fostering joint accountability within health systems

Fostering Joint Accountability Within Health Systems

Wednesday May 23, 2018 | 9:00 am—10:00 am, EDT

www.healthpolicyplus.com

Webinar Agenda Overview Fostering Joint Accountability Within Health

Systems

Hear from the Field

Uganda Pakistan

Review of Curriculum Content

Questions and Discussion

Closing Remarks

Close at 10:00 am EDT

Advocacy and Accountability for FP2020 Two links in the chain from policy to action

“… continued advocacy is needed to make sure that family planning is prioritized

appropriately, that civil society is fully

engaged, and that accountability

mechanisms are in place.”

“Commitment makers must follow through with implementation and hold themselves accountable for results.”

Accountability & Health Systems Brinkerhoff’s accountability linkages framework (2004)

Show how actors are connected in a complex network of implementation, oversight, cooperation, and reporting

Encourage system-wide perspective

Understand strength of important relationships and capacity needs

Inform strategic interventions

Accountability Types Financial Performance (programmatic) Political/democratic

Building on Past Investments • Past Women’s Leadership

programs strengthened leadership and advocacy skills of 70 women in 6 countries

• Fostered capacity, confidence, and connections to effectively advocate for family planning

• For new joint accountability pilot, 3 country teams with: Multisectoral representation Family planning champions Experienced advocates

Ghana Ethiopia

Kenya Uganda

Malawi

Tanzania

HP+ Activity Overview*

* First known field test of Brinkerhoff’s framework.

1 Learn

2 Assess

3 Convene

4Act

Workshop Strengthens technical accountability knowledge and maps accountability linkages between health system actors

Assessment Explores accountability relationships to understand how accountability for a specific family planning issue can be strengthened

Stakeholder Meeting Vets findings among broader group of family planning champions and ensures consensus for action

Intervention Implements actions based on evidence from assessment

HP+ Small Grant and Technical Assistance

Women-led momentum

Learn What is accountability and how to foster it?

3-day workshop to: • Strengthen knowledge and skills on

accountability within health systems • Choose a priority issue • Map accountability linkages • Prepare for assessment

Setting the stage

for a multisectoral

approach to joint

accountability for

meeting FP2020

commitments

1

Assess… Strength of linkages between key pairs of accountability actors Accountability is

Answerability • Information-sharing • Dialogue

Enforceability • Incentives • Sanctions

Query each actor in a pair about: Understanding of role within the system of accountability Quality of the linkage regarding stages of answerability and enforceability Capacity needs to fulfill role Suggestions for improvement

2

Uganda: Priority Issue

Quality of Data Capture and Reporting for Family

Planning (focus on Iganga District)

Kenya: Priority Issue

County Budget Allocation for Family Planning

(focus on Kilifi)

Malawi: Priority Issue

Implementation of Youth-friendly Health

Service (YFHS) Standards (focus on Health Sector)

3 Convene… 4 Act…

Selected Accountability Issue Family Planning Data Capture and Reporting

Why? Accurate data key to monitoring Uganda’s progress for

FP2020

Supervision teams report issues with family planning data capture and reporting

Iganga has low health management information system (HMIS) reporting rates

Inform data collection and monitoring activities in Uganda’s FP2020 Costed Implementation Plan

Mapped Accountability Linkages

1. Identified all key actors 2. Mapped linkages: political/democratic, financial, programmatic

Created this version for

stakeholder feedback

Prepared for the Assessment

1. Selected pairs to interview

2. Tailored interview guide template

3. Practiced interviews and qualitative analysis

4. Created teams for action

Assess

Conducted the Assessment

2

February 2017

14 interviews exploring 12 relationships

Respondents included district-level actors and staff at 2 health facilities in 1 health sub-district

Reviewed family planning registers and 105 HMIS reports.

