Formal commitment has been made to the global strategy.

COUNTRY ACCOUNTABILITY FRAMEWORK: Assessment* Policy Context Global strategy on women and children/ commitment Formal commitment has been made to the global strategy. Situation Analysis National Health Sector Plan and M&E Plan National health sector plan for the year 2012-2016 including Maternal and Child Health indicators exists (to be finalized and shared in future). Roadmap for 2010-2015 for maternal and reproducing health exists. The roadmap has been developed in consultation with other partners and includes costed plans. It includes indicators that are monitored on an annual/mid term basis through annual review or surveys. Country team present at the Cairo multi-country Accountability Workshop, 2-4 September 2012 FEDERAL MINISTRY OF HEALTH CENTRAL BUREAU OF STATISTICS WHO COUNTRY OFFICE Dr Sawsan Eltahier Suleiman Hassan Maternal Health Programme Officer Dr Abdelhafiz Elaghbash Marghany Child Health Programme Officer Ms Hanadi Mohammed Habeib Health Account Programme Officer Mr Amin Ahmed Daoud Director of the Computer Centre Dr Nada Hamza National Programme Officer Maternal and Child Health Mr Mohammed Abdelghani Omar Abdelghani Health Information System Programme Officer Ms Ibtisam Hassan Elnasry Health System Planning, Monitoring and Evaluation Programme Officer *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 1 Both rapid and full assessment of CRVS have not been done. Conduct rapid CRVS assessment and use results for advocacy/mobilization of There is interagency coordinating committee involving key stakeholders. key stakeholders Hospital reporting of deaths is complete using standard format of (ICD 10) Conduct a full CRVS assessment and develop an improvement plan but it is not accurate (refer to the causes of death). There is no quality Coordinating Mechanism control system in place. 3 Strengthen interagency coordinating committee involving all key Some of the community births are reported but deaths are not reported at stakeholders community level. VA is only conducted for maternal deaths. Hospital reporting 3 Vital statistics on fertility and mortality are published every year based on the projections from the latest census and surveys. Data sources are therefore not from CR system. There is no data quality assessment on vital statistics. Improve hospital reporting, use electronic reporting system Establish quality system for the control of certification There is no HDSS system in place. Community reporting 1 Strengthen community reporting of births (scale-up) and deaths, implement innovative approaches to scale up Strengthen community reporting through use of VA by community workers Vital statistics 1 Establishing a system to make civil registration system the main source of vital statistics. Quality control has to be improved on vital statistics. Local studies for mortality 1 Develop/Establish HDSS system *Please note this is a draft that will be finalised and validated through a national accountability workshop involving a broader stakeholder group. Page 2/8

Monitoring of results M&E Plan 3 The M&E plan is being prepared for the National Health Strategy (2012-2016). Indicators for maternal health roadmap are fully aligned, however the period covered by the roadmap for reducing maternal and neonatal Strengthen the M&E component of the NHS Review the RMNCH M&E plan(s) and align with the M&E of the NHS M&E Coordination 1 mortality (2010-2015) is different from that covered by the national health strategy (2012-2016). There is no 5 years plan for child health. However Establish/strengthen M&E coordinating body indicators for M&E child health annual plan are aligned with National Health Health Surveys 2 sector M&E indicators. The previous national health plan did not have an Develop 10 year health survey plan M&E plan. Plan for a national coverage survey 2012-13, that includes RMNCH Currently there is no M&E coordination committee. However the interventions formulation of committee is under consideration (for the current national Facility data (HMIS) 2 Strengthen analytical capacity, annual compilation of statistics from facilities with data quality assessment Conduct annual facility survey for data verification and service readiness health sector strategic plan). There is a plan to conduct Household Health survey within 2 years in coordination with CBS. No MNCH survey is planned. There is a functioning facility based reporting system that generates quarterly and annual reports. There is a review for reports and feedback but Analytical capacity there are no data quality reports. Facility surveys are not conducted 2 Strengthen analytical capacity, involve key institutions; review contents, annually. analyses and presentation Some programs generate analytical reports but the quality of these reports Equity 2 should be strengthened. Data disaggregated by sex and location for some indicators are used in Strengthen equity analyses for reviews reviews. Data sharing 2 Some of data and reports are shared and published but not up to date. Develop/strengthen national data repository with all relevant data and reports *Please note this is a draft that will be finalised and validated through a national accountability workshop involving a broader stakeholder group. Page 3/8

