Malawi. COUNTRY ACCOUNTABILITY FRAMEWORK: Assessment* Situation Analysis. Policy Context Global strategy on women and children/ commitment

Transcription

1 COUNTRY ACCOUNTABILITY FRAMEWORK: Assessment* Policy Context Global strategy on women and children/ commitment National Health Sector Plan and M&E Plan M&E Platform Situation Analysis will strengthen human re for health, including accelerating training and recruitment of health professionals to fill all available positions in the health sector; expand infrastructures for maternal, newborn and child health; increase basic emergency obstetric and neonatal care coverage to reach World Health Organization standards; and provide free care through hips with private institutions. The goal of 's National Health Policy is to improve the health status of all the people of by reducing the risk of ill health and occurrence of premature deaths. This overall goal will be achieved by implementing strategies and interventions that address critical areas in health services delivery such as management, hospital reform, quality assurance, public private hips, human re for health, drugs and medical supplies, blood safety, infrastructure and health financing. The national health policy also redefines the essential health package (EHP) based on the burden of disease study and the STEPS survey and it further puts emphasis on the need for an effective monitoring, evaluation and research system that will address the data of the sector. The Sector Wide Approach (SWAp) Program of Work (PoW) for covered the period and it guided the implementation of interventions aimed at improving the health status of the people of. The MoH, Health Development Partners (HDPs) and other stakeholders in the health sector were involved in the development and implementation of the PoW. In addition to program monitoring and evaluation (M & E) data routinely collected using the Health Management Information System (HMIS), the PoW also provided for Joint Annual Reviews (JAR) for the health sector, the mid-term review (MTR) and the final evaluation as ways of measuring progress towards achieving the targets set in The PoW expired in June 2010 but was extended for one year partly to allow for the final evaluation to be completed. The results from both the MTR and the final evaluation informed the development of the Health Sector Strategic Plan (HSSP) Over the period of the HSSP the MoH and stakeholders will ensure that monitoring and evaluation is strengthened including making the HMIS functional. Some of the key strategies to strengthen M&E are: 1) Strengthen the HIS policy and legislative environment; 2) Build the capacity of the health sector to effectively generate, manage, disseminate and utilise health information at all levels of the sector for programme management and development; 3) Strengthen the monitoring and evaluation system for s health sector. The development of a comprehensive M&E strategic plan is one of the intervention to strengthen M&E. * This final version has been reviewed and validated through a national accountabilty workshop involving a broader stakeholder group. Page 1/20

