As we move ever-closer to defining shared health goals for post-2015 development agenda, we must also take the time to stop and think about assessing our progress. What does success look like? And how will we measure it?
The World Bank, USAID, and World Health Organization, with support from the Bill & Melinda Gates Foundation, have embarked on an important strategy to construct a common agenda to improve and sustain country accountability systems for health results in the post-2015 era. This strategy aims to: (a) tackle stock of the current state of the systems for measurement and accountability for health results; (b) to identify innovative approaches and strategic investments that can strengthen health data availability, quality, and use; and (c) agree on a common roadmap for health measurement and accountability in the context of the post-2015 agenda.
These organizations have convened a global summit starting today at the World Bank headquarters in Washington, D.C., to discuss with decision-makers and thought leaders representing governments, multilateral agencies, and civil society this measurement and accountability strategy. This strategy will produce a roadmap for Health Measurement and Accountability, and identify smart investments that can be adopted at the country level to strengthen basic measurement systems and align partners and donors around common priorities on a five-point call to action.
Ensuring accountability: Where do we start?
It’s important to define what we understand as "accountability.” Accountability can mean the obligation of an individual or organization to account, as well as to hold others accountable, for activities. It means accepting responsibility for goals and indicators, and disclosing results in a transparent manner.
For all indicators, it will be important to clearly define terms such as use, coverage, and quality; state how data will be measured and in what measurement unit; and provide justification for using the indicator. It’s important to note the need for quality baselines and for each indicator to have a baseline. Additionally, it is important to identify who is responsible for data verification and ensuring data collection. Where possible, low-cost methodologies and tools should be utilized and emphasized.
What will this mean at the country level?
As we discuss these issues during the summit, it is important to keep in mind that while this effort will create opportunities to set national standards, it is likewise critical that appropriate standards will be added to the sub-national level. Stakeholders working at those levels must also be accountable to national poverty reduction efforts as part of the development agenda in each country.
Another important area of this strategy will be to increase the capacity of national institutions to produce quality health data and statistics. The participation of different institutions like the Ministries of Education could play an important role in the data collection, since they have access to children’s vaccination, growth, and development monitoring records, among other things.
What systems do we need to measure success?
In terms of governance, this strategy can describe the basic elements needed for “community information systems” to work—for example, bicycles for volunteers so they can collect and share information, stipends to support their transportation, and trainings for them on data collection using technology such as mobile phones. Funding, specifically for the purpose of longitudinal studies, will be needed. In many countries the community health workers (CHWs) are still not considered official cadres in the health sector, and in most cases are still volunteers. The high turnover rate among volunteer CHWs need to be addressed and options available to address this challenge.
Given the challenges of corruption and fraud in various countries, these measurement and accountability systems should prioritize infrastructure and control mechanisms to deter, detect, and prevent intentional abuse of personal and other sensitive information. It will be important to also supplement these systems with web-based remote assistance or patient consultations in areas where it is difficult to have medical professionals. It would also help to identify platforms for disease surveillance, perhaps tapping the work of existing companies like Google or Amazon. The platform infrastructure could be then used to triangulate that data with other sources of information (e.g., web) and social media (e.g., Facebook or Twitter).
It will be important to include in the monitoring of health goals the final report that the Independent Expert Review Group (iERG) will present before the United Nations General Assembly in September 2015. This report will present the results and resources related to the Global Strategy for Women’s, Children’s, and Adolescents’ Health and on the progress in implementing the Commission on Information and Accountability for Women's and Children's Health’s (CoIA) recommendations, which will contain all the findings that the group observed during country visits in 2014 and 2015.
Finally, it’s important that all regions will be represented in the initial group of countries that will implement this strategy, including some countries that have reported significant barriers in reporting data. This will provide a more accurate analysis of current challenges.
This strategy offers a great initiative to educate the media on what the numbers mean, but must emphasize offering raw data for free. This will facilitate analysis of the academic and research community, who may be able to diagnose problems and recommend effective solutions.
Dr. Oscar Cordon is a medical doctor and a director in Chemonics' health practice. This blog was written with the technical support of Chemonics’ Health; Monitoring, Evaluation and Learning; and Democracy and Governance practices.