Maternal death surveillance & response Notification 3 There is a ministerial decree requiring notification of all maternal deaths Revision of MDR formats to capture the root causes of death (but not specifying a 24 hours notification). Both community and facility Capacity to review and act 2 based notifications. Causes of death are identified but not by the level of delay (level of delay is only done in Khartoum state) e.g. if a woman died of bleeding it is not known whether she did not reach the hospital on time or Strengthen national capacity on response Strengthen state capacity on analysis and response whether blood was not available. There is a national and state MDR committee (national MDR committee Hospitals / facilities 2 Orientation of RH program about ICD, strengthen the linkages between the meets quarterly while the state one meets monthly). The capacity to HIS and RH directorate which is responsible for MDR. Improve reporting by analyse is there however. The capacity to respond is weak in some states. hospitals; Training in ICD certification and coding (links with CRVS) Most of the deaths occurring in hospitals are reported. Some of the deaths in private hospitals are reported. There is no specified time for reporting. Causes of deaths are reported according to a national format, but not Strengthen hospital capacity and practices, including private sector according to the ICD. Quality of care assessments are not conducted regularly. EMOC Quality of care 2 assessments was conducted 2 years ago and now planned to be conducted in 2012. Support a regular system of QoC assessments, with good dissemination of results for policy and planning Some of the community deaths are reported but not within 24 hrs. Mobile Community reporting & feedback 2 phones are used to notify deaths. Verbal autopsies are done for community Strengthen a community system of maternal death reporting and response maternal deaths but needs to be strengthened. Communities do not receive feedback and are not involved in the review (feedback is at the state level). Although there are regular meetings to review results of MDR report, the MDR system is not regularly assessed for quality. (Reporting within 24 hrs) Strengthen a system of maternal death reporting and response initiation by electronic devices Strengthen VA for maternal deaths in communities Develop system of involving communities in review and response Review of the system 1 Establish an MDR regular review system to assess surveillance and quality of response including dissemination and use of the report *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 2 There is a proposal for ehealth strategy developed in 2005 but not specific to MNCH. Develop a national ehealth strategy with clear MNCH components with country leadership and broad buy in. Connectivity and infrastructure are available in bigger cities. Use of mobile Infrastructure phone is prevalent in almost all cities. 2 Determine desired outcomes and priorities for infrastructure deployment to Mobile phone is used to notify maternal deaths from community to district support health services delivery and information flows (especially in rural level as part of the MDR. The data is shared but the mechanism of data areas). sharing between locality, states and federal is not effective. RH reporting from the states to the federal level is done quarterly, by email. There is also Services 2 IMCI eclectic reporting system from the states to federal level in place but Plan/strategy for integrated health information system using ICT is infrequently and only from some states. required/needed. There is an initiative to standardize the flow of data management. Situational analysis is needed to identify the gap/priorities. Then, develop a There is a national committee called egovernment which includes also plan based on the results. ehealth (implementing body is the ministry of communication, committee Standards 1 members are ministers/high ranking officials/other stakeholders). Determine the ehealth standards and interoperability components required Data protection, legislation and regulatory frameworks for sharing health information are under establishment. to support ehealth services, applications and infrastructure, as well as to support broader changes to health information flows. Governance 2 Develop and support a strong effective coordination and funding mechanism. Protection 1 Ensure health sector, ministerial and government leadership and support. Ensure that the required program development skills and expertise are available. Determine the needs to strengthen legislation, regulations, policies and their compliance mechanisms on health information and ehealth. *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 3 There is an officially approved NHA framework (developed in 2008) to track public, household and external resources, which is not based on SHA 2011. There is a technical committee responsible for the management and Strengthening NHA framework, particularly on sub-account for MCH. Strengthening the reporting mechanism on financial tracking. implementation of tracking the resources. However, it is not specific to Compact 1 RMNCH. There is a plan to develop a sub-account for MCH. There is no formal agreement between government and partners on Organize a meeting to engage government and development partners and work towards "compact" reporting on expenditures on health, e.g., RMNCH. There is a technical committee responsible for the management and implementation of tracking the resources. The data are well disseminated. Coordination 3 Strengthening a steering committee, officially approved, with institutional Key stakeholders are actively involved. support, and functioning using results-based management methods There is inadequate human capacity at national and subnational levels to produce NHA tables (technical supports were provided by UN agencies previously). Date are collected manually and the process of conversion to Ensure inclusion of all key stakeholders in resource tracking /NHA NHA format is not automatic. No central database exists for automated Production production. 