Health Measurement and Accountability post-2015: A
Health Measurement and Accountability post-2015: A Common Roadmap DRAFT FOR CONSULTATION March 25 2015 Overview This paper provides a common roadmap toward strengthening country health information systems. It discusses mechanisms and steps that countries can implement to improve the collection, management, and dissemination of health-related information in order to monitor and meet their sustainable development goals (SDGs) from 2015 to 2030. These guidelines are intended for national health sector stakeholders as well as international donors, multilateral agencies, and civil society actors contributing to the attainment of national, regional, and global health goals. These guidelines, called the “Common Roadmap,” will be introduced at the Summit on the Measurement and Accountability for Results in Health, to be held from June 9-11, 2015 in Washington, D.C. The summit brings together key stakeholders involved in meeting national and regional healthrelated SDGs to advance a shared agenda for post-2015 health measurement. Acknowledgements: This paper encapsulates the content of the technical papers and presentations prepared for the meetings of the World Health Organization (WHO), World Bank Group (WBG), and United States Agency for International Development (USAID) in Glion, Switzerland, in January 2015. Consultation: This first draft is for consultation. A final version will be prepared for the Summit on Measurement and Accountability for Health Results to be held in June 2015. 1 Table of Contents Why a Roadmap is Needed .................................................................................................................................................. 3 The Way Forward .................................................................................................................................................................. 10 Country Action ................................................................................................................................................................... 10 Global Action....................................................................................................................................................................... 12 Critical Path: Milestones for 2015 – 2030 ................................................................................................................... 16 List of Abbreviations CHW CRVS DHIS 2 HIS HMN HRIS MDG NSO SDG SHA UNGA UNGASS USAID WBG WHA WHO community health worker civil registration and vital statistics District Health Information System 2 health information system Health Metrics Network human resources information system Millennium Development Goal National Statistical Office sustainable development goal System of Health Accounts United Nations General Assembly United Nations General Assembly Special Session United States Agency for International Development World Bank Group World Health Assembly World Health Organization 2 WHY A ROADMAP IS NEEDED There is growing demand for timely and accurate health-related data at the global, country, and local levels; however it is constrained by the many limitations influencing the ability of country information systems to supply the data required. This Common Roadmap for Health Measurement and Accountability Post-2015 outlines ways of redressing these supply-demand imbalances. It describes how low- and lower-middle-income countries can harness the information they need to plan and manage their health policies and programs to achieve national and subnational health goals and the health-related SDGs. This roadmap builds on the work of the Health Metrics Network (HMN), the Organisation for Economic Co-operation and Development (OECD), i the International Health Partnership, ii and the Commission on Information and Accountability for Women and Children’s Health. iii To continue this momentum, the U.S. Agency for International Development (USAID), the World Bank Group (WBG), and the World Health Organization (WHO) have engaged country experts and partners to develop a shared approach to measurement and accountability for the post-2015 development agenda. Countries are at different stages, and priority investments will be based on individual country circumstances, be properly sequenced, and ensure that health information systems optimally respond to national health needs. iv Following the endorsements at the Summit on the Measurement and Accountability for Results in Health, and publication of the roadmap, consultations with countries will continue. Scaled up support for national leadership will come through collaboration across development partners and a focus on country-led approaches to strengthening country data sources and systems. Current challenges to improving measurement and accountability The demand for timely and accurate data and statistics in the post-2015 era is a great opportunity to build stronger health information systems. However, considerable challenges remain: v • • • • Insufficient investment within countries: Inadequate national resources have been directed toward building sustainable and comprehensive information systems, with the result that much data from national systems are of low quality. Inefficient investments in data collection and analysis: Individual initiatives and programs have prioritized the production of quality data for their own indicators. Investments have been ad hoc and fragmented and often focused on stand-alone surveys and one-off impact