COUNTRY ACCOUNTABILITY FRAMEWORK: Assessment* Manila, Philippines Accountability Workshop, March 19-20, 2012 Information updated: April 27, 2012 Policy Context Global strategy on women and children/ commitment Situation Analysis To increase the percentage of pregnant women with access to Prevention of Mother-to-Child Transmission (PMTCT) services from 20% to 50%; To increase the percentage of people with disabilities who have access to reproductive health care services from 20% to 50%; To increase the percentage of pregnant women who receive antenatal care (at least three visits during 3 trimesters) from 80% to 85%; To increase the percentage of couples who received pre-marital counseling and health check from 20% to 50%; and To increase the percentage of women giving birth with trained health workers from 96% to 98%. National Health Sector Plan and M&E Plan Country team present at the Philippines Accountability Workshop, March 19-20, 2012 GOVERNMENT DANG Ngoc Tu Statistics on National Accounts General Statistics Office Email: datu@gso.gov.vn DANG Thi Phuong Nga Vice Director - Health Planning and Finance Department Investment Division Department of Ministry of Health Email: ngadangphuong@yahoo.com Ms Do Thi Phuong Lan Health Statistics Officer Health Statistics Division Planning and Finance Department Ministry of Health Email: dtplanh@yahoo.com Dr Duong Thi Hai Ngoc Expert Maternal and Child Health Department Ministry of Health Email: phuckhaingoc@gmail.com WHO COUNTRY OFFICE Dr Ornella Lincetto Medical Officer E-mail: lincettor@wpro.who.int SAVE THE CHILDREN Ms Nguyen Thi Hue Project Coordinator Maternal and Newborn Health Email: nguyenthi.hue@savethechildren.org H4+ Dr Duong Van Dat Sexual Reproductive Health Team Leader UNFPA Viet Nam Country Office Email: dat@unfpa.org Dr Luu Thi Hong Deputy Director Department of Maternal and Child Health Ministry of Health Email: luuhong1960@yahoo.com *Please note this is a draft that will be finalised and validated through a national accountabilty workshop involving a broader stakeholder group Page 1/8
KEY: 1 Not present, needs to be developed 2 Needs a lot of strengthening 3 Needs some strengthening 5 Already present/no action needed Civil registration & vital statistics systems Assessment & Plan 1 Coordinating Mechanism 1 Hospital reporting 3.5 Community reporting 2 Vital statistics 2 Local studies for mortality 1 The team does not know about national assessments. Viet Nam was part of ESCAP assessment. There not a national committee for coordination, however there is a Government decree establishing the role of different ministries and government bodies. There is a form of hospital reporting, but using only group causes of death (3 digits) not the ICD10 (4 digits). Community births and deaths are reported by hard copy by local People's Committee. Commune health center staff has responsibility of recording births and deaths in the register book of commune health center. Verbal autopsy is studied as part of a pilot project of the Institute for Policy and Strategy and Hanoi Medical University. VA of maternal deaths is implemented in 14 provinces where MMA was piloted and it is part of the MMA methods to be expanded to all country. Vital statistics are published: Population Change Survey conducted every year (3% population) but only national. There are no local studies for mortality statistics. 1. Conduct rapid CRVS assessment and use results for advocacy /mobilization key stakeholders. 2. Conduct full CRVS assessment and develop improvement plan. 3. Establish interagency coordinating committee (or revise TOR of relevant existing ones) involving all key stakeholders. 4. Team. 5. Capacity building of statistic officers and doctors certifying the cause of death in ICD 10; regular quality control of certification; improve coding practices. 6. Strengthen community reporting of births and deaths, implement innovative approaches, like use of ICT and newborn code. 7. Scaling up provincial capacity to conduct VA of maternal deaths. 8. Strengthen the analytical capacity of vital statistics office, to produce subnational data, including data quality assessment. 9. Modify Decree 158/2005 on vital registration of newborn death within 24 hours. 10. There is currently no plan for local studies for mortality. *Please note this is a draft that will be finalised and validated through a national accountabilty workshop involving a broader stakeholder group Page 2/8
Monitoring of results M&E Plan 3 M&E Coordination 1 Health Surveys 1 Facility data (HMIS) 2 Analytical capacity 3 Equity 1 Data sharing 2 There is a M&E plan of the NHS but not comprehensive. In 1. Strengthen the M&E component of the NHS. addition there is a plan for HIS strengthening which is 2. For ANC, revise the national guideline; update/reach consensus on the aligned with NHS. The RMNCH M&E plan is align with health definition of SBA. sector and includes all 11 indicators, however 2 indicators 3. Establish M&E coordinating body with clear TOR or revise the TOR of are not aligned with international definitions (ANC 3 visits existing NHS committee. instead of 4 and birth by trained health professionals 4. Develop 10 year health survey plan. instead of SBA as internationally defined). Limited use of 5. Plan for a national coverage survey 2012-13, that includes RMNCH data for programme management. M&E coordination interventions. committee not yet established, but it will be established 6. Measure MMR through Annual National Population Change Survey (2013, under the Planning and Finance Department of MOH or the 2015) and inter-census survey (2014). M&E will be better defined in the TOR of existing 7. Strengthen analytical capacity, annual compilation of statistics from committee in charge of NHS. There is a plan for conducting facilities with data quality assessment. a national survey, which includes household and health 8. Conduct biannual facility survey for data verification and service readiness. facility survey, however not approved by GSO. HMIS is 9. Strengthen capacity to collect, report, analyse and present data on RMNCH rather developed, however facility survey for data at all levels. verification was done only once in 2009. MOH produces an 10. Improve