Assessment Findings Data Capture Health workers not aware of the

importance of village health teams (VHTs) to data capture and reporting

VHTs are not incentivized to provide timely and accurate family planning data

VHTs do not know how to provide more than one family planning method

Knowledge/Prioritization of Family Planning Data Facility staff lack adequate skills needed

to effectively use family planning indicators in the revised HMIS tools

Data Reporting Low reporting in some

instances is due to reporting delays at the source

Other Need to clean family planning

section of the DHIS2—some data variables are redundant and causing confusion

Need to include all family planning methods (not only Depo) on stock-out page if we are to improve method mix.

Convene

Stakeholder Meetings Validation Meeting in District Commitment to put family

planning data on district quarterly review meeting agendas

Engagement needed to strengthen capacity of data focal persons

3

National Stakeholders Meeting Interest among Ministry of Health

and partners on value of family planning data capture, management, and use

Interest in mapping other districts to confirm generalizability

Act District invites us back to help 4

In September 2017 we conducted a training of family planning data focal persons on key family planning indicators and HMIS reporting

District officials committed to monthly meetings at the facility level to continue capacity building for all family planning data focal persons

Lessons Learned Eye-opening experience for us and for district colleagues Better understanding of roles and awareness of what to report Recognized importance of feedback and supervision at all levels Each actor has a role to play in improving accountability

Locally-driven joint accountability can be sustainable Brought leaders/key stakeholders on board to bridge the gaps Sustainability of follow-up interventions

Personal gains Better understanding of the health system through accountability mapping Can do more in own role about the gaps in awareness that were uncovered Strengthened confidence and leadership esteem

Working on joint accountability can help achieve our FP2020 goals

Pakistan Experience: Mapping Accountability Linkages for Better Advocacy Kamyla Tapal Marvi

23 women 2 operational policy wins for youth 1 united group fostering joint accountability

NATIONAL PROVINCIAL DISTRICT LOCAL

Political Parties

Chief Minister

Minister Health

Chief Secretary

Minister PWD

Governor District,

Chairman

SUB-DISTRICT

Taluka Chairman

Secretary Health

Secretary PWD

Secretary Education

DG PWD

Add. Secretary

PWD

Director Technical

PWD

CIP Technical Lead

District Population

Welfare officer

Taluka Population

Welfare officer

Female Welfare Workers

Male Mobilizers

RHS-A WMOs

Private Providers


Political Parties

Chief Minister

Minister Health

Chief Secretary

Minister PWD

Governor District,

Chairman

SUB-DISTRICT

Taluka Chairman

Secretary Health

Secretary PWD

Secretary Education

DG PWD

Add. Secretary

PWD

Director Technical

PWD

CIP Technical Lead

District Population

Welfare officer

Taluka Population

Welfare officer


Male Mobilizers

RHS-A WMOs

DG Health

PD MNCH

PD LHW

Program

IEC Unit

District Health officer

Taluka Health officer

Deputy Taluka Health officer Additional District

Health officer

Medical Superintendent

Gynecologist

WMOs

District Coordinator

LHW

ADC LHW

LHW Supervisor

LHWs

District Focal

Person MNCH

CMW CMW

CMW

Private Providers

Private Providers

LHVs

LHVs LHVs Sindh Health Care Commission

PMA

SoGP

MAP

PPHI CEO

PPHI Regional Director

PPHI Dist. Manager

IHS, MERF & HANDS

Donor Agencies: DFID, USAID, AusAID, BMGF, LAD/Anon 2, World Bank etc.

Youth led organizations

Curriculum Wing,

Education Dept.

