1. health and fitness

Feedback on “Health Measurement and Accountability Post-2015: A Common Roadmap”
Health in Post-2015 Roundtable
April 22, 2015
As a coalition of advocates from health-related non-governmental organizations engaged in the
post-2015 development agenda process, we appreciate the opportunity to provide feedback on
the draft “Health Measurement and Accountability Post-2015: A Common Roadmap.” Our
recommendations are as follows:
Process to finalize the Roadmap is open and inclusive
It is unclear how many member states are involved in the Roadmap process and invited to the
June Measurement and Accountability Summit in Washington, DC. Participation by member
states should be an open and meaningful dialogue. Additionally, civil society and the private
sector should have the opportunity to provide meaningful feedback in open and transparent
consultations. Additionally, it is unclear how civil society and private sector representatives to
the Summit have been identified and selected; again this needs to be a transparent process.
Clarity on the role of civil society
There remains a lack of clarity on the role of civil society in the measurement and accountability
process. Civil society and community-based organisations play a crucial 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. The Roadmap should provide clear recommendations or guidance on how member
states effectively engage with civil society, support civil society and include a well-defined role
for civil society at global, national and community-level in the accountability process. In
addition, financial and technical resources need to be earmarked to facilitate the meaningful
participation of civil society in these processes – without this support civil society participation
runs the risk of being merely symbolic and true civil society voices are diluted to the point of
being toothless.
Clarity on what is expected of donors
The “Way Forward” section of the Roadmap states that “donors will need to change from
funding disease- or program-specific data systems to a more holistic approach.” It is unclear
from the Roadmap if donors have been consulted in this process. Implementing any changes to
what donors fund, requires a dialogue that includes donors and other stakeholders, based on
donors’ expertise, division of labor and an efficient mix of different data systems. It would be
useful to see concrete expressions of commitment to change from the donors supporting the
Roadmap process: World Bank, USAID and the UN (WHO) among others.
Inclusion of the private sector
The draft Roadmap contains notational mention of the private sector’s contributions to data
collection and management systems, but overlooks the increasingly larger role the private
sector plays in delivering health services. To be successful, health information systems must
include data from all actors engaged in public and clinical health services. At the same time, the
private sector is engaging more and more in global health beyond the specific delivery of health
services. Shared value and corporate social responsibility approaches involve significant
investments by the private sector without necessarily involving health service delivery by these
partners. Increasingly metrics and measurement are being recognized as central to documenting
the successes and challenges of SV and CSR approaches and partnerships. To this end, private
sector partners are investing in thought leadership and technical resources around
measurement. Therefore the presence of and contributions by the private sector in
measurement and accountability is becoming increasingly important. In recognition of this
expanded role, private sector partners should be involved in the Roadmap development as well
as in the Summit preparations and the event itself.
Increase capacity at national level
The Roadmap outlines how countries can strengthen their health information systems (HIS) and
data collection and analysis. However, the Roadmap provides few specifics on how low resource
countries can implement these recommendations, especially for countries that do not currently
maintain or have poor quality HIS. The Roadmap should provide a clear plan on how to build
capacity to collect quality data in a timely and reliable means and to train and retain data
collectors and analysts. We would like to see included more mechanisms for improvement at
the grassroots level, as well as more detail on health systems support for improvement teams in
facilities. The source of funding for this work needs to be identified as well, as this will require
significant investments at the country level.
Implementation of the Roadmap with regard to the SDGs
Although the Roadmap provides general recommendations for HIS in relation to meeting the
targets set out in the Post-2015 framework, it falls short of providing specifics on how this will
be implemented. In addition, the Roadmap should provide specifics to unify the types of data
collected to allow for stronger understanding of how the SDGs are affecting health outcomes
and where there are gaps in delivering health services. We want to emphasize the need for
standard definitions at the local level so that grassroots-led programs are collecting data on the
same terms which can then be fed into the national and global level indicators. The collection of
information pertaining to health across the SDGs (“One Health”) should be clearly considered as
well within the Roadmap approach.
Inclusion of sectors that are key components of health
The Roadmap is focused primarily on health data, and overlooks critical sectors that are key
components of health. The Roadmap would be strengthened with the inclusion of the collection
and analysis of data from WASH, agriculture, nutrition, and other sectors.
Clarity on Figure 4
The metric regarding access to 80% of all essential services is unclear. There is no definition of
what encompasses an essential service and if this includes indirect health-related services.
Regardless, the SDGs are linked to a broader movement to ensure universal health coverage for
all, and we should be striving to achieve access to 100% of services, to all population groups,
including marginalized, excluded and stigmatized groups, rather than first focusing on low
hanging fruit.
Global Monitoring of the SDGs
The Roadmap should provide specifics on how the SDGs will be monitored globally and at the
national level. This should include annual UN SDG review meetings, country reports, civil society
shadow reports, WHA resolutions, and the use of new and existing inclusive country monitoring
mechanisms such as the country coordinating mechanisms of the Global Fund to Fight AIDS,
Tuberculosis and Malaria and IHP country compacts. Regular monitoring of MDG targets and
progress allowed for heightened transparency and accountability around financial investment
made in the name of the MDG agenda. Additionally, important strides were made to insist on
the disaggregation of data to better capture marginalized and hard to reach populations. The
SDG data process must commit to this, build on this and further develop disaggregated data
collection and reporting mechanisms.
Ensure protection and confidentiality of data
With the increased collection of personal health data and other demographics, it is critical that
standards are set and met to ensure the protection and confidentiality of personal data.
Uniform and clear standards need to be in place and followed to prevent misuse of personal
data that could lead to discrimination against or deny services to certain populations.