Health Measurement and Accountability post-2015: A Common Roadmap

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1 Health Measurement and Accuntability pst-2015: A Cmmn Radmap DRAFT FOR CONSULTATION March Overview This paper prvides a cmmn radmap tward strengthening cuntry health infrmatin systems. It discusses mechanisms and steps that cuntries can implement t imprve the cllectin, management, and disseminatin f health-related infrmatin in rder t mnitr and meet their sustainable develpment gals (SDGs) frm 2015 t These guidelines are intended fr natinal health sectr stakehlders as well as internatinal dnrs, multilateral agencies, and civil sciety actrs cntributing t the attainment f natinal, reginal, and glbal health gals. These guidelines, called the Cmmn Radmap, will be intrduced at the Summit n the Measurement and Accuntability fr Results in Health, t be held frm June 9-11, 2015 in Washingtn, D.C. The summit brings tgether key stakehlders invlved in meeting natinal and reginal healthrelated SDGs t advance a shared agenda fr pst-2015 health measurement. Acknwledgements: This paper encapsulates the cntent f the technical papers and presentatins prepared fr the meetings f the Wrld Health Organizatin (WHO), Wrld Bank Grup (WBG), and United States Agency fr Internatinal Develpment (USAID) in Glin, Switzerland, in January Cnsultatin: This first draft is fr cnsultatin. A final versin will be prepared fr the Summit n Measurement and Accuntability fr Health Results t be held in June

2 Table f Cntents Why a Radmap is Needed... 3 The Way Frward Cuntry Actin Glbal Actin Critical Path: Milestnes fr List f Abbreviatins CHW cmmunity health wrker CRVS civil registratin and vital statistics DHIS 2 District Health Infrmatin System 2 HIS health infrmatin system HMN Health Metrics Netwrk HRIS human resurces infrmatin system MDG Millennium Develpment Gal NSO Natinal Statistical Office SDG sustainable develpment gal SHA System f Health Accunts UNGA United Natins General Assembly UNGASS United Natins General Assembly Special Sessin USAID United States Agency fr Internatinal Develpment WBG Wrld Bank Grup WHA Wrld Health Assembly WHO Wrld Health Organizatin 2

3 WHY A ROADMAP IS NEEDED There is grwing demand fr timely and accurate health-related data at the glbal, cuntry, and lcal levels; hwever it is cnstrained by the many limitatins influencing the ability f cuntry infrmatin systems t supply the data required. This Cmmn Radmap fr Health Measurement and Accuntability Pst-2015 utlines ways f redressing these supply-demand imbalances. It describes hw lw- and lwer-middle-incme cuntries can harness the infrmatin they need t plan and manage their health plicies and prgrams t achieve natinal and subnatinal health gals and the health-related SDGs. This radmap builds n the wrk f the Health Metrics Netwrk (HMN), the Organisatin fr Ecnmic C-peratin and Develpment (OECD), i the Internatinal Health Partnership, ii and the Cmmissin n Infrmatin and Accuntability fr Wmen and Children s Health. iii T cntinue this mmentum, the U.S. Agency fr Internatinal Develpment (USAID), the Wrld Bank Grup (WBG), and the Wrld Health Organizatin (WHO) have engaged cuntry experts and partners t develp a shared apprach t measurement and accuntability fr the pst-2015 develpment agenda. Cuntries are at different stages, and pririty investments will be based n individual cuntry circumstances, be prperly sequenced, and ensure that health infrmatin systems ptimally respnd t natinal health needs. iv Fllwing the endrsements at the Summit n the Measurement and Accuntability fr Results in Health, and publicatin f the radmap, cnsultatins with cuntries will cntinue. Scaled up supprt fr natinal leadership will cme thrugh cllabratin acrss develpment partners and a fcus n cuntry-led appraches t strengthening cuntry data surces and systems. Current challenges t imprving measurement and accuntability The demand fr timely and accurate data and statistics in the pst-2015 era is a great pprtunity t build strnger health infrmatin systems. Hwever, cnsiderable challenges remain: v Insufficient investment within cuntries: Inadequate natinal resurces have been directed tward building sustainable and cmprehensive infrmatin systems, with the result that much data frm natinal systems are f lw quality. Inefficient investments in data cllectin and analysis: Individual initiatives and prgrams have priritized the prductin f quality data fr their wn indicatrs. Investments have been ad hc and fragmented and ften fcused n stand-alne surveys and ne-ff impact evaluatins. Natinal institutins respnsible fr mnitring all natinal health pririties are frustrated by prgrams with different reprting systems and funding tied t specific diseases. Lack f cuntry capacity t prduce quality health data and statistics: Ministries f health, Natinal Statistical Offices (NSOs), and civil registries, the backbne f data prductin and management, lack the required capacity, tls, and resurces. Lw-quality data is used t make decisins withut sufficient checks t verify cmpleteness and accuracy. Limited access t and usability f data: Data are nt always shared r disseminated accrding t internatinal standards. Ministry f Health fficials and managers at lwer levels wh, with increasing decentralizatin, shuld be the key champins fr measurement and accuntability are ften nt sufficiently trained and incentivized t utilize data. Requirements in the pst-2015 era Accurate measurement and effective accuntability require strng cuntry health infrmatin systems, driven by cuntry needs and uses. This radmap will redress current supply-demand imbalances and reduce the need fr data estimatins t fill gaps. As mre use is made f data frm 3

