AUC RMNCH ACCOUNTABILITY MECHANISMS

AFRICAN UNION UNION AFRICAINE UNIÃO AFRICANA PMNCH Partners Forum Johannesburg, South Africa June 30th July 1st, 2014 Time: 15:30 17:00 Parallel Session 2C: Accountability for RMNCH: The African Perspective and Prospects AUC RMNCH ACCOUNTABILITY MECHANISMS

Parallel Session 2C: Accountability for RMNCH: The African Perspective and Prospects AUC RMNCH ACCOUNTABILITY MECHANISMS 1. BACKGROUND Accountability is process through which people entrusted with responsibilities are kept under check to carry out the tasks assigned to them. It is a cyclical process that assesses progress, recognizes success, identifies problems, takes remedial action and holds all parties to account. An effective accountability mechanism should be transparent and inclusive, ensuring the meaningful participation of all key stakeholders - particularly civil society; consider disaggregated data that take care of equity concerns and includes an independent review, from the widest range of sources. It should be a combination of political, managerial and social accountability. The Millennium Development Goals (MDGs) specifically concerned with improving the health of women and children are still far from being achieved by 2015, therefore there is urgent need of innovative and strategic actions, supported by political will and resources for greater impact. It has been recognized that accountability will be one of the key pillars of the strategic actions to accelerate the achievement of the MDG targets. It is widely believed that accountability can push partners to deliver on their commitments and responsibilities. In addition, it can demonstrate how actions and investment translate into tangible results (what works, what needs to be improved and what requires more attention. 2. GLOBAL ACCOUNTABILITY FOR RMNCH In recognition of the need to accelerate progress in improving the health of women and children, the Secretary-General of the United Nations in 2010 launched the Global Strategy for Women s and Children s Health. Critical to achieving the objectives of the strategy was the need to put in place accountability mechanisms for financial resources and health outcomes. It is against this backdrop that the Commission on Information and Accountability for Women s and Children s Health was founded. The Commission has developed an accountability framework to ensure that promises of resources for women's and children's health are kept and that results are measured. The framework identifies a core set of indicators for results and resources, proposes an action plan to improve health information systems, and explores opportunities to improve access to information through information technology. The framework links accountability for resources to the results, outcomes and impacts they produce. It places accountability soundly where it belongs: at the country level, with the active engagement of governments, communities and civil society; and with strong links between country-level and global mechanisms. Independent Expert Review Group (ierg) monitors progress

in taking forward the UN Secretary General s Global Strategy for Women s and Children s Health. 3. ACCOUNTABILITY MECHANISMS IN THE CONTINENT Improvement of women and children s health has received particular recognition as a development and human rights issue in Africa. Investing in the health of women and children lays a strong foundation for sustainable social, economic and environmental development, and for peace and security. It is estimated that increasing health expenditure by just US$ 5 per person per year, between 2013 and 2035, in 74 highburden countries (46 of which are in Africa) could yield up to nine-fold dividends in economic and social terms. Over the last two decades, there has been a strong political will on the continent to improve the welfare of women and children. The big question however is - are the pledges and commitments translating into tangible actions? The need to establish a strong accountability mechanism and especially at the continental level is very critical. As part of the global process, a number of continental accountability mechanisms have been put in place. Unfortunately, most continental mechanisms are broader in scope and not specific to RMNCH or even health but cover substantially critical health issues. Key among these includes: 3.1. African Peer Review Mechanism (APRM) The APRM was initiated in 2002 and established in 2003 by the African Union in the framework of the implementation of the New Partnership for Africa s Development (NEPAD). The Mechanism is a mutually agreed instrument voluntarily acceded to by the member states of the African Union (AU) as a self-monitoring mechanism. The objectives are primarily to foster the adoption of policies, standards and practices that lead to political stability, high economic growth, sustainable development and accelerated sub-regional and continental economic integration through experience sharing and reinforcement of successful and best practices, including identifying deficiencies and assessment of requirements for capacity building. 3.2. The Africa Partnership Forum The Africa Partnership Forum (APF) was established following the Evian G8 Summit in 2003 as a way of broadening the existing dialogue between the G8 and the New Partnership for Africa s Development (NEPAD) to include other African institutions and Africa s major bilateral and multilateral development partners. The objective of the Forum is to catalyze and support action on both sides of the partnership in support of Africa s development. It makes recommendations to leaders on decisions which need to be taken in key regional and global processes, including the G8 and G20, the African Union and the UN, in support of Africa s development and to monitor the delivery of commitments by both sides of the partnership.