Divisional Director,

Education Dept

District Education

officers

ACC Counsellors

Elected representative of local council

Private Providers


Political Parties

Chief Minister

Minister Health

Chief Secretary

Minister PWD

Governor District,

Chairman

SUB-DISTRICT

Taluka Chairman

Secretary Health

Secretary PWD

Secretary Education

DG PWD

Add. Secretary

PWD

Director Technical

PWD

CIP Technical Lead

District Population

Welfare officer

Taluka Population

Welfare officer


Male Mobilizers

RHS-A WMOs

DG Health

PD MNCH

PD LHW

Program

IEC Unit

District Health officer

Taluka Health officer

Deputy Taluka Health officer Additional District

Health officer

Medical Superintendent

Gynecologist

WMOs

District Coordinator

LHW

ADC LHW

LHW Supervisor

LHWs

District Focal

Person MNCH

CMW CMW

CMW

Private Providers

Private Providers

LHVs

LHVs LHVs Sindh Health Care Commission

PMA

SoGP

MAP

PPHI CEO

PPHI Regional Director

PPHI Dist. Manager

IHS, MERF & HANDS

Donor Agencies: DFID, USAID, AusAID, BMGF, LAD/Anon 2, World Bank etc.

Youth led organizations

Curriculum Wing,

Education Dept.

Divisional Director,

Education Dept

District Education

officers

ACC Counsellors

Elected representative of local council

INGOs Ipas, Save the Children etc.

Service Delivery NGOs Aman Foundation NCMNH, DKT, Greenstar MSS, Rahnuma FPAP

Youth Alliances NGO

Registration Authorities

Journalists/ Bloggers

UNFPA

Director Technical PW- MoNHSR&C

DG – PW MoNHSR&C

Secretary MoNHSR&C

Minister, MoNHSR&C

Nursing & Midwifery schools

Medical Institutions PMDC

PNC

PTCC

DHPMT REVIEW

DHPMT DTC

FP2020 Taskforce

Photo gallery

Major Takeaways…1 Understanding accountability from a birds eye view helps advocates better understand where advocacy needs to go!

Major Takeaways…2 Many high level policies falter in their implementation.

A more exact understanding of implementation challenges, and who is responsible for each piece, ensures that advocates are able to propose appropriate solutions.

Photo by Khaula Jamil for Johns Hopkins Center for Communication Programs

Major Takeaways…3 Advocates can develop a stronger advocacy plan.

Determine advocacy, issue, goal & objectives

Identify target audiences Build support Develop messages Communication channels Mobilize resources Implement Evaluate Collect data and monitor

(throughout all steps)

Major Takeaways…4 The accountability mapping provided a clear sense of why joint accountability and building stronger linkages—and respect between multiple departments responsible for family planning—is so critical.

Adapted after each country workshop and assessment

Two learning forums

Everything can be tailored

Three Modules

Module Name Objective

1 Understanding the Basics of Accountability

To strengthen basic knowledge around accountability and governance within health systems, specifically regarding family planning and health programming.

2 Understanding and Mapping Accountability Relationships

To develop skills for identifying and visually mapping accountability actors and relationships throughout the health system for an issue of interest. The participatory exercise produces an accountability map that may inform advocacy efforts or program intervention designs.

3 Examining Accountability Relationships to Identify Gaps and Opportunities

To practice applying new knowledge and skills in conducting a participatory assessment of existing priority accountability linkages based on an analysis of the mapping exercise.

Module 1: Understanding the Basics of Accountability

Module 2: Understanding and Mapping Accountability Relationships

Session Name Learning Objectives Estimated Time

1.1 Accountability Fundamentals

• Understand basic accountability concepts and definitions, including three types of accountability within health systems

• Describe accountability roles and relationships between key stakeholder groups in the health system

2 hours

1.2 Case Studies in Accountability

• Identify concepts in real-life examples of accountability gaps and interventions

• Articulate links between accountability, advocacy, and improved outcomes

1.5 hours


2.1 Prioritizing Accountability Issues

• Identify key issues affecting family planning or health programming in a given context

• Prioritize one issue to explore through accountability mapping

1 hour 15 minutes

2.2 Mapping Accountability

• Identify health system actors involved in ensuring accountability for the selected issue

• Classify and define financial, programmatic, and political accountability relationships between actors