4 cuntry systems, the quality f data will imprve, building internatinal cnfidence and remving the need fr separate, duplicating systems. The key cmpnents are described belw. 4

5 Figure 1 ROADMAP TO IMPROVED HEALTH MEASUREMENT REPORTING AND STATUS

6 Civil registratin and vital statistics (CRVS) systems CRVS is the cntinuus recrding f the ccurrence and descriptin f births, deaths, and ther vital events. CRVS systems cmprise the ntificatin and registratin f vital events, the issuance f certificates t individuals, the management f infrmatin flws int ppulatin registers and natinal statistical databases, and the prductin and disseminatin f vital statistics. Figure 2, belw, illustrates the prcess. Vital statistics prvide a basis fr assessing ppulatin size, mrtality and causes f death, life expectancy, and fertility trends. Accurate statistics are therefre essential fr health plicy and pririty setting, planning, mnitring, and evaluatin, althugh CRVS are f imprtance t many stakehlders beynd the health sectr. Figure 2 CIVIL REGISTRATION AND VITAL STATISTICS SYSTEMS Censuses All cuntries must have regular censuses using the principles utlined by the UN. vi The infrmatin generated by a ppulatin and husing census numbers f peple, their distributin, living cnditins, and ther key data is critical demgraphic data used in calculating health indicatrs. Rates f mrtality, mrbidity, and fertility all need a denminatr, and this is prvided by census infrmatin, updated by infrmatin frm the CRVS system. Natinal husehld surveys All cuntries shuld mve t having an agreed prgram f ppulatin-based husehld surveys t address natinal needs cvering ppulatin health status, service cverage, health-related behavirs and risk factrs, and ut-f-pcket spending n health, including equity dimensins f health and service cverage. In mst lw- and middle-incme cuntries this wuld take the frm f a survey prgram cvering a few years that infrms the mnitring and develpment f natinal health plans. Health facility data and cmmunity health infrmatin systems Health facility infrmatin systems prvide data fr client and facility management, disease surveillance, cmmdity lgistics, and rutine health sectr planning, mnitring, and management. With the advent f mre cmmunity health wrkers (CHWs) as fficial cadres in the health sectr, cmmunity infrmatin systems (e.g., CHW registers) will be increasingly integrated 6

