure that

90% of maternity hospitals are certified.

Uzbekistan

• Uzbekistan commits to ensure that 96% of children aged 6-59 months

receive vitamin A twice a year by up to 2015; 100% coverage of

pregnant women with HIV counseling; and testing and reduction of

mother-to-child HIV transmission down to less than 2%. Uzbekistan also

commits to improve quality of care provided to mothers and children by

training 25,000 health workers up to 2015 on evidence-based modern

technologies to provide reproductive health services, emergency

obstetrical care, effective prenatal care, international criteria of live birth,

basic care and resuscitation of newborns, breastfeeding and rational

nutrition of children, integrated management of childhood illnesses in

the primary healthcare and hospitals and child growth monitoring.

Promises must to be kept,

efforts should be harmonized

and progress monitored

Global context

• 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

• First progress report on implementation of

recommendations released September 2012

Commission on Information and

Accountability

Global Strategy for Women & Children’s Health Vs. COIA

Commission on Information and Accountability for Women’s & Children’s Health: Improve global reporting, oversight & accountability for women's & children’s health

•Track results and resource flows

•Identify core indicators & measurement

needs for women's and children's health

•Improve health information & CRVS

•Innovative use of ICTs for access to

reliable info. on resources and

outcomes

Global Strategy for Women’s & Children’s Health: Key Interventions: Financing, Strengthen Policy & Improve

Service Delivery

•Support country-led health plans & investment.

•Integrated delivery of health services & life-

saving interventions

•Stronger health systems with skilled health

workers .

•Innovative financing, product development and

delivery of health services.

•Improved M &E to ensure accountability

CO

MM

ITM

EN

TS

Holding ourselves to

account

• Recommendations 1-3:

Better information for better results

• Recommendations 4-6:

Better tracking of resources

for women's and children's health

• Recommendations 7-10:

Better oversight of results and resources: nationally and globally

What do we mean by

accountability?

Monitor

Action

Review

….accountability of all

stakeholders

… for RMNCH and the

health sector in general

National

review mechanisms

Recommendations 1-3:

Monitoring results

• Vital events: By 2015, all countries have taken significant steps to establish a system

for registration of births, deaths and causes of death, and have well-functioning health

information systems that combine data from facilities, administrative sources and

surveys.

• Health indicators: By 2012, the proposed 11 indicators on reproductive, maternal

and child health, disaggregated for gender and other equity considerations, are being

used for the purpose of monitoring progress towards the goals of the Global Strategy.

• Innovation: By 2015, all countries have integrated the use of Information and

Communication Technologies in their national health information systems and health

infrastructure.

Health indicators: By 2012, the same 11 indicators across the continuum of

care: reproductive, maternal, newborn and child health, including HIV …

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

Monitoring results (details on

indicators)

• Resource tracking: By 2015, all 74+1 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 that

require reporting, based on a format to be agreed in each country, on externally

funded expenditures and predictable commitments.

• Reaching women and children: By 2015, all governments have the capacity to

regularly review health spending (including spending on reproductive, maternal,

newborn and child health) and to relate spending to commitments, human rights,

gender and other equity goals and results.

Recommendations 4-6:

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 aid for women’s and children’s health: By 2012, development partners request

the OECD-DAC to agree on how to improve the Creditor Reporting System so that it can

capture, in a timely manner, all reproductive, maternal, newborn and child health spending

by development partners. In the interim, development partners and the OECD implement a

simple method for reporting such expenditure.

• Global oversight: Starting in 2012 and ending in 2015, an independent ‘‘Expert Review

Group’’ is reporting regularly to the United Nations Secretary-General on the results and

resources related to the Global Strategy and on progress in implementing this Commission’s

recommendations.

Recommendations 7-10:

Better oversight

Two interdependent

cycles

1. Vital events (CRVS) 2. Health indicators & equity

3. Innovation

4. Resource tracking 5. Country Compacts 6. Reaching Women/Children

7. National oversight

8. Transparency

9. Reporting aid for Women/ Children’s health

10. Global Oversight

COMMISSION RECOMMENDATIONS

Country Actions

Global Actions

Birth and death registration

Monitoring of results

Maternal death surveillance & response

Accountability Framework

eHealth & innovation

Monitoring country resources

Advocacy and action

Monitoring results

Tracking resources

Global review (iERG)

The strategic work plan

Concluding compacts

From recommendations

to actions

Key country actions

Country accountability framework: assessment/roadmap

• Monitoring of births, deaths and causes of deaths

• Monitoring of results (strong M&E, data quality verification & transparency,

sub-national analyses including equity analysis, …)

• Maternal deaths review and quality of care evaluation in health facilities

• Use of e-Health and Innovation (ICT) in health information systems

• Tracking of financial resources – national health expenditure tracking,

RMNCH sub-accounts

• Annual review – e.g. annual health sector review including all relevant

stakeholders

• Advocacy and action – political commitment, community participation,

National Countdown conferences, parliamentarians,…

• Conduct self-assessment using the country accountability framework tool

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

• End of workshop: assessment report + key priority actions identified

Process- Regional workshop

National workshop with broader stakeholder group to finalize and validate roadmap • Identify priority actions and including catalytic funding

(250k, 2012-2013) as well as other resources available in the country (partners' investments)

•Submit to WHO the catalytic funding request

•Publish on the internet the initial assessment and roadmap (transparency!)

•Implementation

Process- Country follow-up

• Strengthen and harmonize existing mechanisms and processes(national plans, annual reviews, etc….)

• Ensure national mobilization and ownership of the results

• Strengthen country capacities in terms of M&E for the health sector with a special focus on RMNCH

• Address political challenges (high-level political commitments, reviews, oversight, advocacy)

• Approach based on national planning process

Key

principles/approaches

… and other partners

Mongolian Welfare Association

Thank you

Monitor

Action

Review