Second progress report on implementation of the Commission's recommendations
Translating recommendations into action:
July 2012 – May 2013
In countries, it is clear that the accountability framework has gained traction as a guide to implementing the 10 CoIA recommendations. To date, 58 of the 75 target countries have completed accountability frameworks or are in the process of completion. The Country Accountability Framework (CAF) process (described in Recommendation 1 below) has been instrumental in bringing together donors and country stakeholders and strengthening International Health Partnership (IHP+) processes. The CAF process has also generated high levels of demand from counties for resources and technical support to implement their country accountability frameworks.
By May 2013, 36 countries had received catalytic funds to create accountability frameworks. Countries are requested to submit progress reports twice each year on the implementation of framework activities. Virtually all other countries are in the process of raising awareness about the accountability framework in-country and finalizing their country accountability frameworks.
Assessments of civil registration and vital statistics systems (CRVS) have been completed by 40 countries, of which 13 have completed the comprehensive assessment. There is strong political and partner support for this process, especially in regional bodies such as the United Nations Economic and Social Commission for Asia and the Pacific (UNESCAP) and the United Nations Economic Commission for Africa (UNECA), and through the global human rights bodies. Several countries are in the process of moving from assessment to implementation of plans, with the support and advocacy of multiple partners.
All 75 countries have been oriented to the new approach to maternal death surveillance and response (MDSR). With support from a range of partners, including Centers for Disease Control, Action Network, WHO, UNFPA, E4A, Saving Mothers Giving Life and FIGO, 53 countries have indicated they will prioritize actions to improve national, district and community systems. Capacity building and sustained investment are among the priorities going forward.
Countries are taking steps to strengthen their health information systems, including systems for annual routine reporting on health facilities. More than 20 countries are now using District Health Information Software (DHIS 2.0). This is an integrated approach that includes a web-based element that improves collection, transfer and analysis of facility data. Eleven countries have started to implement data quality mechanisms as part of efforts to improve transparency of data. They have conducted facility assessments to measure and monitor scale up of essential interventions and services for women and children. This includes monitoring the 13 essential life-saving commodities identified by the United Nations Commission on Life-Saving Commodities for Women and Children. Global partners such as the Global Fund, GAVI, PEPFAR and the European Union are increasingly investing in national capacities for monitoring of results and reviews, including health information systems, data quality and analytical capacity building for stronger health reviews and policy dialogue.
National eHealth strategies that include a focus on RMNCH have been developed in 27 countries. Sixteen mHealth solutions are being scaled up in 18 countries, in the context of Every Woman Every Child. Effective multistakeholder collaboration is critical to ensure scale up of eHealth applications and their integration into the health system.
Twenty-one countries are now tracking resources for women’s and children’s health, and an additional 23 are expected to have started work on health accounts by the end of 2013. This harmonized approach is based on the System of Health Accounts methodology (SHA 2011),1 with additional catalytic funding for this activity coming from the Global Fund. Continued technical assistance to institutionalize the approach is required.
To date, 40 countries report having signed a compact or equivalent agreement with development partners, and an additional six countries are in the process of developing such agreements. The accountability framework is an integral part of the Country Compact. With the renewed global momentum around IHP+, there is further opportunity and need to coordinate partner investments in, and work on, accountability processes at country level.
Fifty-three countries have reported they are conducting annual health sector reviews, to build a clearer picture of the gaps in their health-care provision and as the basis for national accountability mechanisms. Broader participation of stakeholders in this process has increased transparency. However, much more needs to be done to engage the active participation of civil society and nongovernmental organizations (NGOs). Improvements in the quality of the analytical inputs would strengthen the evidence base for decision-making, policy dialogue and resource allocation.
Transparency is enhanced by better monitoring of results and tracking of resources, as described above. The benefits include better data on the 11 health indicators and better data and analyses to inform reviews of progress and performance. Dissemination of information is improved by the introduction of DHIS 2.0 and the launch of regional initiatives such as the African Health Observatory. Parliamentarians, civil society organizations (CSOs) and the media are all contributing to gradual improvements in review processes. Work with the Inter-Parliamentary Union (IPU) has already led to greater involvement of parliamentarians in women’s and children’s health issues. However, many countries lack strong CSOs and media that can play a role in regular reviews and accountability processes, which should lead to greater transparency and effective action.
In response to positive feedback on the first Countdown in-depth case study (on Niger’s success in reducing child mortality, published in the Lancet in September 2012), Countdown to 2015 is sponsoring four in-depth case studies in 2013. The countries include: Afghanistan/Pakistan as one case study, Ethiopia and Malawi. These countries have all indicated interest in disseminating their case study findings through a Country Countdown event, to be scheduled towards the end of 2013 or in early 2014 after the case study results become available.