2.5 hours

Module 3: Examining Accountability Relationships to Identify Gaps and Opportunities


3.1 Selecting Critical Accountability Relationships

• Identify critical relationships with the most influence on the family planning issue

1 hour

3.2 Preparing for Qualitative Data Collection

• Understand basic concepts of qualitative assessments

• Describe the principles of effective interviewing

• Review and tailor a structured template to guide interviews for assessing accountability linkages between two key actors

• Draw lessons learned from practicing semi-structured interviews

3.5 hours

3.3 Preparing for Qualitative Data Analysis

• Understand basic concepts of qualitative analysis

• Practice coding and identifying themes from sample interview transcripts

• Draw lessons learned from practicum

2 hours

3.4 Action Planning for Participatory Assessments

• Articulate assessment goals and outputs

• Establish a timeline, budget, and roles and responsibilities

1–2 hours

Each module begins with a descriptive icon of what the module is all about

Each module has an overview and suggested reading section

Session Snapshot Table

Learning Objectives

Overall Time

PowerPoint and Handouts

Materials Requiring Preparation

Other Materials

Considerations for Preparation and Adaptations

Curriculum Components

Pictures of workshop outputs

Facilitator’s Notes

PowerPoint slide text and reference image

Kenya: Stakeholder Accountability Map Ensuring County Budget Allocation for Family Planning in Kilifi

40

Malawi: Stakeholder

Accountability Map

For Ensuring Implementation of

YFHS Standards within the Health Sector

A. Template of a Sample 3-Day Workshop Agenda

DAY 1 DAY 2 DAY 3 Welcome and Opening (1 hour)

Overview of Activity/Contextualization (1.5 hours)

Accountability Fundamentals (1 hour)

Opening and Recap (15 minutes)

Prioritizing Accountability Issues (1.25 hours)

Mapping Accountability (2.5 hours)

Opening and Recap (15 minutes)

Preparing for Qualitative Data Collection (cont.) (1.5 hours)

Preparing for Qualitative Data Analysis (2 hours)

LUNCH LUNCH LUNCH Accountability Fundamentals (1 hour)

Case Studies: Accountability Gaps and Interventions (1.5 hour)

Daily Evaluation and Closing

Selecting Critical Accountability Relationships (1 hour)

Preparing for Qualitative Data Collection (2 hours)

Daily Evaluation and Closing

Action Planning for Participatory Assessment (1–2 hours)

Final Evaluation and Closing

(For instances in which plans include the participatory assessment after the workshop)

Questions and Discussion

Closing Remarks High value in thinking of accountability with a relationship lens

rather than the “ferreting out corruption” or “us vs. them” lens

Accountability mapping elucidates decision-making processes and other learning moments, particularly in new and decentralizing environments

Engaging in participatory assessments has challenges, but payback is in ownership and collateral learning

System actors are interested in engaging in joint accountability discussions as a means toward health systems strengthening and policy implementation

Thank You

USAID Colleagues, please contact: Linda Cahaelen

[email protected]

Other colleagues, please contact: Anne Jorgensen

[email protected]

Access the Joint Accountability Curriculum and Tools at: http://www.healthpolicyplus.com/pubs.cfm?get=8203 Access the Joint Accountability Brief at: http://www.healthpolicyplus.com/pubs.cfm?get=2083

Health Policy Plus (HP+) is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-15-00051, beginning August 28, 2015. The project’s HIV activities are supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). HP+ is implemented by Palladium, in collaboration with Avenir Health, Futures Group Global Outreach, Plan International USA, Population Reference Bureau, RTI International, ThinkWell, and the White Ribbon Alliance for Safe Motherhood. This presentation was produced for review by the U.S. Agency for International Development. It was prepared by HP+. The information provided in this presentation is not official U.S. Government information and does not necessarily reflect the views or positions of the U.S. Agency for International Development or the U.S. Government.

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