7 int the natinal health infrmatin system. 1 Rutine cmmunity and facility health infrmatin systems shuld be transparent, apply data management standards, vii and include data quality assurance prcesses and verificatin thrugh peridic samples f health services assessment. Disease surveillance All cuntries need active disease surveillance systems fr detecting, reprting, and respnding t ntifiable cnditins, especially highly cmmunicable diseases. Disease surveillance systems may draw upn multiple surces f infrmatin, such as rutine health facility recrds, phne recrds, and big data r special systems fr specific surveillance purpses (e.g., envirnmental surveillance invlving testing sewage fr the presence f plivirus). Health systems data All cuntries shuld have cmprehensive databases and electrnic tracking systems n key resurces required fr health service delivery. This infrmatin is gained partly thrugh rutine facility infrmatin systems and partly frm special assessments. Cuntries with different types f insurance prgrams have additinal surces f data n health issues and services claimed. The fllwing health system data are f particular imprtance: Wrkfrce A functining human resurces infrmatin system (HRIS) allws a cuntry t track, manage, and plan its health wrkfrce t get the apprpriate number f health wrkers in the right place at the right time. It can als be used fr prfessinal develpment and training, remuneratin, and supervisin. Other surces, such as prfessinal databases and the private sectr, are imprtant althugh ften difficult t access. The WHO, Wrld Bank, and partners have adpted a minimum data set required in natinal health wrkfrce accunts t imprve the tracking f health wrkfrce statistics. viii Finances A system f health accunts (SHA) facilitates learning frm past expenditure and infrms planning and resurce allcatin t reduce inequities, help prtect again catastrphic health expenses, and increase systems f accuntability. The SHA is usually verseen by ministries f health and cmplements the rutine expenditure reviews that mst treasuries undertake. T be f use, health accunts must be up t date and rutinely available t permit trend analysis, as well as allw fr disaggregatin by prgram r gegraphical area. Drugs and medical supplies Reliable infrmatin systems fr drugs, medical supplies, and vaccines are required t manage supply and demand, prevent stck-uts, and reduce circulatin f unsafe prducts. Breakthrughs are cming with increased engagement by civil sciety and the private sectr, the mve frm paperbased systems t electrnic systems, bar-cding f prducts, and the use f mbile devices and web-based systems t prvide real-time assessments f stcks. Internatinally, there is als cnsiderable fcus n mnitring drug prices ix t make natinal prcurements mre efficient and n building pharmacvigilance t imprve drug safety. x Facility infrastructure Access t health services remains a majr challenge in many cuntries, especially in rural areas where transprt and maintenance f facilities is pr, and there are limited supplies f health wrkers, supplies, and equipment. Gegraphic infrmatin system (GIS) tls are being used 1 Fr example, OpenSRP Fr example, Open Smart Register Platfrm (OpenSRP) 7

8 increasingly t evaluate the distributin f health facilities. A facility census, with gecding t prvide a master facility list with unique identifiers, is nw a critically imprtant part f health sectr planning t imprve access t services. xi xii System investments and appraches Gvernance and institutinal capacities Strengthening and sustaining cuntry data surces requires strng gvernance mechanisms, with adequate institutinal and human resurce capacities. Investments may be required in ministries f health, Natinal Statistical Offices (NSOs), and natinal public health and academic institutins. NSOs als require a degree f independence frm plitical decisin making t be able t carry ut their functins in an bjective way. ehealth 2 ehealth strategies, with natinal data architecture cvering the use f infrmatin and cmmunicatins technlgies (ICT) in the sectr, have becme essential enabling parts f the verall public health and health care delivery system. ehealth interventins have the ptential t empwer frnt-line wrker and citizens in a persn-centered health care system. They can be critical t maximizing perfrmance mnitring and accuntability at all levels. Increasingly, ehealth systems are expected t be interperable t allw brad integratin and bring synergy acrss multiple health infrmatin systems. Imprving accuntability Accuntability fr health requires credible statistics at a number f levels. At all levels, regular independent analyses and reviews will strengthen accuntability and shuld galvanize remedial actins. This requires transparent, inclusive mechanisms that can discuss the findings and identify remedial actins. Engagement f civil sciety is key, as has been shwn in areas such as mnitring the glbal HIV respnse fr UNGASS reprts. Data sharing and cmmunicatins Data cllected shuld be disseminated and shared with thse wh use the infrmatin t strengthen the health system as well as with users wh have a right t knw hw well it is functining. A supprtive legal and administrative framewrk enables sharing in accrdance with agreed standards fr cnfidentiality and data security. Data sharing is greatly facilitated by a data warehuse, a central repsitry f current and past data frm diverse surces, and web access fr the public. Mrever, having cmmn data standards facilitates integratin and analysis, while skills in data interpretatin, presentatin, and delivery are as imprtant as the skills required t cllect them. 3 Lcal press and media als need t be supprted in the interpretatin f different indicatrs s that they can reprt n health infrmatin and help make it understandable t the public. Need fr new appraches The cnfluence f infrmatin technlgies, investment pririties, and natinal and internatinal cmmitment presents a majr pprtunity t establish cuntry wnership f rbust and sustainable health infrmatin systems. The strategic actins required are summarized belw: 2 ehealth is use f infrmatin and cmmunicatin technlgies (ICT) in supprt f health and health-related fields Surce: Wrld Health Assembly Reslutin n ehealth See Cmmunicating Data fr Impact website 8