evaluations. National institutions responsible for monitoring all national health priorities are frustrated by programs with different reporting systems and funding tied to specific diseases. Lack of country capacity to produce quality health data and statistics: Ministries of health, National Statistical Offices (NSOs), and civil registries, the backbone of data production and management, lack the required capacity, tools, and resources. Low-quality data is used to make decisions without sufficient checks to verify completeness and accuracy. Limited access to and usability of data: Data are not always shared or disseminated according to international standards. Ministry of Health officials and managers at lower levels—who, with increasing decentralization, should be the key champions for measurement and accountability—are often not sufficiently trained and incentivized to utilize data. Requirements in the post-2015 era Accurate measurement and effective accountability require strong country health information systems, driven by country needs and uses. This roadmap will redress current supply-demand imbalances and reduce the need for data estimations to fill gaps. As more use is made of data from 3 country systems, the quality of data will improve, building international confidence and removing the need for separate, duplicating systems. The key components are described below. 4 Figure 1 ROADMAP TO IMPROVED HEALTH MEASUREMENT REPORTING AND STATUS Civil registration and vital statistics (CRVS) systems CRVS is the continuous recording of the occurrence and description of births, deaths, and other vital events. CRVS systems comprise the notification and registration of vital events, the issuance of certificates to individuals, the management of information flows into population registers and national statistical databases, and the production and dissemination of vital statistics. Figure 2, below, illustrates the process. Vital statistics provide a basis for assessing population size, mortality and causes of death, life expectancy, and fertility trends. Accurate statistics are therefore essential for health policy and priority setting, planning, monitoring, and evaluation, although CRVS are of importance to many stakeholders beyond the health sector. Figure 2 CIVIL REGISTRATION AND VITAL STATISTICS SYSTEMS Censuses All countries must have regular censuses using the principles outlined by the UN. vi The information generated by a population and housing census—numbers of people, their distribution, living conditions, and other key data—is critical demographic data used in calculating health indicators. Rates of mortality, morbidity, and fertility all need a denominator, and this is provided by census information, updated by information from the CRVS system. National household surveys All countries should move to having an agreed program of population-based household surveys to address national needs covering population health status, service coverage, health-related behaviors and risk factors, and out-of-pocket spending on health, including equity dimensions of health and service coverage. In most low- and middle-income countries this would take the form of a survey program covering a few years that informs the monitoring and development of national health plans. Health facility data and community health information systems Health facility information systems provide data for client and facility management, disease surveillance, commodity logistics, and routine health sector planning, monitoring, and management. With the advent of more community health workers (CHWs) as official cadres in the health sector, community information systems (e.g., CHW registers) will be increasingly integrated 6 into the national health information system. 1 Routine community and facility health information systems should be transparent, apply data management standards, vii and include data quality assurance processes and verification through periodic samples of health services assessment. Disease surveillance All countries need active disease surveillance systems for detecting, reporting, and responding to notifiable conditions, especially highly communicable diseases. Disease surveillance systems may draw upon multiple sources of information, such as routine health facility records, phone records, and “big data” or special systems for specific surveillance purposes (e.g., environmental surveillance involving testing sewage for the presence of poliovirus). Health systems data All countries should have comprehensive databases and electronic tracking systems on key resources required for health service delivery. This information is gained partly through routine facility information systems and partly from special assessments. Countries with different types of insurance programs have additional sources of data on health issues and services claimed. The following health system data are of particular importance: Workforce A functioning human resources information system (HRIS) allows a country to track, manage, and plan its health workforce to get the appropriate number of health workers in the right place at the right time. It can also be used for professional development and training, remuneration, and supervision. Other sources, such as professional databases and the private sector, are important although often difficult to access. The WHO, World Bank, and partners have adopted a minimum data set required in national health workforce accounts to improve the tracking of health workforce statistics. viii Finances A system