2 Country team present at the National Accountability Workshop, May 2012 MINISTRY OF HEALTH Dr. Ann Maureen Phoya, Director Fannie Kachale, Reproductive Health Unit Diana Khonje, Reproductive Health Unit Dr. Chris Moyo Clifford Dedza, IMCI Programme Willie Kachaka, CMED WHO Dr. Felicitas Zawaira, WHO Representative Ms Ellen Thom - PMTCT thome@mw.afro.who.int Ms Harriet Chanza - Family Health Planning chanzah@mw.afro.who.int Dr. Kambale Susan - Child and Adolescent Health & Nutrition kambales@mw.afro.who.int Dr. Leslie Mgalula - Maternal and Child Health mgalulal@mw.afro.who.int UNFPA Gift Malunga, Deputy Rep - malunga@unfpa.org Dr. Chris Oyeyipo, Reproductive Health - oyeyipo@unfpa.org Grace Hiwa - hiwa@unfpa.org CHAM Grace Banda, Program Manager - gbanda@cham.org.mw UNFPA Jean Mwandira, Reproductive Health - mwandira@unfpa.org UNICEF Ellubey Rachel Maganga, Health Specialist - ermaganga@unicef.org Grace F. Mlava, Reproductive Health & Newborn specialist - gfmlava@unicef.org Nyson Chizani - nchizani@unicef.org NORWEGIAN EMBASSY Georgina Chinula - gfc@mfa.no CIVIL SOCIETY (MHEN) Martha Kwataine - mkwataine@mhen.org MEDICAL COUNCIL OF MALAWI Kondwani Mkandawire - mkandawirekondwani30@yahoo.com CENTRE FOR REPRODUCTIVE HEALTH - COLLEGE OF MEDICINE Dr F. Taulo - ftaulo@yahoo.co.uk FAMILY HEALTH INTERNATIONAL Malla Mabona, Acting Country Director - mmabona@phi360.org UNICEF Clemens Gros, M&E Officer - cgros@unicef.org USAID Chimwemwe Chitsulo, Monitoring, Learning &Evaluation - cchitsulo@usaid.gov BAOBAB HEALTH TRUST Patricia Khomani, Senior Project Coordinator - patricia.khomani@baobabhealth.org NURSES AND MIDWIVES COUNCIL OF MALAWI Thokozire Lipato - thokozire.lipato@nmcm.org.mw LUKE INTERNATIONAL NORWAY (LIN) Francis J. Mafupa, Deployment Officer - francismafupa@lukeinternational.no CIDA Julita Manda Nkhwazi, Nutrition Advisor - jmanda@cidamalawi.org KAMUZU COLLEGE OF NURSING Martha Kamanga - marthakamanga@yahoo.com NATIONAL REGISTRATION BUREAU Peter Chitedze, Director - peterchitedze@yahoo.com Dr. Francis Magombo - MPN magombof@mw.afro.who.int Stanley Midzi - MPN (Zimbabwe, HARARE) midzis@zw.afro.who.int Ishmael Nyasulu - INCO (TB/HIV NPO) nyasului@mw.afro.who.int Dag Roll-Hansen - Headquarters (Health Statistics) rollhansend@who.int E4A Gibson Masache, Chief Executive. Officer - g- masache@pachimalawi.mw Jimmy Innes, Options Consultancy - j.innes@options.co.uk UNIVERSITY COLLEGE OF LONDON Dr. Bejoy Nambiar, Research Associate - b.nambiar@ucl.ac.uk Bernadette Daelmans - Headquarters (Maternal, Newborn, Child and Adolescent Health) daelmansb@who.int PARENT AND CHILD HEALTH INITIATIVE (PACHI) Charles Makwenda, Head of Programmes - c- makwenda@pachimalawi.mw * This final version has been reviewed and validated through a national accountabilty workshop involving a broader stakeholder group. Page 2/20

3 COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard* Civil registration & vital statistics systems Context Possible actions Assessment 1 Plan 1 Coordinating Mechanism 1.5 Commitment 2 Hospital reporting 1.5 Community reporting 1 Vital statistics 1.5 Local studies 3.00 The Government of is committed to civil registration and vital statistics (CRVS) strengthening. Legal Framework in place,several Acts( Constitution of R.of, Refugee Act, Local Government Act, Presidential and Parliamentary Act, National Registration Act), CRVS Strategic plan ( ), registration is mandatory, roll out hospital reporting within 24 months, roll out - Mass registration using mobile community vans, community reporting through current system and Village Registers, pilot electronic reporting within Lilongwe through Baobab health Trust( 2012). Hospital reporting is not complete, verbal autopsy protocal and ICD under discussion. Community reporting systems are in pilot stage. There are 2 health and demographic surveillance (HDSS) site in Karonga and Mangochi,one proposed additional site in Central region - 10yrs project - then establish 1 HDSS site( under LSTM ), Mai Mwana( since 2005, 10yrs project)- Mchinji. Coordination of CRVS through NRB. 1. NRB conducted an assessment on civil registration but Vital statistics issues not done.national CRVS Coordinating body (MoH and NRB) to conduct quick assessment, Review the current strategic plan if necessary to improve it. 2. Formulation of Regulations to support the acts by NRB 3. Roll out and Strengthen hospital reporting of births across ( phased apporach start with Lilongwe( 52 MW by December2012). Capacity building and training, 4.Innitiate use of ICD for causes of death for hospital reporting ( Build capacity through- In service and pre service Training, on- line ICDtraining, ICDmanual provision, Look at possibilities of use of ICD. Phased approach - start Central Hospital 5. Community reporting of birth and deaths (with cause): learn from pilots, roll out,use innovative approaches, verbal autopsy, Village Health register to compliment Civil Village Register at community level. Pilot use of key informants to ID births and deaths - use interva for verbal autopsy. 6. Strengthen analytical capacity of vital statistics office 7. Establish and strengthen 1 additional HDSS sites in Central Region and the 2 existing sites (Karonga, Mangochi) and ensure good reporting. Intergrate existing system into government systems for sustainability ( use project and program approach - eg. Mai- Mwana Project) Monitoring of results Context Possible actions National M&E Plan 3 M&E Coordination 1.5 Health Surveys 1.5 Facility data (HMIS) Data sharing 1 Analytical capacity 3 Equity 2 MNCH indicators There is a national monitoring and evaluation (M&E) plan and coordinating committee. Greater involvement of academia is needed. Discussions are underway to conduct an endline survey in 2013 with the purpose of reporting on the MDG in HMIS has problems of completeness and data quality. There is a District Health Information System 2 (DHIS-2) pilot in 2 districts. Analytical capacity is limited and there is no specific focus on maternal, neonatal and child health (MNCH). Equity data are presented but can be done more effectively. Limited capacity of data consolidation and storage at district level. 1. Participate in the design of the MDG end-line survey 2. Strengthen analytical capacity of MOH at district and central 3. Ensure functional district databanks and establish a central data repository 4. Review and revise the M&E plan for the Health Sector Strategic Plan (HSSP) to ensure the 11 RMNCH core indicators are included 5. Conduct data quality analysis, with verification of key indicators * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 3/20