9 Actin 1: Create cultures f data use thrughut all levels f health systems: Decisin makers, senir managers, district-level fficials, and service prviders regularly use health infrmatin t imprve public health plicy, health system management, and clinical services. This actin item will require investment and training t imprve capacity and mandates fr ministries f health and partners such as lcal universities t undertake regular implementatin research and t imprve use f data. Actin 2: Align stakehlders in natinal health infrmatin systems (HIS): Develpment partners and natinal-level institutins will align investments in cuntry health infrmatin systems. Data cmpacts 4 will be agreed n cvering (i) bjective reviews f health sectr perfrmance; (ii) the results and impact f different health investments; and (iii) natinal assessments f capacity t analyze and share health statistics. Actin 3: Invest in strengthening data surces and capacities: Investments will strengthen natinal infrmatin gvernance, ehealth and data standards, and capacities fr analyzing, disseminating, and using health statistics fr clinical and district-level decisin making. Key cmpnents f the cuntry HIS and accuntability platfrm utlined in this radmap will be strengthened in line with internatinal standards and cmmitments. Actin 4: Use the digital revlutin 5 t scale up health interventins: Cuntries and glbal partners will seize the pwer f innvatin t imprve the availability, quality, and use f data fr decisin making in health. Data will be shared mre freely t rigrusly cmpare, learn, and build the evidence base fr scaling up interventins in different subnatinal cntexts. Actin 5: Strengthen glbal public gds fr health infrmatin and accuntability: Publicprivate sectr cllabratin is needed t imprve and align cmmn internatinal standards fr natinal HIS. Open access sftware systems will cntinue t respnd t cuntry demands, and research will be used t vercme implementatin challenges and strengthen glbal HIS standards, guides, and tls. Actin 6: Strengthen glbal health accuntability and reprting: Prgress tward the Cmmn Radmap shall als be reviewed glbally, as requested by member states in the Wrld Health Assembly (WHA), and by making data available fr public review. Regular prgress reviews f the health-related SDGs will be cmplemented by regular Cuntdwn reprts cvering the fllwing: Each cuntry s prgress tward the health-related SDGs n an annual basis Each cuntry s prgress in fllwing this radmap, reprted every tw years and addressing specifically: The use f infrmatin (measured by use f data frm maternal, perinatal, and child death audits and reviews, reallcating resurces based n results f natinal health mnitring and evaluatin (M&E) plans, alignment f dnr supprt, and cuntry reprting n health-related SDGs) The state f the enabling envirnment (infrmatin gvernance, ehealth and data standards, and key natinal institutinal capacities) 4 Data cmpacts are natinal-level agreements between gvernments, dnrs, and civil sciety fr bjective third-party mnitring f prgress tward natinal health gals. 5 The digital revlutin is the change frm analg, mechanical, and electrnic technlgy t digital technlgy. Wikipedia, Digital Revlutin, 9

10 The surces f infrmatin in the cuntry HIS platfrms (CRVS, census and husehld surveys, health facility and cmmunity infrmatin systems, disease surveillance, and data systems fr health wrkfrce, finance, drugs, and infrastructure) Figure 3 POSSIBLE HEALTH-RELATED SDG INDICATORS AND THEIR SOURCES THE WAY FORWARD Implementatin f the radmap requires specific actins by relevant cuntry and internatinal stakehlders. Dnrs will need t change frm funding disease- r prgram-specific data systems t a mre hlistic apprach. Key actins are utlined belw. Cuntry Actin Strengthening cuntry health infrmatin and accuntability platfrms Natinal health sectr stakehlders will need t access and assess data regularly t harness the benefits f the data revlutin. xiii Statistical literacy is als essential, even at the level f data cllectin, such as the use f data by health care prviders t imprve quality f care. District fficials can use aggregate facility and cmmunity health services data t identify data gaps in health care prvisin, track health status, display trends, and make cmparisns acrss cmmunities, facilities, r districts. xiv Develpment f a cuntry health infrmatin platfrm is a dynamic prcess, driven by the demand fr data and its analysis, implementing changes, and setting f standards r targets, as shwn in Figure belw. 10

