UNFPA Dan Okoro. UNICEF Dr Khadija Abdalla

Transcription

1 COUNTRY ACCOUNTABILITY FRAMEWORK: Assessment* Policy Context Global strategy on women and children/ commitment Situation Analysis will recruit and deploy an additional 20,000 primary care health workers; establish and operationalize 210 primary health facility centres of excellence to provide maternal and child health services to an additional 1.5 million women and 1.5 million children; and will expand community health care and decentralize resources. National Health Sector Plan and M&E Plan M&E platform NHSSP 11 ( ) was extended for an additional 2 years until The NHSSP II is under development., a member of IHP+, signed the Code of Conduct in 2007 where the G0K, development partners and implementing partners agreed to meet the targets in the second National Health Sector Strategic Plan, (NHSSP II) and Joint Program Work and Funding, 2006/ /2011 (JPWF) through a Sector-Wide approach (SWAp) and to achieve Millennium Develepment Goals (MDGs). M&E review of done in 2009 to inform health policy currently in drafting stage; health sector strategic plan will be developed in 2012 for Country team present at the National Accountability Workshop, 12 March 2013 MINISTRY OF PUBLIC HEALTH & SANITATION, DIVISION OF REPRODUCTIVE HEALTH Shiphrah Kuria Annie Gituto Cosmas Mutunga Tabitha Mwangi WHO COUNTRY OFFICE Stephen Cheruiyot Hilary Kipruto Joyce Lavussa FAMILY CARE INTERNATIONAL Angeline Mutunga UNFPA Dan Okoro UNICEF Dr Khadija Abdalla * This final version has been reviewed and validated through a national accountabilty workshop involving a broader stakeholder group. Page 1/11

2 KEY: 1 Not present, needs to be developed 2 Needs a lot of strengthening 3 Needs some strengthening 5 Already present/no action needed Civil registration & vital statistics systems Assessment 3 Both comprehensive and rapid civil registration and vital events Review the report and carry out dissemination (CRVS) assessments were done and current figures for coverage are: births 57% and deaths 49%. There is a CRVS strengthening Plan 1 strategic plan in the ministry of immigration. A Technical Working Resource mobilization for implementation to improve coverage. Group (TWG) is in place with key stakeholders in the Ministry of health (MOH), Ministry of Immigration, Health Metrics Network Coordinating Mechanism (HMN), and the National Bureau of Statistics (KNBS). 2 Establish a functional ICC involving all key stakeholders and give it However, not all stakeholders are represented and not all are sure powers to introduce changes to the civil registration and vital of the existence of the interagency coordinating committee (ICC). statistics (CRVS) system where needed Awareness creation in the general population and advocacy for Commitment 1 birth and death registration at sub-national level is needed. Create awareness in the general population and advocacy for birth Improve hospital reporting, use of electronic reporting system, and death registration at sub-national level training of doctors and other clinicians in ICD 10, and conduct Hospital reporting 1.5 regular quality control of certification. Community reporting is Improve hospital reporting, use of electronic reporting system, done through the provincial administration (local chiefs) but is more of numbers than cause of death. The community health workers (CHW) also report. Data quality analysis (DQA) is done at training of doctors and other clinicians in ICD 10, and conduct regular quality control of certification the national level only, but not regularly. Vital statistics, mainly Community reporting 1 Strengthen community reporting of birth and death through national level information, are published and available. The 6 community workers, test new approaches, e.g. cell phones. health and demographic surveillance sites (HDSS) across the Develop/strengthen use of verbal autopsies (VA) by community country generate regular vital statistics including cause of death, workers, test new approaches but it is not government led and is not representative nationally. Vital statistics 1 Strengthen the analytical capacity of vital statistics office, including DQA. Local studies for mortality 0.8 Develop and strengthen a national representative HDSS which is government led. * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 2/11