of health accounts (SHA) facilitates learning from past expenditure and informs planning and resource allocation to reduce inequities, help protect again catastrophic health expenses, and increase systems of accountability. The SHA is usually overseen by ministries of health and complements the routine expenditure reviews that most treasuries undertake. To be of use, health accounts must be up to date and routinely available to permit trend analysis, as well as allow for disaggregation by program or geographical area. Drugs and medical supplies Reliable information systems for drugs, medical supplies, and vaccines are required to manage supply and demand, prevent stock-outs, and reduce circulation of unsafe products. Breakthroughs are coming with increased engagement by civil society and the private sector, the move from paperbased systems to electronic systems, bar-coding of products, and the use of mobile devices and web-based systems to provide real-time assessments of stocks. Internationally, there is also considerable focus on monitoring drug prices ix to make national procurements more efficient and on building pharmacovigilance to improve drug safety. x Facility infrastructure Access to health services remains a major challenge in many countries, especially in rural areas where transport and maintenance of facilities is poor, and there are limited supplies of health workers, supplies, and equipment. Geographic information system (GIS) tools are being used 1 For example, OpenSRP For example, Open Smart Register Platform (OpenSRP) http://smartregister.org/. 7 increasingly to evaluate the distribution of health facilities. A facility census, with geocoding to provide a master facility list with unique identifiers, is now a critically important part of health sector planning to improve access to services. xi xii System investments and approaches Governance and institutional capacities Strengthening and sustaining country data sources requires strong governance mechanisms, with adequate institutional and human resource capacities. Investments may be required in ministries of health, National Statistical Offices (NSOs), and national public health and academic institutions. NSOs also require a degree of independence from political decision making to be able to carry out their functions in an objective way. eHealth 2 eHealth strategies, with national data architecture covering the use of information and communications technologies (ICT) in the sector, have become essential enabling parts of the overall public health and health care delivery system. eHealth interventions have the potential to empower front-line worker and citizens in a person-centered health care system. They can be critical to maximizing performance monitoring and accountability at all levels. Increasingly, eHealth systems are expected to be interoperable to allow broad integration and bring synergy across multiple health information systems. Improving accountability Accountability for health requires credible statistics at a number of levels. At all levels, regular independent analyses and reviews will strengthen accountability and should galvanize remedial actions. This requires transparent, inclusive mechanisms that can discuss the findings and identify remedial actions. Engagement of civil society is key, as has been shown in areas such as monitoring the global HIV response for UNGASS reports. Data sharing and communications Data collected should be disseminated and shared with those who use the information to strengthen the health system as well as with users who have a right to know how well it is functioning. A supportive legal and administrative framework enables sharing in accordance with agreed standards for confidentiality and data security. Data sharing is greatly facilitated by a data warehouse, a central repository of current and past data from diverse sources, and web access for the public. Moreover, having common data standards facilitates integration and analysis, while skills in data interpretation, presentation, and delivery are as important as the skills required to collect them. 3 Local press and media also need to be supported in the interpretation of different indicators so that they can report on health information and help make it understandable to the public. Need for new approaches The confluence of information technologies, investment priorities, and national and international commitment presents a major opportunity to establish country ownership of robust and sustainable health information systems. The strategic actions required are summarized below: eHealth is “use of information and communication technologies (ICT) in support of health and health-related fields” Source: World Health Assembly Resolution on eHealth 58.28 3 See Communicating Data for Impact website http://communicatingdata.org/# 2 8 Action 1: Create cultures of data use throughout all levels of health systems: Decision makers, senior managers, district-level officials, and service providers regularly use health information to improve public health policy, health system management, and clinical services. This action item will require investment and training to improve capacity and mandates for ministries of health and partners such as local universities to undertake regular implementation research and to improve use of data. Action 2: Align stakeholders in national health information systems (HIS): Development partners and national-level institutions will align investments in country health information systems. Data compacts 4 