4 COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard* Maternal death surveillance & response Context Possible actions Notification 1 Capacity to review and act 1.5 Hospitals / facilities 2 Quality of care 2 Community reporting & feedback 0.5 Review of the system 3 The national level committee is not functional and has not produced any report since it was constituted. While reviews take place and most of the districts report on maternal deaths, there is no reporting at the national level. The capacity to do maternal death surveillance and response (MDSR) is limited. Reporting is timely but ICD is just being piloted. The private clinics sometimes are not willing to provide data/information. The competence of those doing the maternal death audits is not at the desired level in some cases. An emergency obstetric and neonatal care (EmONC) assessment was done in Conduct a qualitative assessment of the current status of maternal deaths review and notification in selected districts to identify strengths and weaknesses, as well as opportunities for strengthening the system. 2. Build capacity of district health managers and health staff to conduct maternal deaths surveillance and response using new WHO/CDC/University of Aberdeen guidance. 3. Adapt the existing guidelines, forms and classifications based on standards recommended by WHO. 4. Review legislation and ensure that there is a national policy recommending notification of maternal deaths within 24 hours, as well as protection of health professionals engaged in maternity services. 5. Develop a plan for introducing MDSR, phasing in the various components. A first priority will be to strengthen reporting in public health facilities. This can be followed by strengthening community-based reporting and verbal autopsy. A blended approach might be considered for selected districts. 6. Build capacity for implementation of MDSR 7. Introduce new components in MDSR as the system is getting stronger, e.g. for perinatal deaths or near miss events, confidential enquiry. 8. Strengthen the national committee and support the preparation of periodic reports. 9. Integrate MDSR in the Integrated Disease Surveillance and Response system 10. Collaborate with the HMIS unit on the introduction of the ICD classification system. * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 4/20