1 Train states/national staff on system of health accounts 2011. No analytical summary is produced on SHA 2011 health accounts. Projection Map government codes to NHA codes and develop/establish IT conversion is carried out in an ad-hoc manner for the prospective two years, and is tool for NHA. based on the NHA of previous year. Result is not published in the website. Initiate the plan to develop database for production of NHA in an automated NHA, although not published, was used in the development of 5 year manner. national health strategy. However it has not been used for the development of RMNCH specific policies (no sub-account). Analysis 2 Strengthen analytical capacity in government and other institutions Disseminate report and analyses on public website Data Use 2 Develop sub-account for 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 3 The national health strategy under development provides for annual reviews on progress towards goals and targets. Key stakeholders are involved in the preparation of the reviews. A report is prepared to review Strengthening the M&E capacity to coordinate the review process across the different programmes, and take the lead for future policy actions. the RMNCH programmes, and the results are fed into the national health Strengthen the involvement of key stakeholders at different stage, starting sector review. Furthermore, the meetings with key partners are held for the from preparation/analysis to making recommendations. programme review. More coordination may be needed. There is no wider health sector performance review; however there is Synthesis of information & policy context 2 annual review of programmes within the ministry of health with Establish the wider health sector performance review. participation of both states and federal levels. There are mechanisms in place to reflect the results of programme review into planning and resource allocation to inform decision at all level. Annual operational planning meetings including RMNCH programmes involve From review to planning 3 various key stakeholders. Strengthen the use of review results for planning purposes Establish mechanism to compile all policy / qualitative information to inform annual reviews Ensure greater involvement of all stakeholders Compacts or equivalent mechanisms Ensure the existence of a single M&E framework that fits into the single national health plan *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 3 There is a heath committee in the parliament but not specific to RMNCH. The committee follows-up on health issues and reviews health budget (e.g. in 2012 the parliament advocated for increasing PHC allocated budget). Information sharing is confined to national and states parliaments and Parliamentarians are mobilized (through awareness)to engage in RMNCH accountability, especially on financing Facilitate the organization of public hearings/forums for sharing of information on RMNCH other stakeholders, however not specifically for RMNCH. There are different NGOs and women's group working on RMNCH however Civil Society Coalition 2 they are not united under one coalition. NGOs and women movements Establish coalition produce evidence based advocacy messages but the strategy for dissemination is unclear. Media are actively engaged on reporting of health topics. Engagement in Support capacity of civil society to synthesize evidence and disseminate messages. Dissemination plan should be developed and shared. RMNCH topics is not regular. Media are not engaged in the accountability Media role 2 process or the national commitments towards global strategy. Media receive regular briefings from RMNCH programs (briefing is done by RH twice/year but there is no regular media briefing by IMCI). No national countdown event is planned yet. No report is produced. Work with the media to strengthen their capacity to report on RMNCH related issues at both national and state levels. Mobilise funds to use a wider range of media channels (TV, radio...etc) Develop a mechanism to work with the media and strengthen their capacity to report on the monitoring the implementation of the Global Strategy Improve information flows to media and strengthen the media department at MOH capacity to generate reports 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 2 A renforcer nettement Needs some strengthening 3 A renforcer légèrement Already present/no 5 Déjà action en place, needed aucune action nécessaire Prepare Countdown report/profile using all evidence *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