3 Monitoring of results M&E Plan 1 is currently developing its national health sector plan -- NHSSPIII ( ). It has planned to develop a monitoring and Strengthen analysis skills, analytical data and staffing especially at sub-national level evaluation (M&E) plan with a strong and comprehensive technical M&E Coordination 1 framework. The process has already started with roles and responsibilities of key actors in data collection, compilation, Strengthen equity focus of reviews analysis and dissemination being specified (the current plan does Health Surveys 3 not have such a detailed M&E plan). Currently, M&E coordination Strengthen capacity to conduct annual DQAs is a mandate of the health sector coordinating committee (HSCC) Facility data (HMIS) but a proposal has been made to create a separate M&E/Health 1 Improve involvement of key institutions - academia, private sector management information system (HMIS) - ICC. Health surveys are and women orgs Analytical capacity included in the plans of the Ministry of planning and most of the 1 maternal neonatal child health (MNCH) interventions are captured Equity 1.5 in the Demographic Health Survey (KDHS). Data quality and Data sharing 0.5 data reliability will require a lot of strengthening. Strengthen national data repository with all relevant data and reports MNCH indicators 1 * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 3/11

4 Maternal death surveillance & response Notification 2 Notification of maternal deaths (MD) is a policy but not yet a law. Strengthen enforcement of MD notification Development of legislation is at an advanced stage. Provincial and district committees have been formed but with limited capacity. Capacity to review and act 1 Private hospitals are not yet on board. A service provision Strengthen national and sub-national capacity through training in assessment (SPA) survey was conducted (2010) with a detailed maternal death surveillance and response (MDSR) maternal neonatal health (MNH) quality of care assessment. Hospitals / facilities 2 However, dissemination was only done at the national level. Community reporting & feedback is still poor although its been built into the reporting tool. This needs strengthening. Electronic Improve reporting by hospitals; training in ICD certification and coding (links with CRVS), strengthen hospital capacity and practices, including private sector devices are used only in a few pilot areas. While reviews are being Quality of care 2 conducted, they are neither systematic nor widely disseminated. Support a regular system of QoC assessments, with good dissemination of results for policy and planning Community reporting & feedback 0.1 Strengthen Community level reporting an and strengthen verbal autopsy (VA) for maternal deaths in communities response including initiation by electronic devices Review of the system 0.1 Support and strengthen review system including dissemination and * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 4/11

5 Innovation and ehealth Policy 2.5 A policy and strategy for ehealth exists where MNCH is included. District Health Information System (DHIS), E-Mobile, SMS etc. are Infrastructure 2.5 available in urban, district and rural areas but not all areas are high speed. There is no effective data sharing between systems Improve connectivity in rural areas (e.g. facility data on child health, with health worker information). Services 1.3 There is no linkage between HMIS and human resources (HR), showing a need for integration. There is need for compatibility with DHIS. e-health TWG exists and establishment of an e-health Develop/strengthen the use of ehealth services to improve information sharing. Enhance interoperability through ehealth services and improved resource mobilization Standards 0 ICC is in process. There is a draft health law (legal framework) to be finalized. Protection policies exist but need improvement. Governance 0 Protection 1 * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 5/11

6 Monitoring of resources National health accounts 1.5 National health accounts (NHA) framework is in place. NHAs were conducted in 2003, 2006 and A more recent NHA not conducted due to expenses. Only a few indicators tracked Organize a multisectoral meeting with decision makers and technical staff to disseminate the SHA Ensure inclusion of health account specific indicators for RMNCH. annually (total health (TH) allocation, total health expenditures (THE) total and by source, and total allocation to primary health care (PHC)). The tools used are public expenditure tracking survey Compact and Coordination 1.6 Restructure and strengthen both the ICC and the NHA steering committee with institutional support and functioning using resultbased management methods (PETS), public expenditure review (PERs) and annual national AIDS spending assessment (NASA). There is a code of conduct (COC) but not strictly adhered to, >90% of the development partners (DPs) have signed the compact and MOH format for reporting is used. However, a number of partners/donors do not report or provide returns. A health finance - ICC exists but rarely meets. There is Production 0.3 limited capacity at all levels with poor retention of trained staff. Train staff on system of health accounts 2011; train district and Health accounts data are not utilized for reviews of budget but are regional staff. Regular production and dissemination of NHA reports. used for policy review. Currently dissemination is ad hoc, need to develop a strategy and plan for dissemination. Raise awareness and sensitize program managers, partners and public. Data Use 0 Meet with policy makers, identify their needs, and work with them the systematic integration of NHA data in policy process. * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 6/11