5 COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard* Innovation and ehealth Context Possible actions Policy Infrastructure Services Standards 3 Governance 2 Protection 1 Health management information system (HMIS) strategy is available and the e-health is part of the HMIS strategy. Draft national ICT policy at national level( Housed by Min. of Information- process since 2003, ehealth strategy at MoH being complied- by task forcedraft by end 2012, All systems at aggregate level to be linked to DHIS 2.0( currently in 2 districts- Sallima and Lilongwe), to roll out national wide-unfpa- 5 districts, UNICEF- 6 districts, USAID- 12 districts, MoH to introduce in remaining districts-5, Norway has re for this,plan for roll out available, Cover equipment, Training, follow ups. Piloted Electronic medical records system and roll out to all sites. Start with High burden sites, start with District Hospital then Health Centres. ICT being used for Reproduction, maternal, neonatal and child health (RMNCH). Baobab for MoH has developed ANC, Maternity Modules, Pilot in Bwaila and roll out to 7 sites. Birth Reports to be intergrated into the Maternity system. Various organisations working on mhealth and ehealth - coordinated through mhealth and data standards sub group- landsacpe available to define area of operation. Cell phones are available but internet to be upgraded, costs for SMSing an issue. The availability of electricity in all facilities also to be upgraded. There are issues with compatibility of data from different systems. 1. Evaluate the RMNCH project and then scale up ICT for MNCH 2. Advocate for upgrading of the infrastructure for electronic communication- by MoH, Ministry of Information 3. Connect electricity in all health facilities and staff houses that dont have power and also look at altanative power such as solar and wind energy. 4. Strengthen the use of ehealth services to improve information sharing through M and E technical working group under SWAP governance structure. Use Data standards working group and mhealth forum sub groups to feed into M and E TWG- MoH 5. Develop / strengthen a system of coordination of standards to ensure interoperability ( DHIS 2- defacto) 6. Use existing Data Standards Subgroup on data security, archtecture, data to develop data protection, legislation and regulatory framework for sharing health and protecting information. 7. HIS strategic plan - conducting functional reviews by 2016 with view to establish ICT positions in MoH. Monitoring of re Context Possible actions National health accounts 2 Compact and coordination 2 Production capacities 0 Data use 1 There is a national health account (NHA) framework and in 2004 and in 2010 MNCH subaccounts were done. There is no compact but resource mapping is done and there is a joint agreement for sector-wide approach (SWAp). However, the coordinating mechanism for NHAs and resource tracking is not functioning properly. NHA production capacity considerable strengthening. Capacity to monitor and track re at subnational level, including zones and districts, is very limited. 1. Build capacity of MOH Planning Unit to routinely conduct NHA 2. Set up a steering committee, officially approved, with institutional support, and functioning using results-based management methods 3. Support institutionalization of NHA at MOH Planning department 4. Use subaccounts for RMNCH for budgeting * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 5/20

6 COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard* Accountability processes Context Possible actions Annual reviews 2 Synthesis informs reviews 1.5 From review to planning 2.5 Compacts or equivalent 3 Annual multi-sector reviews and joint annual reviews (JAR) are conducted mid-year and annually. While key stakeholders are involved, follow-up of agreed upon action points is not done adequately. Civil society are involved but women s organizations are not adequately involved. M&E framework is available in the HSSP and is used for the reviews; however, the M&E plan is understood differently by different and there is a multiplicity of tools used to measure this. Data collection for the millennium development goals (MDG) monitoring is weak. Reproductive health (RH) indicators are not included in the Welfare Monitoring Surveys. While survey data are good, there is weakness in the way HMIS data is collected. More work is needed in data utilization. There are multiple reporting channels by different stakeholders that do not involve the MOH. Maternal death audits are conducted (by civil society) but it is not systematically done and it is not discussed at the national level. A maternal death audit committee was put in place but is not active. Mechanisms for M&E exist e.g. the new HSSP has been developed based on the review of the previous strategic plan (sector wide approach (SWAp) programme of work). While stakeholders are involved through technical working groups (TWG), in the zonal and district review meetings, challenges remain on how to translate the review milestones at the district level. No full compact exists - only those in the SWAp pool are involved. SWAp is midway to achieving this. While typically not the case, reprogramming can occur within an organization when an activity has already been done using other funds. Sector reviews do take place but not all are engaged and not all buy in. Synthesis of information is done but does not make full use of data available. 1. Conduct district and zonal reviews biannually in order to assess the situation and collect relevant information for discussion in the technical working groups and for input in the mid-term and annual health sector review meetings. 2. Conduct an annual review of progress of MNCH at the national level, and prepare a consolidated report for input in the annual health sector review meeting. 3. Establish the position of a monitoring and evaluation office in the RHU 4. Build capacity for conducting a full a progress and performance review of the health sector as a key preparation for a sector review, with technical assistance from WHO. 5. Strengthen collaboration of the MoH with civil society organizations, to contribute in the management and review of programs and progress. * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 6/20

7 COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard* Advocacy & outreach Context Possible actions Parliament active in RMNCH 1.5 Active RMNCH civil society 1.67 RMNCH progress report/review 2.6 Media role 0.75 National Countdown meeting 0 Parliament: Legislative support for MNCH issues is weak. Civil society not active in 1. Develop an engagement strategy to define approaches and working mechanisms RMNCH. While there is no coalition of civil society, there is strong engagement of to collaborate with multiple. community leaders on maternal health. RMNCH progress report and reviews are not 2. Establish strong links with the Presidential Initiative on MDG5. prominent, but some reviews on the integrated management of childhood illness ( IMCI) 3. Organize a national Countdown to 2015 event to discuss actual progress data by and MNCH acceleration plan review have been done district, and stimulate action of a broad range of constituencies including high level Media: There is a weekly column on RMNCH in newspapers and community radio decision makers and parliamentarians on the most pressing issues regarding the programmes on RMNCH issues. However, sustainability of these programmes could be a health of women and children. Time it prior to the annual sector review. problem as they ares a donor-funded initiative. 4. Build capacity of media and civil society organizations to communicate on MNCH related issues. 5. Implement the engagement strategy and interact with parliamentarians, media, community leaders and other relevant groups. KEY: Needs to be developed/done Needs a lot of strengthening Needs some strengthening Already present/no action needed * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 7/20

