‘Leave the diamonds and gold for the people who need it.’
Streamlining measurement of results and accountability: IHP+ at the World Health Assembly
‘The data is not for us here in Europe or America. The data should be for the people who are managing the health of poor people in poor countries,’ said Anders Nordstrom, Global Ambassador for Health Sweden, as he opened the IHP+ informal session at the World Health Assembly on strengthening information and accountability. The discussion in Geneva between IHP+ signatories from development agencies, governments and NGOs highlighted some key issues about streamlining measurements of results and accountability.
Global health leaders recently agreed to reduce the number of indicators and have fewer reporting requirements in order to reduce the burden of reporting on developing country governments. How will these actions support progress towards stronger country information and accountability platforms? How real is this change by agencies at global level? How far has it gone at country level?
Dr Ties Boerma, Director, Health Statistics & Information Systems at the World Health Organization, identified three problems with current ways of working. There are too many indicators (more than 600 for each country), too many reporting requirements and fragmented investments in data generation and systems strengthening. What can be done about this? Awareness of these issues exists at global and country level, and there are innovative approaches to solve some of the problems. However, there is a huge demand for immediate results and accountability and the monitoring and evaluation of disease programmes is often fragmented. Dr Tran Gian Huong, Director-General, International Cooperation Department, from the Vietnam Ministry Of Health, reiterated that the burden of reporting puts stress on scarce human resources, with particular difficulty for health staff working at community and local level. However, Vietnam recently agreed a core set of indicators developed by both partners and the government and there are now only 86 indicators to report on.
The Minister of Health In Cape Verde, Dr Cristina Fontes Lima, commented that it is good that IHP+ is focusing on reporting and accountability, and that strengthening a country’s health information system is very important as it can serve both local and global needs. Real time data and ICT at local and national levels is vital as it encourages transparency, accountability and good quality management.
How far can global agencies go towards reducing reporting requirements? GAVI and the Global Fund have changed their business model and reporting requirements to become more aligned and harmonised with country systems. Dr Osamu Kunii, Head of Strategy, Impact and Investment at the Global Fund said that they have reduced the number of indicators by one third and are now aligned to country reporting cycles. He said that more strategic country-level investment in information systems is needed.
Dr Robert Newman, Head of Policy and Performance at the GAVI Alliance agreed that monitoring has become an extractive industry and there needs to be a shift to support countries to get the data they need. Monitoring should be beneficial to the sub-national level, so it becomes more like a grassroots movement where people see the advantage of what they are doing. Anders Nordstrom supported this and said we need simple ways for local managers to get high quality data. “If monitoring is extractive, then let’s leave the diamonds and gold for the people who need it,” he said.
Participants discussed the issue of contribution versus attribution of results in relation to donor funding and Karen Cavanaugh from USAID said that one challenge they face is the need to show accountability to the legislator. Is it possible to work in a harmonised and aligned way with multiple partners, when agencies need to demonstrate their impact? Nina Schwalbe from UNICEF said, “We work in partnership and that means contribution, not attribution.”
Anders Nordstrom summarised the discussion by saying:
- In quite a few countries, there is a movement emerging to harmonise and align indicators and reporting requirements.
- Globally, at the highest level, heads of agencies are giving a strong message on the need for change. There is interest in joint investment in M&E, but still a gap between global talk and local action.
- IHP+ is still needed to help make the connection between levels, and help get joint agreements on frameworks and indicators.
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