Lessons from Health Sector Performance Reporting & Monitoring Strengthening Accountability to Achieve the Health MDGs Geneva, 5 th October 2012

Results Framework Performance Monitoring & Evaluation of the IHP+

AVAILABILITY COLLECTION UTILIZATION DEMAND HEALTH RESULTS THROUGH STRENGTHENED HEALTH SYSTEMS HEALTH RESULTS THROUGH STRENGTHENED HEALTH SYSTEMS Why monitor? 2. Transparent Information from Performance Reporting & Monitoring 3. Mutual Accountability Processes with Forum for Discussion 1. Mechanism for Participation, based on IHP+ Global and Country Compacts

Reflecting on 5 Years of Monitoring August 2008May 2010April 2011October 2012

GOVERNMENTS OF: Cambodia, Cameroon, Cape Verde, Chad, Côte dIvoire, Gambia, Guinea, Kenya, Madagascar, Pakistan, Vietnam, Zambia. DEVELOPMENT PARTNERS: Canada, Finland, France, Italy, Portugal, International Labour Organisation (ILO), Bill & Melinda Gates Foundation. GOVERNMENTS OF: DEVELOPMENT PARTNERS: NOT YET PARTICIPATING IN IHP+RESULTS FOR ANNUAL PERFORMANCE REPORTING OR SELF REPORTING & ACCOUNTABILITY PARTICIPATING IN IHP+RESULTS TAKING STEPS TO USE IHP+RESULTS REPORTING TO STRENGTHEN MUTUAL ACCOUNTABILITY 12 3 ENSURING HEALTH SECTOR AID EFFECTIVENESS COMMITMENTS ARE SYSTEMATICALLY AND ROUTINELY MONITORED 4 This represents the end goal of a virtuous cycle. 1. Mechanism for Participation, based on IHP+ Global and Country Compacts

2. Transparent Information from Performance Reporting & Monitoring

How information has been collected & managed MAR - JUL 2010 Developed and/or agreed by IHP+ signatories. Reviewed in July FEB - APR 2012 Questionnaire based on Standard Performance Measures. Data collected and used as basis for ratings. MAY - JUL 2012 Draft scorecards discussed with participating signatories. IHP+ GLOBAL COMPACT STANDARD PERFORMANCE MEASURES QUESTIONNAIRERATING SCORECARD

How this Information has been used (or not!) Development agenciesHQ-level reviews; Country sector reviews National governments Govt Reviews; Country sector reviews; Compact Reviews Civil Society Parliamentarians (Nigeria); IHP+ Civil Society Consultative Group; Busan side-event. The IHP+ networkKey contributor to TT HATS (Busan) Accountability meetings Southern Civil Society Forum (Ghana, Feb 2011), Action for Global Health (Paris, May 2011; Madrid, June 2011) Researchers Center for Global Development paper on QuoDAH (May, 2011); Globalization & Health paper (July 2012) General PublicLancet article and letter. 3. Mutual Accountability Processes with Forum for Discussion

What change has IHP+Results contributed to Some evidence of increasing cooperation to deliver more effective aid (but not yet at level of collaboration) Information is now available Voluntary Participation is increasing Greater Transparency with Performance Reports, Scorecards and Web Data Discussions are being had about aid in the health sector (some country-led), with power shift in conversations Other: Conceptual positioning of IHP+ as an aid effectiveness intervention; Sectoral perspective on aid effectiveness (TTHATS); Alignment for COIA etc

What have been the challenges? Lack of appropriate use of the IHP+Results mechanism and information products, to improve coordination or to inform collaborations between partners Not collecting and reporting the right Information at the right time Participation for the wrong reasons (cooperative compliance rather than learning) and incentives are not compelling Transparency without data integrity because information is not systematically validated, or being questioned Discussions not taking place at the right levels, with the right people (mutual accountability and review mechanisms are not in place or being routinely used) Lack of capacity within partner institutions?

What we have learned MEASURES (TRANSPARENCY) 1.Paris Indicators a good strategic choice 2.Some indicators need attention: not appropriate, not useful (procurement, PBAs, capacity building) 3.Some definitions need attention (active) 4.Lack of qualitative information weakens potential for learning & improvement 5.Framework needs to be able to detect & report unanticipated changes 6.Targets need to be better defined (lowest common denominator vs aspiration?) 7.IAG PROCESS (PARTICIPATION): 1.Voluntary participation seems to work 2.Some sense of compliance (cooperation) driving participation, rather than learning 3.Transaction costs are heavy and will continue to be if reporting has value 4.Triangulation is important for credibility, but how important – can we ever reach truth? 5.Locating the process at country level remains the aspiration 6.NB: Monitoring must adapt and evolve USE (FORUM FOR DISCUSSION) 1.Limited discussion of reports and scorecards 2.Prospects for use in 2012/13 are better – key to future demand for monitoring 3.Civil society role in promoting use is important – IHP+ needs to better resource CSOs to engage 4.Important to articulate the value of monitoring aid effectiveness to health results 5.Use and accessibility are connected – scorecards have been valuable in this regard

AVAILABILITY COLLECTION UTILIZATION DEMAND HEALTH RESULTS THROUGH STRENGTHENED HEALTH SYSTEMS HEALTH RESULTS THROUGH STRENGTHENED HEALTH SYSTEMS How to improve? 2. Transparent Information from Performance Reporting & Monitoring 3. Mutual Accountability Processes with Forum for Discussion 1. Mechanism for Participation, based on IHP+ Global and Country Compacts

Questions on Future Monitoring 1)What needs to be done to stimulate demand for future monitoring? 2)How should specific technical issues relating to information relevance, validity & availability be addressed (and by whom?) 3)How can better use be made of the information – especially through collaborative discussions & by country level decision- makers?