the dissemination of results and use of the data for policy annual statistics yearbook, there is an annual JARH with a making. different topic every year, every 2 years there is a 11. Strengthen equity analyses for program reviews and for targeting population change survey (which cover 2% of population vulnerable women and children. and includes MMR and IMR). MICS and small studies looked 12. Develop an ID system to better trace key information at individual level. at some disaggregated data; HIS can produce disaggregated 13. TA to develop a national data repository with all relevant data and reports data by 6 main regions, not by smaller units; national and to develop data warehouse in MOH. nutrition survey provides disaggregated data by province; however there is no system to routinely collect and analyze data by sex, income, minority and location. There is a statistics website of MOH where health profiles by year are published, National Institute of Nutrition website publishes good data, however updating is a challenge because of limited human resources, the MOH server capacity is limited. *Please note this is a draft that will be finalised and validated through a national accountabilty workshop involving a broader stakeholder group Page 3/8
Maternal death surveillance & response Notification 2 Capacity to review and act 2 Hospitals / facilities 2 Quality of care 1 Community reporting & feedback 1.5 Review of the system 1 All deaths should be notified within 15 days (including maternal death) - Ministry of Justice, however notification/reporting of notified cases varies across the country. There is no specific policy on notification of maternal deaths. The national capacity to coordinate the review and response is still weak. Only pilot districts and provinces have modest capacity. Hospital reporting of maternal deaths is high, mostly not within 24 hours and 3 digits ICD coding is applied. In pilot areas all maternal deaths are reviewed; not in not pilot areas. The MOH has national guidelines, however no official regular quality of care assessment is in place. Not all community deaths are reported. Electronic devices are not yet used for reporting. Verbal autopsy is done only in pilot localities. Community does not receive feedback yet. There is currently no system review in place for maternal death surveillance and response. 1. Advocate and develop instruction for maternal death notification within 24 hours for MMA. 2. Add MMA to the responsibilities of health workers under Decree 385; make MMA part of national target programs to secure national funding; intersectoral monitoring of maternal death; annual review meeting on maternal deaths /MMA. 3. Orientation of local authorities (multisectoral) on maternal death, particularly in 62 priority districts identified by national SM plan 2011-15; strengthen district capacity through TA mechanism from province to district and commune on MDSR. 4. Improve monitoring to ensure timely reporting by hospitals. Training hospital staff in ICD certification and coding (links with CRVS). 5. Strengthen hospital capacity and practices to review maternal deaths. 6. Support the establishment of a regular system of QoC assessments, with good dissemination of results for policy and planning. 7. Develop / strengthen a community system of maternal death reporting and response, using ICT. 8. Develop a system of maternal death reporting and response initiation by electronic devices, set up a hotline for maternal death. 9. Expand VA to more communities. 10. Develop system of involving communities in review and response. 11. Support and strengthen review system including dissemination and use of the report, including conduct an annual review meeting. *Please note this is a draft that will be finalised and validated through a national accountabilty workshop involving a broader stakeholder group Page 4/8
Innovation and ehealth Policy 3 Infrastructure 2 Services 2 Standards 1 Governance 1 Protection 1.5 Viet Nam has an overall ICT strategy for all sectors, MOH has its own ICT strategy, the HIS plan of action has a chapter on ICT. Internet broadband and mobile infrastructures are widely available. At the provincial level 100% have broadband internet, storage data system in 77%. At district level 75% of hospitals have internet. 100% of medical colleges have internet. Computers for health statistics are not available at commune level, and not all districts have computers only for the health statistics. E- Health services and applications are applied only partially. Sharing of information is not comprehensive. There are no commonly agreed interoperability requirements or standards for ehealth services and application. There is no national mechanism for ehealth governance. Legislation on data protection is partly developed and there is no clear mechanism for enforcement. 1. Develop a hotline for maternal and neonatal deaths for better information and response to causes of death. 2. Upgrade infrastructure and capacity of statics officers in 63 poor districts. 3. Determine the ehealth services required to support the country s priority programs and goals, particularly with respect to information flows. 4. Effective data sharing between systems is a priority. 5. Determine the ehealth standards and interoperability components required to support ehealth services, applications and infrastructure, as well as to support broader changes to health information flows. 6. Develop and support a strong effective coordination mechanism. 7. Determine the gaps and needs to strengthen the legal framework for data protection, including for e-health. 8. Enforce compliance to data protection policies. *Please note this is a draft that will be finalised and validated through a national accountabilty workshop involving a broader stakeholder group Page 5/8