will be agreed on covering (i) objective reviews of health sector performance; (ii) the results and impact of different health investments; and (iii) national assessments of capacity to analyze and share health statistics. Action 3: Invest in strengthening data sources and capacities: Investments will strengthen national information governance, eHealth and data standards, and capacities for analyzing, disseminating, and using health statistics for clinical and district-level decision making. Key components of the country HIS and accountability platform outlined in this roadmap will be strengthened in line with international standards and commitments. Action 4: Use the digital revolution 5 to scale up health interventions: Countries and global partners will seize the power of innovation to improve the availability, quality, and use of data for decision making in health. Data will be shared more freely to rigorously compare, learn, and build the evidence base for scaling up interventions in different subnational contexts. Action 5: Strengthen global public goods for health information and accountability: Publicprivate sector collaboration is needed to improve and align common international standards for national HIS. Open access software systems will continue to respond to country demands, and research will be used to overcome implementation challenges and strengthen global HIS standards, guides, and tools. Action 6: Strengthen global health accountability and reporting: Progress toward the Common Roadmap shall also be reviewed globally, as requested by member states in the World Health Assembly (WHA), and by making data available for public review. Regular progress reviews of the health-related SDGs will be complemented by regular “Countdown” reports covering the following: • • Each country’s progress toward the health-related SDGs on an annual basis Each country’s progress in following this roadmap, reported every two years and addressing specifically: o o The use of information (measured by use of data from maternal, perinatal, and child death audits and reviews, reallocating resources based on results of national health monitoring and evaluation (M&E) plans, alignment of donor support, and country reporting on health-related SDGs) The state of the enabling environment (information governance, eHealth and data standards, and key national institutional capacities) 4 Data compacts are national-level agreements between governments, donors, and civil society for objective third-party monitoring of progress toward national health goals. 5 The digital revolution is the change from analog, mechanical, and electronic technology to digital technology. Wikipedia, “Digital Revolution,” http://en.wikipedia.org/wiki/Digital_Revolution 9 o The sources of information in the country HIS platforms (CRVS, census and household surveys, health facility and community information systems, disease surveillance, and data systems for health workforce, finance, drugs, and infrastructure) Figure 3 POSSIBLE HEALTH-RELATED SDG INDICATORS AND THEIR SOURCES THE WAY FORWARD Implementation of the roadmap requires specific actions by relevant country and international stakeholders. Donors will need to change from funding disease- or program-specific data systems to a more holistic approach. Key actions are outlined below. Country Action Strengthening country health information and accountability platforms National health sector stakeholders will need to access and assess data regularly to harness the benefits of the data revolution. xiii Statistical literacy is also essential, even at the level of data collection, such as the use of data by health care providers to improve quality of care. District officials can use aggregate facility and community health services data to identify data gaps in health care provision, track health status, display trends, and make comparisons across communities, facilities, or districts. xiv Development of a country health information platform is a dynamic process, driven by the demand for data and its analysis, implementing changes, and setting of standards or targets, as shown in Figure below. 10 Figure 4 COUNTRY HEALTH INFORMATION AND ACCOUNTABILITY PLATFORM Establishing accountability mechanisms • Regular analyses at all levels to assess progress and performance in reviews, with transparent, inclusive, and independent mechanisms to analyze, share, and discuss available information and identify remedial actions. Creating the enabling environment – governance, institutions and eHealth • • • Oversight of country health information and accountability platform: generates timely, quality data for key indicators and serves as the basis for reporting on national and international goals Adequate institutional capacity for health data collection, compilation, and sharing; data quality assurance, analysis, and synthesis using all relevant data sources; and for communication and use of results. Innovation and eHealth to improve data availability and quality, increase transparency and accessibility of data, and strengthen capacity in national statistics systems and for decision making. Strengthening civil registration and vital statistics • Registration of births, deaths, and other vital events: continuing recording of occurrence and characteristics to produce fertility and mortality statistics 11 • • Sample vital registration systems: used as an intermediate measure to generate representative vital statistics using innovative methods and verbal autopsies Medical certification of cause of death: available according to the standards set out in the International Statistical Classification of Diseases (ICD) Establishing regular census and program of household surveys • • • Quality censuses carried out on a regular ten-year cycle using international principles and standards Multi-year program of national health surveys: identifies strategic priorities, periodicity, and scope of data collection Ensure international standards and comparability of results between populations and over time: enforce quality assurance, ethical practices, transparency, and data sharing in accordance with stringent confidentiality protocols and international standards Strengthening health facility data and community health information systems • • • Timely and reliable statistics from health facilities and community health workers: public and private facilities and workers use electronic recording and reporting systems Regular verification: performed in a transparent manner on facility and community information systems through health services assessments Data are used at all levels of the health system in combination with other sources for patient care, planning, reviews, and action Strengthening disease surveillance • • National International Health Regulations (IHR) core surveillance and response capacities to reduce levels of hepatitis and water-borne and other communicable diseases Outbreak disease surveillance systems: effective, real-time systems supported by laboratory infrastructure Strengthening health system data sources • • • Comprehensive databases with international standard data: electronic tracking systems on health facilities and services, finances, spending, and logistics including commodities, medicines, equipment, and supplies System of health accounts: operational, using international standards Electronic health workforce registry to track health workforce statistics and provide information for health workforce accounts Global Action Global public goods o o Global health indicator registry: In response to country demands for a more rational approach to monitoring global health goals, 19 global health agencies agreed on a global reference list of 100 core indicators. xv. This will continue to evolve to build global consensus on a set of global core indicators for health measurement. Open access software: Software and related tools, such as the District Health Information System 2 (DHIS 2) for web-based health information xvi and the Census and Survey Processing System (CSPro) for censuses, xvii will continued to be made available for national 12 o o o o institutions to adapt and use for their own purposes. Such innovation will require the use of internationally recognized protocols or systems. Donor behavior and coordination: International agencies will continue to rationalize approaches to country support as has already been achieved in areas such as for CRVS, household survey instruments, health facility assessment, disease surveillance, and some areas of eHealth. The funding structure of major donor agencies will need to change to support this new, more efficient and more sustainable approach. Public-private collaborations: The frequent summits and web-based platforms sponsored by the private sector will showcase and compare new technology and new approaches. These can empower managers, users, and health workers through the use of mobile devices to collect or share data. 6 7 xviii Research and learning on HIS: Many low-resource countries have not yet targeted national HIS for research and development. They can now harness the data revolution to develop country platforms and dedicated HIS research programs, using conferences and online forums for documenting lessons and exchanging knowledge. Global HIS standards, guides, and tools: A common set of tools will be regularly updated and further developed using international standards for measurement and to ensure interoperability of systems. International agencies will rationalize approaches, building on what has already been started in areas such as for CRVS, household survey instruments, health facility assessment, disease surveillance, and some areas of eHealth. Global reviews of country progress o o o Global monitoring of the health goals: This is more complex now than in the MDG era and a future UN Interagency and Expert group will require a health monitoring subgroup to work with expert groups in countries. This activity will build on the experience of the Countdown to 2015 for interventions to reduce maternal, newborn, and child mortality. Peer reviews of progress of SDGs and roadmap across countries: These reviews will be conducted by member states through the World Health Assembly and be complemented by independent review mechanisms, including social accountability mechanisms that provide a direct avenue for people’s voices. Identifying and sharing the quick wins: Actions identified in countries should be shared to bring quick results elsewhere. These include documentation of data sources, georeferencing existing data, analyzing and visualizing existing data more creatively, linking survey and administrative data; enhancing the usability, accessibility, and affordability of existing data sources; and small area estimates of marginalized or uncounted groups.xix Moving to a country-led approach As the quality of country data improves, and as country health information systems become more comprehensive, the international community will increasingly rely on country systems to monitor all aspects of health, health systems, and the determinants