3.3. African Committee of Experts on the Rights and Welfare of the Child As provided under Article 43(1) of the African Charter on the Rights and Welfare of the Child (ACRWC), every State Party to the Charter shall undertake to submit to the Committee through the Secretary-General of the Organization of African Unity, reports on the measures they have adopted giving effect to the provisions of the ACRWC and on the progress made in the enjoyment of these rights. States Parties are required to submit initial reports to the African Committee of Experts on the Rights and Welfare of the Child (ACERWC or the Committee) within two years of entry into force of the ACRWC and every three years thereafter. The charter has been ratified by 47 Member States representing more than 80% of African Union States Members. Currently, 23 State Parties have complied duly to their obligations to submit initial reports to the Committee as stipulated in Article 43 of the ACRWC, among which few have submitted their periodical reports. Based on this treaty-based obligation, since its establishment in 2001, the ACEWRC has been receiving initial and periodic State Party reports, analyzing the Reports, and issuing Concluding Observations to States Parties on the protection of child rights. The State reporting which is aimed at assessing the extent to which States have adhered to their obligations is regarded as the backbone of human rights treaty bodies mission. The reporting mechanism provides comprehensive review on the extent to which harmonization and compatibility of national processes is with international or regional obligations and also provides a regular forum for self-assessment by a State Party on the extent to which the various rights are, or are not being enjoyed in its jurisdiction. 4. AUC RMNCH ACCOUNTABILITY MECHANISMS The African Union has consistently rallied its Member States around addressing the issues and challenges posed by adverse maternal and child health status in Africa. Several continental frameworks and policies have been adopted in this regard and include the Continental Policy Framework for Sexual and Reproductive Health and Rights (SRHR) adopted in 2005, followed by the Maputo Plan of Action (MPoA) for its implementation in 2006; and the Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA) in 2009. During the 15 th Ordinary Session of the AU Assembly in 2010, Africa s political leaders committed to key actions to reduce mortality and morbidity. The commitments were again renewed during the 20 th and 22 nd ordinary session of the AU Assembly in January of 2013 and 2014 respectively. In a renewed determination and strong desire not only to consolidate current gains but also to focus attention of its Member States on results-oriented actions to address Africa s MNCH needs, the African Union Commission (AUC) in collaboration with the

Government of South Africa, convened in Johannesburg, South Africa in August 2013, the First International Conference on Maternal, New-born and Child Health in Africa. The multi-sectoral conference was attended by African Heads of State and Government, Ministers of health and Ministers from other sectors whose decisions had a bearing on MNCH outcomes. Also in attendance were partners from within and outside the UN system and civil society organizations. The Conference took stock of the progress made in addressing MNCH issues; highlighted prevailing challenges and forged a collective resolve in preparation for the post 2015 development agenda. The conference also witnessed the launch of the Mama Afrika Award, which is dedicated to celebrating individuals and organizations that work at keeping Africa s mothers and children survive and thrive into the future. The conference culminated with an Action Plan towards Ending Preventable Maternal, Newborn and Child Mortality. Implementation of the Action Plan towards Ending Preventable Maternal, Newborn and Child Mortality has started in earnest, the Republic of South Africa working with partners such as UNFPA is spearheading the implementation of the Maternal Death Surveillance Response and sharing experiences and lessons with other member states to motivate action. The AUC, having recognized the negative impact of adolescent pregnancy on maternal mortality and morbidity, recently launched the Campaign to End Child Marriage in Africa. The AUC remains confident that partners are implementing the actions to end preventable maternal, newborn and child mortality and will soon initiate the annual review of progress as part of the accountability mechanism. The need to put in place mechanisms to ensure that the commitments made thus far are translated into actions to accelerate progress to improve maternal and child health cannot be overemphasized. More importantly, the accountability initiatives must speak to existing mechanisms at country and global level. In this respect, the AUC will forge strong partnerships and collaboration between global and regional partners to strengthen accountability mechanisms for improved MNCH outcomes and share the experience of countries that have implemented tools for increased accountability and tracking of MNCH outcomes. 4.1. The AUC RMNCH Accountability Framework The AUC RMNCH framework comprises of the classical three key components of accountability framework namely monitoring, review and action. Monitoring finds out what is/is not happening, where and who is affected. Whereas review asks whether or not pledges, promises and commitments have been kept and duties discharged. It further asks what good practices can be learned. Remedy or action is more concerned

with measures needed to put things right if they have not gone as intended as well as rewarding performance. a) Monitoring MNCH commitments The AUC is in the final stages of putting in place an M&E system to track progress made in implementing RMNCH pledges and commitments and especially those that relates to its key policies and continental frameworks. The monitoring system for the MPoA and Abuja call will provide the requisite information to document the MNCH situation in the AUC member states. It will provide the much needs evidence on whether the pledges and commitments are translating into action and tangible results. The system has a set of priority indicators to track progress in RMNCH, health financing, HIV&AIDS, TB and Malaria. In addition, it includes an MNCH score card consisting of 10 RMNCH indicators. The system is supported by an online data platform http://dev.africanhealthstats.org/cms/. The site is currently on its final phase of development and will be ready by the end of July 2014. b) Reviewing the MNCH situation in the continent Pursuant to the AU Assembly Declaration (Assembly/AU/Decl.1(XI)) the AUC has established the MNCH Task Force mandated to amongst others, prepare annual reviews and reports of MNCH status to the Assembly. Membership of the Task Force as adopted by the 5th Conference of the AU Ministers of Health (CAMH5) is at two levels as follows: i) Technical working group of the taskforce composed of experts from the African Union Commission, the United Nations Population Fund, World Health Organization, United Nations International Children s Fund, International Planned Parenthood Association and any other organization co-opted as need may arise. The working group considers the status report and MNCH score card, deliberates on the extent to which commitments have/have not been achieved and makes recommendations on next steps. ii) High level taskforce comprising of five (5) eminent persons selected from the 5 AU regions (one from each) deliberates on the findings of the review and presents them to the AUC policy organs for action. c) Taking Action to address maternal and child health The Specialised Technical Committees (STCs), constitute an important technical organ of the Union established under Article 25 of the African Economic Community Treaty (the Abuja Treaty) and enshrined by the Constitutive Act of the African Union under Articles 14 to 16. The STC on Population, Health and Drug Control is composed of Ministers in charge of Population, Health and Drug Control from Member States and shall among others review progresses in the implementation of policies, strategies,

