Improving Health Information and Accountability on MDGs

1. Improving Health Information and Accountability on MDGs WPRO/WHO

2. Outline • Key Feature of Good Health Information System • Challenges on Data analysis and use • Recommendations on Improving Health Information and Accountability

3. Timely, reliable and accessible health information is critical for accountability. Having this solid information at country level is essential to measuring and monitoring results. Dr. Margaret Chan, Director-General of the WHO

4. Key features of good system • M&E PLAN : A strong M&E plan of the NHS, including a framework for indicators, data sources, analysis etc • Framework and HEALTH INDICATORS with well defined baselines and targets used to monitor progress • Functioning Data Collection system for all data sources: • SURVEYS: Regular harmonized survey system • FACILITY DATA: Well functioning facility reporting system, with data quality reports • Civil Registration/Vital Statistics: target population and Denominators • EQUITY: Disaggregated health survey and facility data on core indicators • CAPACITY: Analytical capacity for report of progress and performance & statistical summary to feed into reviews and Countdown processes. • DATA SHARING : Data transparency and access to information

5. Key challenges for developing a strong M&E Plan The M&E plan should always link with overall national health develop plan or strategy One system wide practicable Monitoring & evaluation technical framework  Coverage indicators, data sources, compilation, analysis, data quality, and communication and use Clear Coordination and Institutional capacity  system with coordination, clear roles and responsibilities including all major country institutions Country mechanisms for review and action need to be applied

6. A technical M&E framework

7. Challenges on Data Analysis and Use • Data Quality • Denominators • Institution Capacity on Analysis • Disaggregation of data • Sharing the Results

8. Data Sources and Data quality Key quality issues limited the use of data Completeness: report from public and private facilities; Accuracy: inaccurate population and mortality data Timeliness: estimates based on old data; no timely feedback Lack of data quality assessment and adjustment, and transparency Hard to interpreting results; hard to be used by broader user Possible actions for overcome quality issue Long term plan to improve overall HIS system Systematic examination (Quality Assessment): completeness, internal consistency and accuracy, external consistency Sharing of the results of the data quality assessment - accompanying performance review reports Transparency: sharing of the underlying data and methods Improving Civil Registration/Vital Statistics: important source for population, Preferred data source for MDG 4 5 6 monitoring

9. Data Quality Assessment in Cambodia • Background • The national Health Information System (HIS) is one of priority programs in Cambodia to provide the MOH and its parts with valid, reliable, and timely information for decision making. • The HIS performs satisfactory, actions including HIS assessment, development of a medium term National HIS Strategy, regular revision of HIS data collection forms and instruments, using data for health strategic plan review, and development of a web-based HIS. • Continuing challenges relate to quality of data and lack of knowledge and skills in conducting data analyses and interpretation among staff at all levels of the health system.

10. Routine Data Quality Assessment tool (RDQA) • Based on methodology of GAVI/WHO data quality audit (DQA) • Providing a current estimate of reporting accuracy in four dimensions routinely • Completeness of reporting • Internal consistency of the reported data • External consistency of population denominators • External comparison of coverage rates • Identify areas where error can be introduced into the data at each level. • Data quality assessment could be combined with routine data audit and supervision. • Improving the use of data and better interpreting the results

11. Improving Civil Registration Preferred data source for MDG 4 5 6 monitoring

12. Actions to improve capacity for analysis at All Level Producing annual reports of progress and performance reports to inform reviews at central and local level Integration of data from multiple sources and assessment of data quality from the lowest level of data collection Comparison of inputs and results / value for money through whole system approach Benchmarking of progress, comparison with peer countries and sub-region Qualitative data on policy and contextual changes National institutional capacity and supporting mechanism from central to local level

13. Equity analysis and disaggregated data Need special focus on disaggregated analysis to track and target disadvantaged populations Sex age income residence geographic location This implies regular surveys and strengthening analytical capacity