11 Figure 4 COUNTRY HEALTH INFORMATION AND ACCOUNTABILITY PLATFORM Establishing accuntability mechanisms Regular analyses at all levels t assess prgress and perfrmance in reviews, with transparent, inclusive, and independent mechanisms t analyze, share, and discuss available infrmatin and identify remedial actins. Creating the enabling envirnment gvernance, institutins and ehealth Oversight f cuntry health infrmatin and accuntability platfrm: generates timely, quality data fr key indicatrs and serves as the basis fr reprting n natinal and internatinal gals Adequate institutinal capacity fr health data cllectin, cmpilatin, and sharing; data quality assurance, analysis, and synthesis using all relevant data surces; and fr cmmunicatin and use f results. Innvatin and ehealth t imprve data availability and quality, increase transparency and accessibility f data, and strengthen capacity in natinal statistics systems and fr decisin making. Strengthening civil registratin and vital statistics Registratin f births, deaths, and ther vital events: cntinuing recrding f ccurrence and characteristics t prduce fertility and mrtality statistics 11

12 Sample vital registratin systems: used as an intermediate measure t generate representative vital statistics using innvative methds and verbal autpsies Medical certificatin f cause f death: available accrding t the standards set ut in the Internatinal Statistical Classificatin f Diseases (ICD) Establishing regular census and prgram f husehld surveys Quality censuses carried ut n a regular ten-year cycle using internatinal principles and standards Multi-year prgram f natinal health surveys: identifies strategic pririties, peridicity, and scpe f data cllectin Ensure internatinal standards and cmparability f results between ppulatins and ver time: enfrce quality assurance, ethical practices, transparency, and data sharing in accrdance with stringent cnfidentiality prtcls and internatinal standards Strengthening health facility data and cmmunity health infrmatin systems Timely and reliable statistics frm health facilities and cmmunity health wrkers: public and private facilities and wrkers use electrnic recrding and reprting systems Regular verificatin: perfrmed in a transparent manner n facility and cmmunity infrmatin systems thrugh health services assessments Data are used at all levels f the health system in cmbinatin with ther surces fr patient care, planning, reviews, and actin Strengthening disease surveillance Natinal Internatinal Health Regulatins (IHR) cre surveillance and respnse capacities t reduce levels f hepatitis and water-brne and ther cmmunicable diseases Outbreak disease surveillance systems: effective, real-time systems supprted by labratry infrastructure Strengthening health system data surces Cmprehensive databases with internatinal standard data: electrnic tracking systems n health facilities and services, finances, spending, and lgistics including cmmdities, medicines, equipment, and supplies System f health accunts: peratinal, using internatinal standards Electrnic health wrkfrce registry t track health wrkfrce statistics and prvide infrmatin fr health wrkfrce accunts Glbal Actin Glbal public gds Glbal health indicatr registry: In respnse t cuntry demands fr a mre ratinal apprach t mnitring glbal health gals, 19 glbal health agencies agreed n a glbal reference list f 100 cre indicatrs. xv. This will cntinue t evlve t build glbal cnsensus n a set f glbal cre indicatrs fr health measurement. Open access sftware: Sftware and related tls, such as the District Health Infrmatin System 2 (DHIS 2) fr web-based health infrmatin xvi and the Census and Survey Prcessing System (CSPr) fr censuses, xvii will cntinued t be made available fr natinal 12