8 (government & ) CIVIL REGISTRATION AND VITAL STATISTICS SYSTEMS (CRVS) 1. Engage the National Registration Bureau in OPC to identify the existing gaps (e.g. vital statistics) and find out how the health sector can collaborate/contribute to the process Rapid Assessment of National CRVS using the WHO Quick CRVS assessment tool MOH -Planning Dept., NRB, NSO Partners: USG, WHO,UNICEF Oct-12 Dec-12 USAID, CDC, UNICEF Establish a National CRVS Coordinating unit NRB, MoH, MoLGRD,and Partner- USG, WHO, UNICEF, UNFPA, Baobab, Pachi, NSO, Plan International Sep-12 Review the current CRVS strategic plan ( ) NRB, MoH, MoLGRD,and Partner- USG, WHO, UNICEF, UNFPA, Baobab, Pachi, NSO, Plan International Jan Enforce of the National Registration Act of Jan 2010 Formulate regulations to support the National Registration Act of 2010 Sensitize all stakeholders e.g. chiefs, civil society and religious bodies, general population, government MoJ, MoH, NRB, MoLGRD 2013 NRB, Ministry of Information, Civil Society, media and all applicable stakeholders Roll out and strengthen hospital reporting of births across Implement a phased approach in NRB, Ministry of Health and rolling out of birth reporting (start with Lilongwe- 52 MW by December 2012). Dec-12 Review the pilot project on birth reporting ( paper based and electronic based systems) before national roll out NRB, MoH, and :UNFPA,UNICEF, NGOs- Plan International, Baobab Health Trust Jan-13 * This final version has been reviewed and validated through a national accountabilty workshop involving a broader stakeholder group. Page 8/20

9 (government & ) Build capacity for hospital-based reporting of birth through pre and in-service training, targeting training institutions e.g. College of Medicine, Chanco, Health Sciences, KCN, Christian Health Association (CHAM) nursing schools NRB + MoH in conjunction with training institutions Strengthen hospital reporting and use of ICD for causes of death Conduct Sample Vital Registration with Verbal Autopsy (SAVVY) MOH - Planning Dept., USG Oct-12 Discuss ICD in M and E TWG in MoH MoH- Clinical and Planning department Conduct ICD Training (pre and in service), targeting training institutions e.g. College of Medicine, Chanco, Health Sciences, KCN and Christian Health Association (CHAM) nursing schools NRB + MoH in conjunction with training institutions Jun-12 Jan-13 Dec-13 Initiate use of ICD for causes of death in hospital reporting Adapt the ICD Manual Do a phased implementation starting with the Central Hospital MoH- Clinical and Planning department, Baobab Health Trust MoH- Clinical and Planning department MoH- Clinical and Planning department Produce and distribute adapted ICD manual MoH- Clinical and Planning department and - USG and Health training institutions 2013 Roll out ICD to hospitals then Health Centres MoH- Clinical and Planning department and - USG 2013 * This final version has been reviewed and validated through a national accountabilty workshop involving a broader stakeholder group. Page 9/20

