M&E for UHC 2 WPRO Global Learning Program The value of information Reliable and timely health information is an essential foundation of public health action and health systems strengthening, both nationally and internationally. Framework and standards for country health information systems. Health Metrics Network, World Health Organization. (2008) 3 WPRO Global Learning Program Recap: human rights in practice A human rights-based approach to health aims to apply the principles of non-discrimination, participation and accountability to all health policies, interventions and processes towards the progressive realization of the right to the highest attainable standard of health for all. 4 WPRO Global Learning Program What is accountability? Who is accountable? To whom? For what? How are they held accountable? 5 WPRO Global Learning Program What is accountability? 6 WPRO Global Learning Program Participation..should be free, active, meaningful and inclusive Some practical considerations: Are all beneficiaries (w/m) able to participate freely in their own development, including marginalized and excluded population groups? Do marginalized groups have access to information and the capacities to participate meaningfully? Are there spaces for public participation in the decision-making process? Is there an active and independent civil society that has the capacity to participate in such processes? Are CSOs representing the voice of the most marginalized and excluded? 7 WPRO Global Learning Program Non-discrimination Defined as freedom from discrimination of any kind, incl. race, sex, age, language, religion, political or other opinion, national or social origin, disability, property, birth or other status. Overt (direct) or implicit (indirect) discrimination often lies at the root of poor health status: o Health laws, policies and practices that treat various population groups unequally. o Implementation of neutral laws and policies, resulting in inadvertent discrimination of specific excluded individuals or population groups. 8 WPRO Global Learning Program Two people, one bowl of rice 9 WPRO Global Learning Program Equality or equity? EQUALITY: equal chances to access and control social, economic and political resources EQUITY: fairness, considers different needs of population groups Both are needed! 10 WPRO Global Learning Program Through monitoring and evaluation: Disaggregate information by income, sex, ethnicity, rural-urban residence, employment status, etc. Conduct operational research to: Analyze incidence of benefits: do population groups benefit at least proportionately? why or why not? Identify and evaluate options Improve health system responsiveness 11 WPRO Global Learning Program Why M&E? Regular M&E provides needed information to governments based on which they can identify priorities for action. M&E empowers the public with needed info to participate in policy-making. Effective M&E and open access to info are core to accountability and transparency. 12 WPRO Global Learning Program Case study 13 WPRO Global Learning Program What would you do? Your national counterparts recently attended a conference on UHC and been inspired to promote greater equity and accountability in health. You know that improving the health of marginalised groups will not be achieved through technical interventions and the provision of funding alone. Significant, sustainable change can only happen if all groups have a much greater involvement in shaping policies, practices and programmes, and by ensuring what is agreed actually happens. You come up with some ideas to promote greater accountability and participation in health services. 14 WPRO Global Learning Program Measuring UHC Availability Accessibility Acceptability Quality Satisfaction Continuity of care Impacts Reach and outcomes Health Sector Other Sectors Outputs Education Housing Health risk education and interventions Food and nutrition Societal, infrastructural, environment and employment interventions Monitoring and evaluation of health system performance and progress towards UHC and the SDGs Inputs and processes QUALITY, EFFICIENCY, EQUITY, ACCOUNTABILITY and RESILIENCE Governance and policies Health financing Health workforce Resources and infrastructure Health information system Governance and policies Health-related interventions and social determinants Out-of-pocket spending Health care cost risk pooling Financial management Health financing mechanisms Health service delivery Household health- related expenditure Catastrophic expenditure Promotive Preventive Treatment Rehabilitative Palliative Health intervention coverage Health literacy Substance use Nutrition Physical activity Safe practices Lifestyle factors and practices Impoverishment Well-being Life expectancy Mortality Morbidity Disability Population health Human development Inclusion Participation Cultural safety Societal impacts Responsiveness Efficiency Financing Resources and infrastructure Workforce health awareness Health systems performance Household health- related financial security Framework to Monitor Health Systems Performance, Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs) in the Western Pacific Region QualityEfficiency Accountability EquityResilience Health system inputsAttributes Service delivery (individual and population-level services) Goals Reduced health risks Improved levels and distribution of health Social and financial security Achieving Universal Health Coverage through Robust Health Systems Governance and policies Health financing Health workforce Resources and infrastructure Health information system Persons with disabilities having assistive devices Proportion with severe mental disorder who are using services Access to palliative care Tobacco cessation treatment TB success treatment rate Second line treatment coverage among MDR-TB Family planning needs satisfied ANC4 visit Institutional delivery Children