1. health and fitness

20th April 2015
Action for Global Health response to “Health measurement and Accountability post-2015: A
Common Roadmap”
We would like to commend the leadership of the World Bank, WHO and USAID in developing this
first common roadmap for health measurement and accountability post-2015. The Millennium
Development Goals (MDGs) have clearly shown that the absence of clear means of implementation
for global development goals slows down progress. To advance the sustainable development agenda
we will need to adequately monitor the Sustainable Development Goals (SDGs) and this roadmap
presents a strong foundation upon which health measurement and accountability systems might be
improved.
The draft roadmap can be complimented in highlighting the importance of strong health information
systems. Every individual should have the right to be counted, every baby to be registered and every
death recorded. It is promising to see such a commitment to strengthening data capture as this will
further enable each individual to be recognised, whether they live in remote rural areas or are an
undocumented migrant. In highlighting the importance of national household surveys that include
equity dimensions of health and service coverage the Roadmap has identified an important
dimension that needs much further elaboration.
The use of health information systems to identify the gaps in equity across a country’s health
provision will be essential to achieving the SDGs. Moreover, measuring inequity can and should go
further than measuring income. It will be essential to highlight groups or sectors of the population
who are more likely to be excluded in health access including minorities and persons with
disabilities. To complement this we would suggest that the monitoring framework includes
reference to “access to, and use of, data by civil society”.
Building capacity of health information systems is a huge task that will demand sustained
commitment to the improved collection, management and review of health systems information.
We believe the Roadmap could give further insights into the governance aspects of information as
all information systems have both technical and governance components and information quality
and availability often has a political dimension, something that could be acknowledged within the
Roadmap.
In addition to political and technical commitment improved health measurement will demand
continued international investment to strengthen capacities to meet data collection requirements.1
We are pleased to see the Roadmap identify the need for a global investment plan to outline what is
necessary for the development of health information and accountability platforms.
There are a large number of helpful recommendations within the Roadmap although we would like
to see further guidance on prioritisation and implementation. To ensure practitioners are not
1
Obare et al. International Journal for Equity in Health (2014) 13:123
20th April 2015
overburdened by a huge agenda some support in sequencing necessary steps ahead of others would
be welcome.
We believe the framework as proposed is an ambitious undertaking but can go further to
demonstrate the linkages between health service and the wider determinants of health. There are a
number of indicators that can be used as proxy indicators for health, something that could be
recognised within the roadmap as a means of encouraging stronger interlinkages, not only through
health SDG but also across related SDG areas.
While this Roadmap plays a crucial role in identifying key steps necessary to improve the collection
and use of health-related data we believe its focus on accountability could be elaborated upon and
strengthened. Accountability is key to ensure the SDGs will be implemented and make a change for
people in country. Ensuring someone is responsible for achieving a certain outcome and upholding
their commitments gives that goal or target a much higher chance of success. Accountability should
therefore be based on principles such as transparency, inclusiveness, responsiveness, efficiency and
effectiveness. We would like to emphasise three components of accountability for health that are
missing in the roadmap:
1. Participation of all stakeholders
It was already set out in the United Nation’s Secretary General Synthesis report that the new
development agenda should include all stakeholders representing local, national regional and
international level. This can only happen if they are all participating in the monitoring and
accountability systems.
Civil society and community based organisations play a profound but often unrecognized role,
ranging from delivering health services to an advocacy role at national, regional and global levels.
Unfortunately, they are rarely seen as an equal partner in the planning, development,
implementation and monitoring of health policies. Civil society and community involvement is
critical to ensuring the right to health for all, especially for the poorest and most marginalised
populations. However while the draft Roadmap recognises this it can go a lot further to demonstrate
how this can be done practically and ensure participation is not only tokenistic. Participation sits on
a spectrum ranging from observation to active consultation and influencing decisions. Only if
participation is meaningful can we harness the real benefits of it.
Openness and transparency are essential for CSOs to meaningfully engage and in this regard we are
pleased to see the commitment to open data and transparency in the Roadmap.
2. Political accountability
National governments must be held accountable both to domestic and international stakeholders to
reach the goals and targets they signed up for. To make that happen governments will need to
translate the whole SDG agenda into ambitious national action plans respecting local context,
strengths and weaknesses. We believe this should be accompanied by established procedures that
ensure regular, open and transparent engagement with key constituencies and provide health sector
oversight.
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Parliaments have a key responsibility in this regard and their role in health sector accountability
should not be neglected. Parliamentarians are positioned to critically review and question a
government’s approach or take parliamentary initiatives to propose new ideas and best practices
from other countries.
3. Finance tracking
If governments are to deliver on their collective responsibilities health must be funded in an
effective, sustainable and efficient way. An important instrument to monitor whether governments
are maintaining their commitments on health and towards internationally agreed goals and targets
will be the tracking of financial investments for health. This should include both domestic and
external financing and can clearly demonstrate levels of political commitment as well as levels of
dependency on donor resources. Civil society should play a key role in this process and we must
acknowledge the need to build the capacity of such groups, at both national and regional level, to
track budget allocations and (public and private) health expenditure.