DEPT. OF CIVIL AND NATIONAL REGISTRATION Ms Lenah Mokgwaela

COUNTRY ACCOUNTABILITY FRAMEWORK: Assessment* Country team present at the Harare multi-country Accountability Workshop, 1- October 01 MINISTRY OF HEALTH Mr Akeem Tshepo Ketlogetswe M&E Officer MINISTRY OF LABOUR & HOME AFFAIRS Mr Michael Mokgautsi Laatsoga Deputy Director FAMILY WELFARE ASSOCIATION (ROFWA) Mr Kabelo Poloko Programmes Director Mr Mooketsi Kenneth Moalosi Economist (Policy & Planning) Ms Boitumelo Seikokotelo Thipe Programme Officer, MNCH Mrs Zanele Petronella Busang Principal Health Officer, Dept of Public Health & Child DEPT. OF CIVIL AND NATIONAL REGISTRATION Ms Lenah Mokgwaela WHO COUNTRY OFFICE Mrs Lucy Sejo Maribe NPO/FHP PARLIAMENTARIAN Hon. Gibson Ramukonki Matthews Nshimwe *Please note this is a draft that will be finalised and validated through a national accountability workshop involving a broader stakeholder group. Page 1/8

Civil registration & vital statistics systems Assessment & Plan Coordinating Mechanism Hospital reporting A rapid assessment conducted but was not comprehensive. However, it indicated areas that need to be addressed. Other stakeholders not included in the civil registration coordinating mechanism. They do not meet regularly. District committees exist. There are on-site vital registration in 6 major hospitals.. The new policy on education (requirement for birth certificate) has helped to improve birth registration and has raised awareness on birth registration. District Officers undertake regular field trips to provide registration services at community level. Health Statistics data is behind time (by five years). Health data is not analysed & utilised at facility level. However, MMR is calculated every year. Mortality statistics come from surveys such as DHS, Census and BFHS. However, there are surveillance sites reported through IDSR. Should take into account other areas of vital statistics (maternal deaths, marriage, divorce, etc) Should take into account other areas of vital statistics (maternal deaths, marriage, divorce, etc) Bring more stakeholders like UNFPA and WHO, need to re-visit the terms of reference, re-orient the committee Continue rolling out on-site vital registration to 15 health facilities by 015 Training of doctors in ICD 10; regular monitoring for quality of death certification/ classification; improve coding practices Community reporting Strengthen the link between community reporting of births and deaths with health facilities, mobile registration using ICT Intensify public education on births and deaths registration Vital statistics Strengthen capacity building on data analysis & interpretation. Integration between data sources Local studies for mortality #### Review current IDSR to include MDSR as well as Infant & child mortality. *Please note this is a draft that will be finalised and validated through a national accountability workshop involving a broader stakeholder group. Page /8

Monitoring of results M&E Plan The M&E plan needs to be disseminated, yearly plans need to be drawn, Strengthen dissemination of the M&E plan to other stakeholders national bulletin is produced quarterly, unmet needs indicators are not Review the RMNCH M&E plan(s) and align with the M&E of the NHS and incorporated. There is a recently established national M&E coordination include unmet needs, eg: family planning committee. Central Statistics Office has plans for surveys such as the M&E Coordination Aids Impact Survey, Demographic Health Survey, and Strengthen M&E coordinating body by drawing terms of reference and Family Health Survey. Different programs conduct their own operational include other stakeholders, and make linkages with Parlimentary Portfolio surveys.. There is a functioning reporting system; however, the quality of committee for Health and HIV data needs to be assessed. Data disaggregation needs to be addressed. Data Health Surveys is not accessible to public. Conduct regular and consistent survey and strengthen research agenda BFHS needs to be done Facility data (HMIS) Strengthen compilation of statistics from facilities with data quality assessment and include other indicators Conduct facility survey for data verification and audits Analytical capacity Strengthen analytical capacity, involve key stakeholders; review data quality, analyses and presentation Equity Strengthen collection and analysis of disaggregated data Data sharing Data management needs to be improved and data made accessible to the public. *Please note this is a draft that will be finalised and validated through a national accountability workshop involving a broader stakeholder group. Page /8

Maternal death surveillance & response Notification 4 Notification of maternal mortality is done within 4 hours. There is a Fast track adoption of public health act by parliment functional national maternal mortality review system. There is review of Capacity to review and act deaths at the district level but response levels are low. Around 80% of hospital maternal deaths are reported but not all of them are timely. Not all train to improve implementation capacity causes are classified using ICD 10. All reported maternal mortality cases are Strengthen district capacity to review and respond reviewed at national level. EmONC needs assessment was conducted in 010. Communities are not aware of maternal deaths reporting, but Hospitals / facilities Improve reporting by hospitals (e.g general wards); Training in ICD maternal deaths are reported like any other death. Community deaths are certification and coding reported to health facilities regardless of cause of death. Currently verbal Strengthen hospital capacity to review maternal mortality, including private autopsy is not done. sector Quarterly reviews are conducted that build up to the annual report and result in the compilation of a report. About 80% of health facility report Quality of care maternal deaths, but the response remains low. Improve dissemination and use of results from the assessment. Assessments should be conducted regularly Community reporting & feedback 1 Strengthen a community system of maternal death reporting and response, using public education Review of the system Support and strengthen review system, surveillance including dissemination and use of the result. *Please note this is a draft that will be finalised and validated through a national accountability workshop involving a broader stakeholder group. Page 4/8