13 institutins t adapt and use fr their wn purpses. Such innvatin will require the use f internatinally recgnized prtcls r systems. Dnr behavir and crdinatin: Internatinal agencies will cntinue t ratinalize appraches t cuntry supprt as has already been achieved in areas such as fr CRVS, husehld survey instruments, health facility assessment, disease surveillance, and sme areas f ehealth. The funding structure f majr dnr agencies will need t change t supprt this new, mre efficient and mre sustainable apprach. Public-private cllabratins: The frequent summits and web-based platfrms spnsred by the private sectr will shwcase and cmpare new technlgy and new appraches. These can empwer managers, users, and health wrkers thrugh the use f mbile devices t cllect r share data. 6 7 xviii Research and learning n HIS: Many lw-resurce cuntries have nt yet targeted natinal HIS fr research and develpment. They can nw harness the data revlutin t develp cuntry platfrms and dedicated HIS research prgrams, using cnferences and nline frums fr dcumenting lessns and exchanging knwledge. Glbal HIS standards, guides, and tls: A cmmn set f tls will be regularly updated and further develped using internatinal standards fr measurement and t ensure interperability f systems. Internatinal agencies will ratinalize appraches, building n what has already been started in areas such as fr CRVS, husehld survey instruments, health facility assessment, disease surveillance, and sme areas f ehealth. Glbal reviews f cuntry prgress Glbal mnitring f the health gals: This is mre cmplex nw than in the MDG era and a future UN Interagency and Expert grup will require a health mnitring subgrup t wrk with expert grups in cuntries. This activity will build n the experience f the Cuntdwn t 2015 fr interventins t reduce maternal, newbrn, and child mrtality. Peer reviews f prgress f SDGs and radmap acrss cuntries: These reviews will be cnducted by member states thrugh the Wrld Health Assembly and be cmplemented by independent review mechanisms, including scial accuntability mechanisms that prvide a direct avenue fr peple s vices. Identifying and sharing the quick wins: Actins identified in cuntries shuld be shared t bring quick results elsewhere. These include dcumentatin f data surces, gereferencing existing data, analyzing and visualizing existing data mre creatively, linking survey and administrative data; enhancing the usability, accessibility, and affrdability f existing data surces; and small area estimates f marginalized r uncunted grups. xix Mving t a cuntry-led apprach As the quality f cuntry data imprves, and as cuntry health infrmatin systems becme mre cmprehensive, the internatinal cmmunity will increasingly rely n cuntry systems t mnitr all aspects f health, health systems, and the determinants f health. Cuntry plans will detail the phasing-in f this mve t natinally defined data. Specific actins will include the fllwing: 6 Fr example, mhealth Summit website 7 See GSMA Pan African mhealth Initiative website 13

14 Cuntry-led assessments, many f which are already cmpleted, will infrm natinal strategies t strengthen and use cuntry data fr mnitring and evaluatin f health plans. Natinal health sectr crdinatin mechanisms fr mnitring and evaluatin will facilitate jint planning f internatinal and natinal HIS investments and a timetable t strengthen HIS platfrms and accuntability. The level f investments will be agreed n by cuntry stakehlders, using a prprtin f natinal and internatinal develpment funds. Crss-sectr crdinatin mechanisms, led by senir levels f gvernment, will align effrts t strengthen CRVS and undertake censuses and husehld surveys. A small virtual secretariat will be established glbally with stakehlders frm the UN, Wrld Bank, expert grups, and investing partners t mnitr and crdinate effrts. The secretariat will wrk clsely with existing glbal and reginal platfrms that are prviding supprt t cuntries. Strengthening crdinatin and accuntability All cuntries shuld have strng accuntability mechanisms managed by institutins nt directly respnsible fr financing r implementing natinal prgrams r services. These mechanisms shuld be bth within the gvernment thrugh sectr perfrmance reviews and audits verseen by treasuries and the central gvernment and utside f gvernment thrugh public health institutins, academia, and civil sciety. T help develp these capacities, a data cmpact will be explred invlving the gvernment, dnrs, and civil sciety. This data cmpact will specify ne r mre institutins selected t assess the fllwing: Overall health sectr perfrmance, based n the health sectr mnitring and evaluatin plan; Results f gvernment and dnr investments in specific prgrams and interventins (fr example frm the Glbal Fund, bilateral prjects, develpment banks, and the UN); Assessment f natinal capacities fr mnitring, evaluatin, and health infrmatin, based n internatinal standard tls and framewrks; and In cuntries with sufficient capacity and experience, results-based funding appraches will be included in these cmpacts, with funding linked t imprvements in the cverage, accuracy, and penness f cre health statistics. These assessments will need t be undertaken in the cntext f lnger-term plans and strategies t build natinal mnitring and evaluatin capacity fr prducing, analyzing, and using data in the health sectr. A prprtin f the natinal and internatinal develpment funds in a cuntry will be allcated t the crdinatin and accuntability mechanism and building lnger-term institutinal capacities. The specifics will be wrked ut n a cuntry-by-cuntry basis, accmpanied by implementatin research t incrprate lessn learning. Investment required fr health infrmatin systems The investment plan will fcusing initially n three t fur cuntries and build n cuntry mnitring, evaluatin, and review strategies and plans and related activities in accuntability. This experience will be used t develp a mre streamlined apprach in ther cuntries that request such supprt. 14