7 Review processes Reviews 2 Review done but not according to prepared plan. The National Annual plans are clear with roles and M&E component. However, Enhance involvement of Private sector, academia and women organizations in the review and planning process there are many data sources that create a challenge. Not all Synthesis of information & policy context sectors are involved in the data collection, review, synthesis and 1.5 Strengthen feedback of national reviews to sub-national levels and reporting and sharing. Mostly uncoordinated qualitative health up to the community data by individuals. Compacts or similar mechanisms are in place, Strengthening capacity and staffing to improve data analysis and the challenge is compliance. Development partners budget are synthesis of relevant health data always declared for inclusion in the annual planning process. From review to planning 2 Compacts or equivalent mechanisms 1.5 Strengthen social accountability Framework * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 7/11

8 Advocacy & outreach Parliament active on RMNCH issues 0.5 MDG 4 and 5 caucus exists, focus on advocacy including for budget. There is also a Parliamentary Network for Population and Development. No Public hearings. Women Parliamentary Association exists for advocacy in RMNCH. WRA and Women Alive exist with participation from GOK. Child Survival activities supported by Save the children, World Vision, Parliamentarians are informed/encouraged to engage in RMNCH accountability, especially on financing. Improve governance and leadership structures for better service delivery. Parliamentarians need to advocate for increased allocations for health. Need to institutionalize social accountability. Policies need to be formulated to address gender issues and male involvement in RMNCH PATH, PSI Annual report available which includes sub-national data but not Civil Society Coalition comprehensive. DHS 2 HMIS in place. Data collected but not used 1.3 Support /strengthen coalition, Support capacity to synthesize for decision and policy making at all levels of health care. evidence and disseminate messages. Mapping of CSOS in the entire Limited capacity building on a range of RMNH related topics but country needs to be done. Capacity building of CSOs in advocacy of the quality of the reporting needs improvement. There is RMNCH needed. Need for partnerships/networks in RMNCH infrequent reporting of variable quality. organizations with MOH, Development partners, line ministries. No country level count down event has been held though there Identify strategies that address socio-cultural factors / gender has been participation of MOH Program managers and inequalities that tare barriers to access and utilization of RMNCH parliamentarians. CD meeting held in 2013 information and services. RMNCH progress report and review 1.6 Strengthen the RMNCH progress and performance assessment in reviews and Produce a consolidated report on RMNCH, Effective dissemination of RMNCH report, Ensure that the findings feed into the health sector reviews. Harmonization and implementation of existing polices and guidelines Dissemination and utilization of reports and data for decision making, policy making and resource mobilization. Sensitize the public and CSOs on the availability od these data and reports. Follow up on the implementation of report recommendations. Facilitate the health workers at lower levels in the health system to access these reports with ICT and internet access and airtime. More investment in ICT at lower levels of the health system needed. Media role 1.3 Work with the media to strengthen their capacity to report on these issues and Improve information flows Countdown event for RMNCH 0.5 CD Coordinating Committee, H5, and other partners encourage/support national stakeholders to plan national CD and Prepare CD report / profile using all evidence. Multi sectoral approach in implementation of activities. Implementation of M&E frameworks. Capacity building for media, community health workers * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. in RMNCH Page 8/11