programme and decisions in the respective sectors. The STC will deliberate on the actions proposed by the taskforce and make recommendations to the Executive Council which in turn will pronounce itself and further recommend to the Assembly issues that my require further guidance in accordance to the rules of procedure of the Union. In addition, the AUC in recognition of the need to reward success as a critical part of the accountability framework has established the Mama Afrika Award. The award honours remarkable efforts by individuals or organizations in Africa that ensure Africa s mothers, newborn and children survive and thrive into the future. The Award was launched at the International Conference on Maternal, Newborn and Child Health, in Johannesburg on 1 st August, 2013. Illustration of the AUC RMNCH accountability framework Monitoring committments RMNCH M&E system MNCH score card On line data platfrom Reviewing progress MNCH taskforce Taskforce TWG HL taskforce Taking action and rewarding performance Specialist Technical Committee Executive Council The Assembly Mama Afrika Award 4.2. Accountability mechanism to assess implementation of previous commitments of the African Ministers of Health In recognition of the increasing number of ministerial meetings across the continent of Africa and beyond and bearing in mind that failure to implement such commitments will deny the African people the chance to improve their health status, could result in loss of confidence and even fatigue among the intended beneficiaries. The AUC Commission working jointly with World Health Organization African Regional Office (WHO AFRO) presented during the AU-WHO Joint Ministerial meeting held in Luanda, Angola a proposal to put in place an accountability mechanism to assess the implementation of previous commitments of the African Ministers of Health. The mechanism aims to ensure that all the decisions made are implemented in order to produce the desired outcomes. In addition, it seeks to obtain buy-in for implementation from all stakeholders. The Ministers committed to establish an assessment committee composed of representatives of the AUC, WHO and experts/institutions of Member States, adhere to the set deadlines for implementation of the commitments and report

through the assessment committee. Constitution of the assessment committee is currently ongoing. 5. CHALLENGES IN PUTTING IN PLACE AN ACCOUNTABILITY MECHANISM Setting up the AUC accountability mechanism for RMNCH a process which was initiated in 2010 has had its own share of bottlenecks both at operational and political level namely: a) Data managements systems at country level Most countries do not have reliable data collection and management systems. In majority of the countries, the data are either incomplete or inconsistent. In sum, the quality, completeness and validity of performance information in most countries is not sufficient to facilitate accountability. In addition, most countries do not submit the requisite reports to the African Union compounding the operations of the accountability mechanism. b) Accountability mechanisms at regional economic community level Each Regional Economic Community (REC) has its own development architecture through which governments and development partners are held accountable. The quality and comprehensiveness of accountability mechanisms varies considerably. Where mechanisms do exist, capacity issues often limit their effectiveness. More importantly, the regional accountability mechanisms do not speak to each other and rarely take into consideration the continental mechanisms. c) The missing link country to global mechanism Though accountability ultimately lies at the country level were actions are taken to improve maternal and child health, the need to strengthen the link between the country and the regional level is equally important. Though clear links exists between the country and global RMNCH accountability mechanisms the link between country and regional mechanisms is weak or does not exist altogether. Advocacy and follow up on implementation of commitments is likely to be more effective and yield better results at the regional level. The need to strengthen regional accountability mechanisms for RMNCH is therefore paramount. d) Holding development partners accountable The capacity of the AUC to deliver the accountability mechanism is significantly dependent on efficient and coordinated technical and financial support from partners. Whereas substantial support has been provided by the partners, regulations on activities that the financial resources can support have resulted to delays in implementation of some activities resulting in overall delay in putting in place the

accountability mechanism. In view of the complex nature of the mechanism more resources will be required to operationalize the RMNCH mechanism. 6. OPPORTUNITIES FOR IMPROVEMENT There exist a number of opportunities to strengthen both the country, regional and global accountability mechanisms. Key among them is the need to strengthen linkages between the AUC led RMNCH mechanism and the global accountability initiatives on RMNCH. The AUC mechanism can benefit greatly from the country mechanism and therefore it is critical to explore practical options to establish this vital link including with and among the RECs. Strengthening health information systems including vital registration system is a prerequisite for a functional country accountability mechanism. Although, substantial progress has been recorded, countries and partners should increase their resource allocation to establish the required infrastructure and human resources.