15 Mnitring prgress Once the Cmmn Radmap has been endrsed, a glbal framewrk fr mnitring and evaluatin will be finalized, with clearly defined indicatrs, targets, and benchmarks. TABLE: DRAFT MONITORING FRAMEWORK FOR COMMON ROADMAP Gal: By 2030, all cuntries have the necessary infrmatin t effectively and efficiently plan and manage their health prgrams tward achievement f natinal health gals and the health-related SDGs Cre bjectives 1. Data frm natinal health infrmatin systems used at all levels t imprve health, infrm decisin making, and strengthen accuntability Indicatrs Use f data at districts/facilities (e.g. maternal, perinatal, and child death audits and reviews) Use f data natinally/subnatinally (e.g. reallcatin f resurces based n natinal M&E results) Use f data at glbal/reginal levels (e.g. cuntry peer review f prgress tward cmmn health gals) 2. Gvernments and develpment partners align investments t enable gvernance and develpment f health infrmatin and accuntability platfrms Indicatrs Cuntries with functining HIS gvernance mechanism in place Natinal Statistics Office with cre capacities Cuntries with natinal ehealth standards agreed Gvernment and dnr alignment f HIS investments in natinal health M&E plans 3. Cuntry health infrmatin and accuntability platfrms strengthened thrugh building cmpnents in line with internatinal standards and assessments 3.1. Universal registratin f births, deaths, including reprting cause f death Indicatrs Birth registratin cverage Death registratin cverage Cause f death (COD) cverage and quality 3.2. Regular census and husehld survey prgram using internatinal standards Indicatrs Census cverage fr 2020 rund Percentage f cuntries with natinal health survey prgram 3.3. Natinal health facility data and cmmunity infrmatin with regular data quality assurance Indicatrs Percentage f cuntries with natinal versight bdy fr rutine HIS and cmmunity infrmatin systems Number f cuntries with web-based systems that prduce quality data and statistics Regular quality assurance 3.4. Disease utbreak surveillance and respnse capacity cmpliant with IHR Indicatrs Cmpliance with Internatinal Health Regulatins Effective real-time utbreak disease surveillance systems, supprted by labratry infrastructure 3.5. Health system infrmatin prviding regular natinal data Indicatrs System f Health Accunts cverage Natinal Wrkfrce Accunts cverage Cverage f real-time, electrnic reprting f stck supplies 4. Glbal accuntability n health reprting strengthened Indicatrs Use f data frm cuntry systems t mnitr health-related SDGs Glbal public gds fr HIS Access t, and use f, data by civil sciety 15

16 CRITICAL PATH: MILESTONES FOR Key events and timetable The radmap signals a majr change in the way the internatinal cmmunity wrks with cuntries t deliver mre accurate and sustainable measurement and accuntability fr the health-related SDGs. This prcess will evlve in three phases ver the next fifteen years: PHASE 1, : Endrsement and cnsensus Health related SDGs, targets, indicatrs, and measures t be agreed and endrsed by all member states thrugh the gvernance mechanisms f WHO and UNGA. A glbal investment plan, utlining required pririty natinal and internatinal investments fr health infrmatin and accuntability platfrms t be cmpleted. Participating lw- and middle-incme cuntries t identify pririties fr strengthening their health infrmatin systems, leveraging internatinal nrms and guidance. Natinally set timetables fr natinal and internatinal stakehlders and investrs t define cuntry specific cmmitments in natinal plans and data cmpacts cvering natinal accuntability mechanisms. The UN, Wrld Bank, USG and ther partners t establish technical wrking grups based n existing MDG mnitring mechanisms. Launch f cllabrative glbal prgram f public gds t supprt cuntry health infrmatin and accuntability platfrms. Launch f Glbal Financing Facility fr reprductive, maternal, newbrn and child health (RMNCH), including windw n CRVS investments PHASE 2, : Investments in plans fr cuntry health infrmatin and accuntability platfrms Majr dnrs lead effrts t transitin frm prgram-specific investments in infrmatin and reprting t cuntry reprting using a natinal health infrmatin system. Based n individual cuntry assessments, CRVS systems will be aligned with internatinal standards; regular census schedules will be established; husehld surveys, cnducted every three t five years, will be initiated; natinal health facilities will build infrmatin capacities t include surveillance and respnse; and relevant gvernment institutins and internatinal partners will have access t basic health system data, such as annual natinal health accunts, and a minimum dataset fr the wrkfrce. PHASE 3, : Sustainable measurement and accuntability Cuntries t transitin away frm internatinal develpment assistance, with sufficient supprt fr strengthening and sustaining rbust health infrmatin systems. 16

