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…
Uganda Experience Innocent Owomugisha and Cornelia Asiimwe
1 Learn HP+ workshop in November 2016
Twenty women working in family planning arena in Uganda
Government of Uganda | Parliament | Civil society | Providers | Donors | Implementing partners
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
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
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
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
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
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
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.
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
Session Name Learning Objectives Estimated Time
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
Session Name Learning Objectives Estimated Time
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
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)
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
Other colleagues, please contact: Anne Jorgensen
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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