of health. Country plans will detail the phasing-in of this move to nationally defined data. Specific actions will include the following: 6 For example, mHealth Summit website http://www.mhealthsummit.org/about-summit/overview See GSMA Pan African mHealth Initiative website http://www.gsma.com/mobilefordevelopment/programmes/mhealth/pan-african-mhealth-initiative 7 13 • • • • Country-led assessments, many of which are already completed, will inform national strategies to strengthen and use country data for monitoring and evaluation of health plans. National health sector coordination mechanisms for monitoring and evaluation will facilitate joint planning of international and national HIS investments and a timetable to strengthen HIS platforms and accountability. The level of investments will be agreed on by country stakeholders, using a proportion of national and international development funds. Cross-sector coordination mechanisms, led by senior levels of government, will align efforts to strengthen CRVS and undertake censuses and household surveys. A small “virtual secretariat” will be established globally with stakeholders from the UN, World Bank, expert groups, and investing partners to monitor and coordinate efforts. The secretariat will work closely with existing global and regional platforms that are providing support to countries. Strengthening coordination and accountability All countries should have strong accountability mechanisms managed by institutions not directly responsible for financing or implementing national programs or services. These mechanisms should be both within the government—through sector performance reviews and audits overseen by treasuries and the central government—and outside of government—through public health institutions, academia, and civil society. To help develop these capacities, a data compact will be explored involving the government, donors, and civil society. This data compact will specify one or more institutions selected to assess the following: • • • • Overall health sector performance, based on the health sector monitoring and evaluation plan; Results of government and donor investments in specific programs and interventions (for example from the Global Fund, bilateral projects, development banks, and the UN); Assessment of national capacities for monitoring, evaluation, and health information, based on international standard tools and frameworks; and In countries with sufficient capacity and experience, results-based funding approaches will be included in these compacts, with funding linked to improvements in the coverage, accuracy, and openness of core health statistics. These assessments will need to be undertaken in the context of longer-term plans and strategies to build national monitoring and evaluation capacity for producing, analyzing, and using data in the health sector. A proportion of the national and international development funds in a country will be allocated to the coordination and accountability mechanism and building longer-term institutional capacities. The specifics will be worked out on a country-by-country basis, accompanied by implementation research to incorporate lesson learning. Investment required for health information systems The investment plan will focusing initially on three to four countries and build on country monitoring, evaluation, and review strategies and plans and related activities in accountability. This experience will be used to develop a more streamlined approach in other countries that request such support. 14 Monitoring progress Once the Common Roadmap has been endorsed, a global framework for monitoring and evaluation will be finalized, with clearly defined indicators, targets, and benchmarks. TABLE: DRAFT MONITORING FRAMEWORK FOR COMMON ROADMAP Goal: By 2030, all countries have the necessary information to effectively and efficiently plan and manage their health programs toward achievement of national health goals and the health-related SDGs Core objectives 1. Data from national health information systems used at all levels to improve health, inform decision making, and strengthen accountability Indicators Use of data at districts/facilities (e.g. maternal, perinatal, and child death audits and reviews) • • Use of data nationally/subnationally (e.g. reallocation of resources based on national M&E results) • Use of data at global/regional levels (e.g. country peer review of progress toward common health goals) 2. Governments and development partners align investments to enable governance and development of health information and accountability platforms Indicators Countries with functioning HIS governance mechanism in place • National Statistics Office with core capacities • • Countries with national eHealth standards agreed • Government and donor alignment of HIS investments in national health M&E plans 3. Country health information and accountability platforms strengthened through building components in line with international standards and assessments 3.1. Universal registration of births, deaths, including reporting cause of death Indicators • Birth registration coverage • Death registration coverage • Cause of death (COD) coverage and quality 3.2. Regular census and household survey program using international standards Indicators • Census coverage for 2020 round • Percentage of countries with national health survey program 3.3. National health facility data and community information with regular data quality assurance Indicators • Percentage of countries with national oversight body