17 Figure 5 ROADMAP FOR INFORMATION AND ACCOUNTABILITY Investments in cuntry health infrmatin and accuntability plans Sustainable measurement and accuntability Endrsement and cncensus Cuntry Radmap Glbal /Reginal UNGA review prgress f SDGs Jint health sectr review WHA health-related SDG review Final "Cuntdwn" prgress reprt Expert and scial accuntability review Jint health sectr review Final SDG prgress reprt th "Cuntdwn" prgress reprt Expert and scial accuntability review Jint health sectr review SDG prgress reprt Jint health sectr review SDG prgress reprt Jint health sectr review SDG prgress reprt rd "Cuntdwn" prgress reprt Expert and scial accuntability review SDG prgress reprt Jint health sectr review WHA health-related SDG review Jint health sectr review SDG prgress reprt 5 cuntries cmplete HIS investment plan Jint health sectr review SDG prgress reprt 6 cuntries cmplete HIS investment plan nd "Cuntdwn" prgress reprt Expert and scial accuntability review Jint health sectr review SDG prgress reprt 7 cuntries cmplete HIS investment plan Jint health sectr review SDG prgress reprt 8 cuntries cmplete HIS investment plan SDG prgress reprt Jint health sectr review WHA health-related SDG review 10 cuntries cmplete HIS investment plan st "Cuntdwn" prgress reprt Expert and scial accuntability review Jint health sectr review SDG prgress reprt 10 cuntries cmplete HIS investment plan Jint health sectr review SDG prgress reprt 9 cuntries cmplete HIS investment plan Jint health sectr review SDG prgress reprt 8 cuntries cmplete HIS investment plan Baseline "Cuntdwn" prgress reprt Launch f Glbal Financing Facility Jint health sectr review Final MDG reprt WHA endrse radmap 7 cuntries cmplete HIS investment plan Establish UN health mnitring sub-grup Launch glbal radmap investment plan Agree health related SDGs UNGA finalize SDGs M4H Summit 5 cuntries cmplete HIS investment plan Glin cnsensus 17

18 References i OECD Health Plicy Studies Imprving Value in Health Care Measuring Quality. OECD, 2010 ii Internatinal Health Partnership. iii Cmmissin n Infrmatin and accuntability fr maternal and child health. iv Mnitring, Evaluatin and Review f Natinal Health Strategies A cuntry-led platfrm fr infrmatin and accuntability, WHO, v Amanda Glassman and Alex Ezeh. Delivering n a data revlutin in Sub-Saharan Africa. Brief. Centre fr Glbal Develpment, July vi Principles and Recmmendatins fr Ppulatin and Husing Censuses Revisin 2. Series M N. 67/Rev.2 UN, 2008 vii Guidelines fr data management standards in rutine health infrmatin systems. USAID, Measure Evaluatin 2014 viii Campbell J. Minimum data set and health wrkfrce accunts. Presentatin WHO, Glin, January ix WHO/HAI Medicine Prices: x Wrld Health Organizatin. Pharmacvigilance, xi Rhan P Fisher and Brnwyn A Myers. Free and simple GIS as apprpriate fr health mapping in a lw resurce setting: a case study in eastern Indnesia. Int J Health Gegr. 2011; 10: 15. xii Cinnamn J, Schuurman N. Injury surveillance in lw-resurce settings using Gespatial and Scial Web technlgies. Int J Health Gegr May 24;9:25. xiii C AbuZahr, Assessing and mnitring the perfrmance f health infrmatin systems: metrics and mdels. HMN Wrking Paper Series, Number 29, June 2013 xiv G. Chee, N. Pielemeier, A. Lin, and C. Cnnr, Why differentiating between health system supprt and health system strengthening is needed, Internatinal Jurnal f Health Planning and Management, vl. 28, n. 1 (2013), pp xv Glbal Reference List f 100 Cre Health Indicatrs. Wrking versin 5. Nvember xvi District Health Infrmatin System: https://www.dhis2.rg/ xvii Census and survey prcessing system xviii Cmpendium f innvative health technlgies fr lw-resurce settings. Assistive devices, ehealth slutins, Medical devices: , WHO. xix Amanda Glassman, Data Revlutin frm the Bttm Up, Glbal Health Plicy Blg, August 8, 2014, 18

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