9 COUNTRY ACCOUNTABILITY FRAMEWORK: Roadmap* PRIORITY ACTIONS ( ) *First year actions (2012-early 2013) RESOURCE REQUIREMENTS (tools, money (catalytic/caf), money (country/partners), TA, collaboration etc) Lead govt/ national institute Partners 2012/15 Catalytic funding CIVIL REGISTRATION AND VITAL STATISTICS SYSTEMS (CRVS) - Improve hospital reporting: use of electronic reporting system. - Training/sensitization of doctors and other clinicians in ICD Conduct regular quality control of certification. - Strengthen community reporting of birth and death through community workers. - Test new approaches, e.g. cell phones. - Develop/strengthen use of verbal autopsy by community workers, test new approaches. - Use MCH for registration of births & establish and strengthen more community units. Develop and strengthen a national representative HDSS which is government led and linked to CRVS. Improve involvement of key institutions : academia, private sector and women organisations. Strengthen national data repository with all relevant data and reports. MIRP, MOH, NCPD, KNBS MOH/MIRP/PA MOH/MIRP/PA/HDSS MIRP, MOH, KMTC, Universities, relevant professional bodies KNBS, MOH, NCPD, MIRP, Academia WHO,CDC,UNFPA,UNICEF, EU,WB,ADB, USAID, NGOs MOBILE PROVIDERS, FBOs, CBOs, NGOs, Community NGOs, DPs $40,000 MONITORING OF RESULTS Strengthen analysis skills, analytical data and staffing especially at sub-national level. Technical Assistance required & Financial assistance Ministry of Planning, Ministry of Finance WHO, UNICEF, UNFPA, DFID Strengthen equity focus of reviews. Technical Assistance required Ministry of Planning WHO, UNICEF, UNFPA, DFID Strengthen capacity to conduct annual DQAs. Technical Assistance required Ministry of Planning WHO, UNICEF, UNFPA, DFID Improve involvement of key institutions - Academia, private sector and women Financial Assistance required Ministry of Finance WHO, UNICEF, UNFPA, DFID organisations. Strengthen national data repository with all relevant data and reports. Technical Assistance required Ministry of Planning WHO, UNICEF, UNFPA, DFID $30,000 MATERNAL DEATH SURVEILLANCE AND RESPONSE Advocate for full enforcement of the national policy on MD notifications. Head - Dept. of Family Health WHO, UNICEF, UNFPA, DFID $50,000 Strengthen capacity through training in MDSR. UNICEF - Kes 16.5m; DFID Kes?; Tool - MPDSR orientation package Improve hospital reporting and use of ICD 10. UNICEF - Kes 16.5m; DFID Kes?; WHO; Tool - MPDSR orientation package; Adaptation of WHO Head - Dept. of Family Health Head - Dept. of Family Health Strengthen community reporting and verbal autopsy of maternal deaths. Adaptation of WHO guidelines and tools Head - Dept. of Family Health * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 9/11

10 COUNTRY ACCOUNTABILITY FRAMEWORK: Roadmap* PRIORITY ACTIONS ( ) *First year actions (2012-early 2013) RESOURCE REQUIREMENTS (tools, money (catalytic/caf), money (country/partners), TA, collaboration etc) Lead govt/ national institute Partners 2012/15 Catalytic funding INNOVATION AND E-HEALTH Disseminate ehealth policy and strategy, strengthen leadership and buy in. $20,000 Develop and strengthen the use of ehealth services to improve information sharing. Enhance interoperability through ehealth services and improved resource mobilization. MONITORING OF RESOURCES - Train staff on system of health accounts 2011; train district and regional staff. - Regular production and dissemination of NHA reports. Currently dissemination is ad hoc, need to develop a strategy and plan for dissemination. - Raise awareness and sensitize program managers, partners and public. $40,000 Restructure and strengthen both the ICC and the NHA steering committee with institutional support and functioning using result-based management methods. REVIEW PROCESSES Enhance involvement of Private sector, academia and women organizations in the review and planning process. Strengthen feedback of national reviews to sub-national levels and up to the community. Strengthening capacity and staffing to improve data analysis and synthesis of relevant health data. $20,000 * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 10/11

11 COUNTRY ACCOUNTABILITY FRAMEWORK: Roadmap* PRIORITY ACTIONS ( ) *First year actions (2012-early 2013) RESOURCE REQUIREMENTS (tools, money (catalytic/caf), money (country/partners), TA, collaboration etc) Lead govt/ national institute Partners 2012/15 Catalytic funding ADVOCACY & OUTREACH Parliamentarians are informed/encouraged to engage in RMNCH accountability, especially on financing: improve governance and leadership structures for better service delivery. $50,000 - Parliamentarians need to advocate for increased allocations for health: need to institutionalize social accountability. - Policies need to be formulated to address gender issues and male involvement in RMNCH. Support /strengthen coalition. Support capacity to synthesize evidence and disseminate messages. - Mapping of CSOS in the entire country needs to be done. - Capacity building of CSOs in advocacy of RMNCH needed. - Need for partnerships/networks in RMNCH organizations with MOH, Development partners, line Ministries. - Identify strategies that address socio-cultural factors/gender inequalities that are barriers to access and utilization of RMNCH information and services. CD Coordinating Committee, H5, and other partners encourage/support national stakeholders to plan national CD and Prepare CD report/profile using all evidence. Multi sectoral approach in implementation of activities. Implementation of M&E frameworks. Capacity building for media, community health workers in RMNCH TOTALS 250,000 Catalytic request CRVS $40,000 Monitoring of results $30,000 MDSR $50,000 ehealth & Innovation $20,000 Monitoring of resources $40,000 Reviews $20,000 Advocacy $50,000 TOTAL $250,000 * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 11/11