for routine HIS and community information systems • Number of countries with web-based systems that produce quality data and statistics • Regular quality assurance 3.4. Disease outbreak surveillance and response capacity compliant with IHR Indicators • Compliance with International Health Regulations • Effective real-time outbreak disease surveillance systems, supported by laboratory infrastructure 3.5. Health system information providing regular national data Indicators • System of Health Accounts coverage • National Workforce Accounts coverage • Coverage of real-time, electronic reporting of stock supplies 4. Global accountability on health reporting strengthened Indicators • • • Use of data from country systems to monitor health-related SDGs Global public goods for HIS Access to, and use of, data by civil society 15 CRITICAL PATH: MILESTONES FOR 2015 – 2030 Key events and timetable The roadmap signals a major change in the way the international community works with countries to deliver more accurate and sustainable measurement and accountability for the health-related SDGs. This process will evolve in three phases over the next fifteen years: PHASE 1, 2015 – 2017: Endorsement and consensus o o o o o o o Health related SDGs, targets, indicators, and measures to be agreed and endorsed by all member states through the governance mechanisms of WHO and UNGA. A global investment plan, outlining required priority national and international investments for health information and accountability platforms to be completed. Participating low- and middle-income countries to identify priorities for strengthening their health information systems, leveraging international norms and guidance. Nationally set timetables for national and international stakeholders and investors to define country specific commitments in national plans and data compacts covering national accountability mechanisms. The UN, World Bank, USG and other partners to establish technical working groups based on existing MDG monitoring mechanisms. Launch of collaborative global program of public goods to support country health information and accountability platforms. Launch of Global Financing Facility for reproductive, maternal, newborn and child health (RMNCH), including window on CRVS investments PHASE 2, 2018 – 2024: Investments in plans for country health information and accountability platforms o o Major donors lead efforts to transition from program-specific investments in information and reporting to country reporting using a national health information system. Based on individual country assessments, CRVS systems will be aligned with international standards; regular census schedules will be established; household surveys, conducted every three to five years, will be initiated; national health facilities will build information capacities to include surveillance and response; and relevant government institutions and international partners will have access to basic health system data, such as annual national health accounts, and a minimum dataset for the workforce. PHASE 3, 2025 – 2030: Sustainable measurement and accountability o Countries to transition away from international development assistance, with sufficient support for strengthening and sustaining robust health information systems. 16 Figure 5 ROADMAP FOR INFORMATION AND ACCOUNTABILITY Country Sustainable measurement and accountability Joint health sector review Joint health sector review Joint health sector review Joint health sector review Joint health sector review Joint health sector review Joint health sector review Investments in country health information and accountability plans 5 countries complete HIS investment plan Joint health sector review 6 countries complete HIS investment plan Joint health sector review 7 countries complete HIS investment plan Joint health sector review 8 countries complete HIS investment plan Joint health sector review 10 countries complete HIS investment plan Joint health sector review 10 countries complete HIS investment plan Joint health sector review 9 countries complete HIS investment plan Joint health sector review Endorsement and concensus 8 countries complete HIS investment plan Joint health sector review 7 countries complete HIS investment plan Agree health related SDGs 5 countries complete HIS investment plan Global /Regional Roadmap - 2030 2029 2028 2027 2026 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 17 - UNGA review progress of SDGs WHA health-related SDG review Final "Countdown" progress report Expert and social accountability review Final SDG progress report 4th "Countdown" progress report Expert and social accountability review SDG progress report SDG progress report SDG progress report 3rd "Countdown" progress report Expert and social accountability review SDG progress report WHA health-related SDG review SDG progress report SDG progress report 2nd "Countdown" progress report Expert and social accountability review SDG progress report SDG progress report SDG progress report WHA health-related SDG review 1st "Countdown" progress report Expert and social accountability review SDG progress report SDG progress report SDG progress report Baseline "Countdown" progress report Launch of Global Financing Facility Final MDG report WHA endorse roadmap Establish UN health monitoring sub-group Launch global roadmap investment plan UNGA finalize SDGs M4H Summit Glion consensus References i OECD Health Policy Studies Improving Value in Health Care Measuring Quality. 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