Monitoring of resources National health accounts 2.5 Compact 2 Coordination 1.5 Production 2 Analysis 2.5 Data Use 1 There is an officially approved NHA framework built upon international guidelines, however there is no subnational health account for RMNCH and other program areas. There is no clear governance mechanism, nor a policy on NHA, the process is technically supported by WHO. There is a compact with some partners. NHA steering committee is not yet established officially. Key stakeholders are partially involved. Human capacity at subnational level is limited and national capacity for subaccounts should be developed. Government expenditure data conversion into NHA format is not automated. Analytical summaries are produced every 2 years and a report is developed, but it is not yet available on MOH website. NHA data are not currently being used for annual reviews and for developing national policies. However there is strong intention to do it as Viet Nam is one of the 49 priority countries. 1. Develop NHA framework and conduct capacity building of NHA team to include RMNCH and other programmatic areas. 2. Organize a meeting with decision makers and technical staff to develop institutional arrangements and team. 3. Institutionalize the implementation of the NHA framework, including coordination mechanism. 4. Organize an advocacy event to engage government and development partners and work towards "compact". 5. Set up a steering committee, officially approved, with institutional support, and functioning using results-based management methods. 6. Ensure inclusion of all key stakeholders in resource tracking /NHA. 7. Train staff on system of health accounts 2011 and on RMNCH and other program areas subaccounts; train district and regional staff. 8. Develop IT conversion tool for NHA. 9. Strengthen database for production of NHA. 10. Strengthen analytical capacity in government and other institutions. 11. Disseminate report and analyses on public website. 12. Advocate with leaders the use of NHA data in policy making process and integrate NHA with RMNCH subaccount. *Please note this is a draft that will be finalised and validated through a national accountabilty workshop involving a broader stakeholder group Page 6/8
Review processes Reviews 3.7 Synthesis of information & policy context 3.5 From review to planning 2.5 Compacts or equivalent mechanisms 3 Since 2007 the MOH and the Health Partnership Group agreed to conduct a Joint Annual Health Review (JAHR), every year with a different topic. RMNCH program reviews are held annually, but only partially aligned with health sector review. Health sector performance reviews are informed by good data synthesis and according to policy context. The health sector performance reviews are informed by a synthesis of relevant health data, however, there is a need to ensure that the 11+2 indicators are also included in the review. JAHR analysis are systematic, however JAHR may not cover RMNCH in detail. The mechanism to translate the results of the review into planning and resource allocation is rather weak. The main actor is the Department of Planning and Financing, however other technical departments are less involved and provincial level is not involved at all. The main mechanisms for stakeholder s involvement are Health Partnership Group and UN OnePlan PCG. There is a country compact and most development partners are committed to it. M&E plan for National Health Strategy and 5 year health plan exist, however commitment and funding for implementation are uncertain. 1. Advocate for better utilisation of JAHR findings for planning and programming. 2. Improve the process of preparation of the review, by using the existing Reproductive Health Affinity Group and other groups to get more involvement of key stakeholders, add the 11 +2 indicators, and ensure that the RMNCH review findings feed into the health sector reviews. 3. Align the definition of certain indicators to international definition and criteria. 4. Strengthen the use of review results for planning purposes at subnational level. 5. Strengthen the use of review results for planning purposes at all levels. 6. Make better use of existing mechanisms. 7. Advocate and build capacity for monitoring internationally standardized indicators and ensure that all development partners support the National Health Strategy and action plans. *Please note this is a draft that will be finalised and validated through a national accountabilty workshop involving a broader stakeholder group Page 7/8
Advocacy & outreach Parliament active on RMNCH issues 2 Civil Society Coalition 2 Media role 2 Countdown event for RMNCH 1 There is a parliament committee for social affairs 1. Parliamentarians are mobilized to engage in RMNCH accountability, responsible for health issues and also a parliament especially on financing. committee for finance which is responsible for budget 2. Facilitate the organization of public hearings/forums for sharing of approval. However there is not a clear mechanism of information on RMNCH. accountability for RMNCH. Parliament organizes forums and 3. Advocate for the establishment of a CSO coalition for RMNCH, open to monitoring missions of parliament members on health other partners. including RMNCH. A CSO coalition doesn't exist formally, 4. Support capacity of civil society to synthesize evidence and disseminate however there is great interaction of CSO with stakeholders. messages and advocate. CSO bring evidence on best practices and produce 5. Work with the media to strengthen their capacity to report on RMNCH documents that are shared through different channels, related issues. however there is not a well-defined dissemination strategy. 6. Work with the media to strengthen their capacity to report on the There is media reporting on a wide range of RMNCH-related monitoring the implementation of the Global Strategy. topics, however not frequent coverage and not addressing 7. Improve information flows to media. financing issues. Media not engaged in accountability 8. Countdown Coordinating Committee, UN agencies (H5), and other partners process. Media receive information from national bodies. support national stakeholders to plan and conduct a national Countdown in Two events are planned to take place, before June 2012 and preparation for the national MDG review meeting June 2012. in 2014, and they will include the production of a country 9. Prepare Countdown profile using all evidence. profile. *Please note this is a draft that will be finalised and validated through a national accountabilty workshop involving a broader stakeholder group Page 8/8