10 (government & ) 5. Community reporting of birth and deaths (with cause): learn from pilots, roll out Pilot a system of complementing the Village Health Register with a Civil Village Register, using uniform codes National CRVS Coordinating body (MoH and NRB) National CRVS Coordinating unit to analyse the complementation of Village Health register and Civil Village Register at community level and recommend way forward National CRVS Coordinating body (MoH and NRB) to conduct Roll out verbal autopsy at community level MoH- Clinical and Planning department and - USG Establish the analytical capacity of vital statistics office Build analytical capacity through training within NRB and MoH NRB, MoH- Planning(CMED) Jan-13 Dec ,000 32, , Collaborate and strengthen HDSS sites Collaborate with NCST( National Commission for Science and Technology) on Health Research Capacity Strengthening Initiative and establishment of an additional HDSS site. NRB, MoH- Public Health Institute(MPHI) Partners: NCST Jul-12 Dec-15 Assess existing HDSS systems (in Karonga, Mangochi-College of Medicine and Mchinji- Mai Mwana project) to enhance collaboration. MoH- Planning Department Partners: College of Medicine, Karonga Prevention Study. Jul-12 Dec-12 5,000 5,000 For sustainability, integrate current HDSS with government systems through piloting and eventual roll out of VS, ICD. MoH- Planning Department. Jan-13 Dec-15 10,000 5,000 5,000 * This final version has been reviewed and validated through a national accountabilty workshop involving a broader stakeholder group. Page 10/20

11 (government & ) MONITORING OF RESULTS 1. Participate in the design of the 2013 MDG end-line survey 2. Strengthen analytical capacity of MOH at district and central levels Establish consensus, among stakeholders, on RMNCH indicators to be included in the 2013 endline survey (forum will be TWG) MOH - Planning Dept., RHU, NSO Partners: UN; Kfw; USAID; Norway Support data requirements for the MOH IMCI, RHU; NSO; HMIS MNCH National Evaluation Platform Partners: UN, CIDA, JHU, PSI, and measure implementation Save The Children strength Train health care workers (incl. statistical clerks, HMIS officers and assistant statisticians) in data management, analysis and reporting MOH Planning Dept. Partners: UN, CDC, Statistics Norway, USAID, E4A Jun-12 Jul-12 20,000 Planned and funded Provide ICT equipment to districts health offices for use by HMIS MOH Planning Dept. Jul Support the establishment of district databanks and establish a central data repository 4. Review the M&E plan for the Health Sector Strategic Plan (HSSP) to ensure the 11 RMNCH core indicators are included Establish a follow-up and support mechanism to trained and equiped district health offices Evaluate (internal) pilot of DHIS2 to inform future roll-out MOH Planning Dept. Partners: UN, CDC, Statistics Norway, USAID, E4A MOH -Planning Partners: College of Medicine, CDC, UN, USAID, Statistics Norway Support TWG meetings to discuss and resolve the few discrepancies in MOH-RHU and Planning Dept. the two RMNCH indicators included in the HSSP * This final version has been reviewed and validated through a national accountabilty workshop involving a broader stakeholder group. Page 11/20

12 (government & ) 5. Conduct data quality analysis, with verification of the 11 RMNCH core indicators Conduct an assessment of RMNCH reporting mechanisms with the intent to inform integration/streamlining of data collection and reporting Conduct data quality assessment, with a focus on RMNCH indicators MOH-RHU and Planning Dept. MOH-RHU and Planning Dept. 10,000 Train zonal supervisors in data quality assessments MOH-RHU and Planning Dept. Establish a mechanism for zonal supervisors to implement routine data quality assessments MOH-RHU and Planning Dept. 6. Conduct 2012 Service Provision As Technical Assistance and financial re in support MOH-Planning Dept., NSO Partners: USAID, ICF Macro Feb-12 Jul-13 * This final version has been reviewed and validated through a national accountabilty workshop involving a broader stakeholder group. Page 12/20

13 (government & ) MATERNAL DEATH SURVEILLANCE AND RESPONSE Strengthen the MDR system to Conduct a situational analysis in 6 become MDSR at all levels: districts yet to be identified recommendations to the SRH TWG to form a task force to kick start the MDSR processes are to be made. MOH -RHU Partners: UNFPA; WHO; UNICEF, E4A, CDC, LATH, others Jul-12 Sep-12 20,000 10,000 RHU, E4A, UN, other 10,000 Conduct MDSR orientation and capacity building workshop for all stakeholders at national level ' following the approach used in Tanzania MOH -RHU Partners: UNFPA; WHO; UNICEF, E4A, CDC, LATH, others Sep-12 30,000 20,000 RHU, UN, E4A, other 10,000 0 Work with the HMIS system to adopt the ICD10 classifications - to be discussed RHU, Planning, CDC, others Jul-12 Review and update the national guidelines and forms for MDSR Build capacity for implementation of MDSR in districts Conduct a workshop of national experts to review and revise existing forms /tools to reflect MDSR Integrate MDSR in the IDRS approach Develop a phased plan to roll out components of the MDSR approach in health facilities and communities MOH -RHU Partners: UNFPA; WHO; UNICEF, E4A, CDC, LSTM, others Oct RHU, UN, other MoH Planning and RHU Oct-12 MoH RHU MOH -RHU Partners: UNFPA; WHO; UNICEF, E4A, others Oct-12 15,000 MoH RHU and Implement the plan, focus on strengthening capacity in health facilities first, then strengthen community surveillance and response, implemented a blended approach in selected districts MOH -RHU Partners: UNFPA; WHO; UNICEF, E4A, others Oct-12 Dec ,000 MoH RHU and Add new components as capacity is being strengthened, eg, perinatal deaths review, near miss review Jan-14 MoH RHU and * This final version has been reviewed and validated through a national accountabilty workshop involving a broader stakeholder group. Page 13/20