14. M&E Health Reform of China • Reform Objective:universal coverage and provision of safe, effective, convenient and affordable healthcare services by 2020 • 5 Tasks in first three years (by 2012) • Basic healthcare insurance system – over 90% of Chinese population should be covered by one of three mainstream schemes; • Setting up national essential medicine system; • Strengthening primary health care facilities • Promoting gradually the equitable access to public health care in the rural and urban areas; • Launching public hospital reform pilots;

15. Inputs & processes Outputs Outcomes Impact Intervention access & services readiness Intervention quality, safety and efficiency Coverage of interventions Prevalence risk behaviours & factors Improved health outcomes & equity Social and financial risk protection Responsiveness Infrastructure / ICT Health workforce Supply chain Information Financing Governance Mapping China's health reform priorities on to the M&E framework All five priorities Indicator domains Policy changes Insurance Essential drugs Health services Process / implementation Facilities opened Health workers PHC Service reorganization EMR in hospitals Results (+ equity) Coverage of interventions; Behavioural change Results OOP expenditure Catastrophic Patient satisfaction Responsive services Access to services PHC service package Hospital standards Affordable Financing changes Investments follow new policies Health status 2009 ………. 2010 ………………….……. 2011 ………… 2012… Time 

16. Inputs & processes Outputs Outcomes Impact Intervention access & services readiness Intervention quality, safety and efficiency Coverage of interventions Prevalence risk behaviours & factors Improved health outcomes & equity Financial risk protection Responsiveness Infrastructure / ICT Health workforce Supply chain Information Governance Financing Evaluating health system strengthening and reforms A stepwise approach Have finances been disbursed? Have policies been changed? Contextual changes Non health system determinants Is the process of implementation happening as planned? Has access to services improved? Did the quality of services improve? Has utilization improved? Did intervention coverage improve? Have risk behaviours improved? Contextual changes Non health system determinants Have health outcomes and equity improved? Are services responsive to the needs? Are people protected against financial risks?

17. Using multiple Data Sources • Household surveys • Interim household survey (1/3 NHSS) (2011) • Medicines use survey (2010) • Satisfaction survey (2010/11) • Two provincial household surveys (2011) • General facility Health facility assessment • assessment • EM facility assessment • Prescription survey • Health worker survey (2008/11) • In-depth qualitative studies • Structured and unstructured interviews with health workers • Key informant surveys, focus group discussion (medicines) • Key informant interviews with health decision makers • Pilot sites (hospital reform)

18. Lessons Learned • Single general M&E framework that incorporates all main elements can provide a clear picture of national health systems reforms • Multiple data sources including qualitative data is important for comprehensive system monitoring and evaluation. Indicator need to cover different areas of the framework • Combined approach for accurate measurement of effects in short term and long term impact of the system change

19. Data Sharing and Feedback at all Level Analytical reports for reviews available and accessible Facility data on core indicators on the web Data quality assessment reports – accessible Results feedback at all levels to support the decision making Requires: Data and reports posted to publicly accessible website/country health observatory /portals

20. Recommendations on Improving Health Information and Accountability

21. Global Strategy for Women’s and Children’s Health • UN Secretary General Ban Ki-moon launched GSWCH in Sep 2010 at UN High-level Plenary Meeting of the General Assembly on the MDGs • A response to slow progress of MDGs 4 and 5 • Focus on low and middle-income countries Includes 7 WPR countries:CAM, CHN,LAO, PNG, PHL,SOL, VTN Of the 75 – focus on 49 low-income countries, including5 WP countries

22. CoIA 10 recommendations COMMISSION RECOMMENDATIONS 1 Monitoring results & CRVS 2 11 core indicators & equity 3 Digital health & innovation 4 Financial indicators tracked 5 Comprehensive reporting 6 Capacity for NHA 7 National Accountability mechanisms 8 Transparency 9 MNCH specific reporting 10 Expert Review Mechanism NHA & MNCH tracking Monitoring of results Birth and death registration Maternal death surveillance & response Country assessment & Roadmap ehealth & innovation Country review processes Advocacy and action Monitoring results Global actions Tracking resources Global review (iERG)

23. Conclusion • Good HIS is the system could be used to addressing health challenges at different level. • There is no perfect data. The more the data are used, the more the data can be corrected.