Renewed focus of global health leaders on results and accountability
The IHP+ Core Team interviewed Dr Tim Evans (Director, Health Nutrition and Population, World Bank) and Dr Ties Boerma (Director, Health Statistics & Information Systems, World Health Organization) on the renewed focus among global health leaders on results and accountability that emerged from a recent informal gathering of heads of health agencies in New York. The interview provides an overview of commitments made, and lays out the timeline for action.
At an informal meeting of the Global Health Agency Leaders in New York in early September 2013, a renewed focus emerged on monitoring and accountability for results. Where has the driver for this renewed focus come from?
Dr. Tim Evans: Global Health Agency Leaders have been meeting informally over the last year, piggy-backing on major global events, such as the World Health Assembly, or most recently the United Nations General Assembly in New York. These informal meetings were triggered by the call for action from the IHP+ Country Health Teams meeting in Nairobi, in December 2012, where seven behaviours for development partners were identified as key to accelerate progress in health aid effectiveness. At the latest meeting in New York in September, Global Health Agency Leaders discussed progress and obstacles to realizing the seven behaviours, and proposed that agencies commit to joint action in one specific area: streamlining measurement of results and accountability. The discussions were lively and enthusiastic. A working group emerged from these discussions, chaired by the Director-General of the World Health Organisation, Margaret Chan, and the group committed to deliver action by April 2014.
What will this group concretely do between now and April, and what specific deliverables are expected?
Dr. Tim Evans: The heads of agencies agreed to mobilize their institutions and align their work in three main areas: 1) better alignment of reporting, and rationalizing the demand for indicators; 2) improve measurement of results; and 3) improve the ways results are communicated systematically for decision-making.
Dr. Ties Boerma: Each agency has identified a focal point who will start working on each of these areas. The first phase was to request the focal points to provide an overview of their reporting requirements, so that a harmonized set of core indicators could be agreed upon. It will be a challenge as many indicators are linked to international declarations that Member States have made such as at the HIV/AIDS United Nations General Assembly Special Session (29 indicators) or the non-communicable diseases political declaration action plan (25 or so indicators).
There have been previous efforts to improve accountability, such as for example the Commission on Information and Accountability for Women and Children’s Health. How is this renewed focus linked with such previous work? And how will this work address the accountability of development partners to both the recipients of their funds and their own funders?
Dr. Tim Evans: The Commission has a specific recommendation in this area and this work will only strengthen previous efforts towards alignment and accountability. And accountability to funders will also have to be managed. This process attempts to comprehensively address alignment around specific indicators but also around instruments responsible for getting the data for accountability and measuring impact. For instance, as an initial step, each focal development partner agency will identify key measures of accountability to Parliaments for aid effectiveness and measures that they can do without, so that a common framework can be used by all partners to hold development partners and countries mutually accountable for health sector performance.
Dr. Ties Boerma: In addition, the Country Accountability Framework triggered by the Commission has a larger mandate related to support to countries for strengthening accountability, including monitoring, comprehensive review, and remedy. The Global Health Agency Leaders’ initial focus on results and accountability is narrower in scope and it aims to harmonize reporting requirements and agree on more effective ways of communicating results.
What mechanisms exist to facilitate the involvement of developing countries and civil society organizations in this process?
Dr. Tim Evans: This is all about countries, as IHP+ is about countries. Good practices on alignment and reporting will be collected from countries. We will also get views from countries on improving the mechanisms for getting the data, from national information systems or lower levels of reporting, such as health facilities. The idea is to understand and align better both the numbers of key indicators, as well as the frequency and mechanisms for reporting.
Dr. Ties Boerma: The IHP+ monitoring and evaluation framework for a country-led platform for information and accountability should be the goal. Partners should invest in a single platform that is linked to country processes for information and accountability. This platform should become the basis for all global reporting, and parallel reporting mechanisms will be absorbed by it. This means that it has to be high quality, transparent, meeting global standards.
What would be the timeline for this process, and what would happen after April 2014?
Dr. Tim Evans: The agenda of an improved focus on results and accountability is here to stay, beyond the work of the working group initiated by the Global Health Leaders. It is expected that the ground work done between now and April, in terms of a framework for aligning reporting, better instruments for measuring results and better use for decision making, will help countries accelerate their progress towards improved health systems performance and better accountability for results.
Dr. Ties Boerma: The goal is to have better information on what the resources were invested in and what were the results obtained. We should not be looking at what the individual dollar from each development partner bought, but what collectively has been achieved. Approaches requesting assessment of lives saved as a result of individual projects/funders may lead to fragmentation and it is often technically impossible. It is expected that this process will in effect support IHP+ efforts to support, in the long-term, harmonized country monitoring frameworks and joint reviews.
Update March 2014: the rapid assessment of the burden of indicators and reporting for health monitoring is now available.
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