Innovation and ehealth Policy The e-government strategy has been approved and the data protection bill Need to finalise the e-health strategy is being drafted. Infrastructure is available and bandwidth is being upgraded. Most hospitals and some clinics have internet connectivity. Infrastructure Integrated Patient Management Systems (IPMS) is being installed in major Determine desired outcomes and priorities for infrastructure deployment to hospitals and Patient Integrated Management Systems (PIMS II) for the support health services delivery and information flows in rural areas. clinics. There is some data sharing but it is not very effective. Data storage is available, but interface is not yet complete to enable compilation and Services transfer. National ehealth coordination clusters as well as ministerial coordination teams have been formed. The data protection bill is currently Speed up implementation, coverage Strengthen interfacing of databases is being debated in parliament. The bill will address data protection issues. Standards Develop the standards Governance Strengthen effective coordination mechanism Protection Follow up the drafted bill. Review existing legislative instruments to incorporate e-health Educate both users and community. Enforce compliance to data protection policies after bill is approved *Please note this is a draft that will be finalised and validated through a national accountability workshop involving a broader stakeholder group. Page 5/8

Monitoring of resources National health accounts NHA framework is in place and was launched in March 01. Integrated Develop sub-accounts Health Service Plan (IHSP) is not yet in place; therefore the NHA is looking at Develop sub-accounts general spending There is no formal agreement or compact in place between government and Compact partners. There is a NHA steering committee that provides technical Establish "compact" and hold regular meetings 1 oversight on data needs. All key stakeholders were involved through out the whole process Coordination 4 There is human capacity to produce NHA tables but it still needs to be strengthened. Government expenditure data conversion into NHA format is not automated. The central database for automated production of standard NHA tables is not yet in place Production 1 As of now analytical summaries on SHA 011 are not produced annually. There is one planned for 01. SHA 011 NHA, indicators, analyses are not yet available publicly Train staff on system of health accounts; train district and national staff and recruit more staff Map government codes to NHA codes and develop IT conversion tool for NHA Develop database for production of NHA The NHA published in 01 influenced policy but RMNCH is not yet fully addressed. Analysis 1 Strengthen analytical capacity in government and other institutions to conduct annual analysis Disseminate 01 report to the public Data Use Improve and disseminate NHA more broadly and also address RMNCH *Please note this is a draft that will be finalised and validated through a national accountability workshop involving a broader stakeholder group. Page 6/8

Review processes Reviews A Health PITSO ( consultative stakeholder forum) is conducted annually to There is need to strengthen Health PITSO consult stakeholders. Key stakeholders are involved in the preparation and Develop a work plan with defined timelines execution of the reviews. RMNCH reviews are held annually. Strengthen the reviews processes Synthesis of information & policy context Strengthen the capacity to prepare analytical reports at district level Make the process more regular From review to planning Health sector performance reviews are conducted using qualitative and Strengthen advocacy of more resource allocation quantitative information Ensure greater involvement of all stakeholders Compacts or equivalent mechanisms 1 Develop a compact structure The review process informs resource allocation at all levels, however *Please note this is a draft that will be finalised and validated through a national accountability workshop involving a broader stakeholder group. Page 7/8

Advocacy & outreach Parliament active on RMNCH issues Portfolio Committee on Health and HIV/AIDS has been created in 01 and is responsible for all health issues. There is an umbrella body for civil society (Bocongo, BONELA, etc). These coalitions produce advocacy messages based on evidence. Currently the government is reviewing the NGO Policy with a view to establish an NGO Council. There is media report but it is not sufficient. Media is not actively involved in accountability process and they Civil Society Coalition only receive information occasionally from key national bodies to generate Strengthen coalition and increase budget for civil society reports and public discussion. To date there is no plan yet to hold a Countdown event for RMNCH. Parliamentarians to be orientated on RMNCH issues, mobilize committee members to engage in RMNCH accountability, especially on financing Orientation of parliamentarians on RMNCH in-order to strengthen public hearings/forums for sharing of information on RMNCH Strengthen capacity building of civil society to synthesize evidence and disseminate messages Media role Conduct a workshop for media to strengthen their capacity to report on RMNCH related issues Work with the media to strengthen their capacity to report on the monitoring the implementation of the Global Strategy Conduct regular media briefs. Countdown event for RMNCH 1 Countdown Coordinating Committee, UN agencies (H5), and other partners encourage/support national stakeholders to plan national Countdown SCORE: Not present, needs 1 N'existe to be pas, developed à créer Needs a lot of strengthening A renforcer nettement Needs some strengthening A renforcer légèrement Already present/no 5 Déjà action en place, needed aucune action nécessaire *Please note this is a draft that will be finalised and validated through a national accountability workshop involving a broader stakeholder group. Page 8/8