14 (government & ) Integrate MDSR initiative in preservice and inservice training curriculum for health profesionnals Work with Medical and Nursing Councils to update the curriculum. The councils will work on the syllabuas while training institutions will work on the curricula, so include training institutions, CHAM, KCN & College of Medicine, College of Health sceinces and Mzuzu University MoH RHU with Medical and Nursing Council, : UNFPA, CDC Jan-13 MoH RHU with Medical and Nusring Council * This final version has been reviewed and validated through a national accountabilty workshop involving a broader stakeholder group. Page 14/20

15 (government & ) INNOVATION AND E-HEALTH 1. Identify best practices in e-health for potential scale up Conduct a consolidated situation analysis on e-health Evaluate the RMNCH projects that are using ICT for scale up MOH - Planning Dept., Ministry of Information, e-government, Universities in (UNIMA,MZUNI) Partners: USG, UNICEF, WHO,UNFPA,Norway, NGOs MoH- RHU, IMCI, Planning(CMED), e- government, Partners: UNICEF, UNFPA, WHO, USG, NGOs, Universities in Dec-12 7,000 7,000 0 Dec-12 Conduct e-health dissemination workshop on best practices and promote buy-in MoH, Ministry of Information, Jan-13 4,000 4, Computerisation of Integrated Health Management Information System(HMIS) Feed the findings into the ehealth strategy Provision of ICT equipment for communication, EMRS,e reporting, MoH- Planning, MoFinance, RHU, IMCI, Information Partners: USG, NGO Ongoing activity Training health care workers on ICT systems MoH- Planning, MoFinance, RHU, IMCI, Information Partners: USG, NGO * This final version has been reviewed and validated through a national accountabilty workshop involving a broader stakeholder group. Page 15/20

16 (government & ) 3. Strengthen the use of ehealth services to improve information sharing Conduct quarterly Coordination meetings - M&E TWG under SWAP governance structure, Use Data standards working group and mhealth forum sub groups MOH - Planning Dept., Ministry of Information, e-government, Universities in (UNIMA,MZUNI) Partners: USG, UNICEF, WHO,UNFPA,Norway, NGOs Jan-13 Dec-15 24,000 8,000 Develop / strengthen a system of coordination of standards to ensure interoperability ( DHIS 2- defacto) MOH - Planning Dept., Ministry of Information, e-government, Universities in (UNIMA,MZUNI) Partners: USG, UNICEF, WHO,UNFPA,Norway, NGOs Develop data protection, legislation and regulatory framework for sharing health and protecting information.- through M&E TWG MOH - Planning Dept., Ministry of Information, e-government, Universities in (UNIMA,MZUNI) Partners: USG, UNICEF, WHO,UNFPA,Norway, NGOs 4 Advocate for upgrading of the infrastructure for electronic communication- 5. Facilitate functional review of CMED. Conduct negotiation meetings with Private sector ICT and telecom providers Conduct functional reviews of CMED to establish additional positions including ICT positions MoH, Ministry of Information, Partners: Sep-12 Dec-15 3,000 Dec-15 * This final version has been reviewed and validated through a national accountabilty workshop involving a broader stakeholder group. Page 16/20

17 (government & ) MONITORING OF RESOURCES 1. Build capacity of MOH Planning Unit to routinely conduct NHA 2. Support institutionalization of NHA at MOH 3. Use subaccounts for RMNCH to inform budgeting 4. Tracking RMNCH re at district level Train MOH, MOF and NSO officials in NHA and the use of the NHA production tool Set up a steering committee, officially approved, with institutional support, and functioning using results-based management methods Advocate for the inclusion of a budget line specifically for RMNCH Adopt and adapt NHA tool for monitoring and tracking RMNCH re at district level MOH - Planning Partners: UN, USAID MOH-Planning Partners: UN, USAID MOH-RHU Partners: UN, MHEN MOH-RHU, Planning Dept. Partners: UN 50,000 50, ,000 10,000 0 * This final version has been reviewed and validated through a national accountabilty workshop involving a broader stakeholder group. Page 17/20

18 (government & ) ACCOUNTABILITY PROCESSES Strengthen the RMNCH component in health sector reviews Conduct zonal and district reviews in preparation of the sector reviews Conduct a national MNCH programme review and develop consolidated report to feed into the annual sector reviews Develop a progress and performance report to feed into the annual sector review, level to be decided MOH ' RHU, IMCI Sep-12 Mar-13 25,000 MoH RHU and IMCI with UN and other Jan-13 Mar-13 20,000 10,000 MoH Planning, RHU, IMCI and MOH ' Planning, RHU IMCI Sep-12 Aug-13 50,000 16,000 MoH RHU and IMCI, WHO, other 10,000 15,000 10, ,000 Create M/E officer position in RHU MoH RHU and Planning Sep-13 staff salary UNDP MDG acceleration framework Strengthen collaboration and coordination with civil society organizations Advocate for a RHU-specific budget line Do a mapping of the women s and civil society organisations MOH - Planning Partners: MHEN, CONGOMA, Ministry of Gender, Children and Community Development, Civil Society, NONM, AMAMI Dec-12 Dec-12 MoH RHU with UN MoH RHU and IMCI, Engage civil society on the MDSR at the community level and in preparation of the SWAP reviews MOH - Planning,RHU Partners: Civil Society; CONGOMA Jan-13 Dec-15 MoH RHU, * This final version has been reviewed and validated through a national accountabilty workshop involving a broader stakeholder group. Page 18/20

19 (government & ) ADVOCACY & ACCOUNTABILITY Conduct a National Countdown 2015 exercise Establish an informal task force to start planning Develop a plan and time frame for conducting a country Countdown MOH - RHU and IMCI Partners: UNFPA; UNICEF; WHO, E4A, others Jul-12 Jul-12 UNDP (MAF), other UN agencies, other 20,000 Review data and availability, create data profiles for district or sub'national levels Jul-12 Dec-12 Plan national meeting and media events Nov-12 Mar-13 Conduct a national Countdown conference Apr-13 50,000 30,000 20,000 * This final version has been reviewed and validated through a national accountabilty workshop involving a broader stakeholder group. Page 19/20

20 (government & ) Develop and implement an engagement strategy Engage with E4A experts to develop a strategy for engagement with civil society and other for advocacy, transparency, and accountability MOH, RHU, IMCI E4A, UNFPA; UNICEF; WHO, others Partners: Oct-12 Mar-13 20,000 10,000 E4A; UN 10,000 0 Include RMNCH reports on MOH webpage Jan-13 Jun E4A, UN Brief the parliamentarians of RMNCH MOH - RHU and IMCI Partners: UNFPA; UNICEF; WHO, Women Caucus Oct-12 Dec-15 MoH RHU, IMCI and Support the presidential initiative on maternal health and safemotherhood MOH, RHU, IMCI Partners: E4A, UNFPA; UNICEF; WHO, others Oct-12 Dec-15 MoH RHU, IMCI and Build the capacity of key media institutions (print and electronic) on RMNCH MOH-HEU Partners: MHEN, civil society Oct-12 Dec-13 MoH RHU, IMCI and Conduct media briefings/sensitisation on the importance of RMNCH and accountability Build capacity of community and faith based leaders on RMNCH MOH-HEU Partners: MHEN, civil society MOH-HEU Partners: MHEN, civil society Oct-12 Dec-15 MoH RHU, IMCI and Oct-12 Dec-13 MoH RHU, IMCI and TOTALS 600, ,000 60, ,000 * This final version has been reviewed and validated through a national accountabilty workshop involving a broader stakeholder group. Page 20/20