COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard* Lesotho · COUNTRY ACCOUNTABILITY FRAMEWORK:...

KEY:

1

2

3

5

Situation analysis

(strengths, weaknesses/gaps)Priority Actions

Assessment & Plan 1 Advocacy/mobilization key stakeholders

Conduct full CRVS assessment and develop improvement plan

Coordinating Mechanism 1 Establish interagency coordinating committee involving all key

stakeholders.

Hospital reporting 2.5 Establish a system which will link Ministry of Health and NICR for

ease of reporting births using hospital birth certificate.

Community reporting 2 Strengthen community reporting of births and deaths, implement

innovative approaches. Mobilise Councillors and Village Health

Workers to work together with the Chiefs so that every birth or

death occurring in their communities is registered once they occur.

Training workshops to be conducted to equip them with the

requirements and better appreciation of all the NICR activities

Strengthen community reporting through use of VA by community

workers

Strengthen the linkages between Health Facilities and the

community in terms of reporting deaths and births

Adaptation of Verbal Autopsy tools and capacity building at

different levels

Vital statistics 3 Increase the resources mobilization by all programs for

dissemination of vital statistics

Local studies for mortality 1 Develop the HDSS system

Not present, needs to be developed

Needs a lot of strengthening

Needs some strengthening

A rapid assessment which led to the formation of the Department

of National Identity and Civil Registry in 2010 within the Ministry

of Home Affairs was conducted. Key staff was recruited and

recruiting of junior staff is in the process. Awareness campaigns on

the Department's activities are performed. No assessment of the

status and practices of CRVS has been conducted and no

improvement plan has been developed.

There is no interagency coordinating committee in place.

Hospital reporting of deaths is not done. The only death reports

from the hospitals are the ones made by the relatives if they feel

like it. Hospital reporting of deaths includes a cause of death,

using the ICD-10, with regular quality control are done by the

Ministry of Health.

Community births and deaths are reported covering the whole

country but not using ICT, the Chiefs are responsible for that.

Verbal Autopsy (VA) for deaths is not being done but is in the

pipeline.

Vital statistics (fertility and mortality) are not published every year

but only after survey and census. It is available but delayed in

dissemination to stakeholders.

Local health and demographic surveillance sites (HDSS) are not

available.

COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard*

Civil registration & vital statistics

systems

Already present/no action needed

Lesotho

* This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. /14

COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard* Lesotho

Situation analysis


M&E Plan 3 Finalise the National Health Strategy and update the M&E

framework

Finalise and align the Child Survival M&E plan with the National

Health Strategic Plan

M&E Coordination 2 Strengthen the Strategic Information coordination team, by

reviewing the ToRs, and incorporate relevant stakeholders

(statistics, academia and civil society) in to the SI coordination

committee

Health Surveys 2.5 To have a comprehensive survey plan within the M&E plan

Resource mobilisation

Facility data (HMIS) 2 Strengthen district information officers in data collection, collection

and analysis and integrate different data sets. Carryout data quality

baseline which will inform routine data quality assessment.

Enhance data analysis and advocate for data usage at district level

for informed decision making

Analytical capacity 3 Strengthen analytical capacity at district level

Equity 4

Data sharing 3 Strengthen national data repository with all relevant data and

reports and share information with the public

There is an M&E plan for the health sector running from 2008/09

to 2010/11, therefore there is a need to review M&E plan to be in

line with updated National Health Strategy. The Maternal and

Newborn M&E plan is aligned with the National Health sector

M&E plan. The Child survival strategy is in place but not as part of

the RMN. The national Strategic Information (M&E, Research and

HMIS) committee is in place but it is not inclusive of some

members such as statistics, academia and civil society and it

doesn’t meet on regular basis. There is no stand alone Health

survey plan, but the plan is inclusive in the overall National M&E

plan. There is insufficient funds for conducting health surveys. The

plan to conduct EMoNC is in place for 2012-2013. A system is

available with defined times of reporting from the facility, to the

next level. But we still have fragmented data sets collected by

different programmes which can compromise quality. Annual Joint

Review is informed by facility data verification and routine data

quality assessment is planned to be implemented in 2013. There is

a regular production of reports on progress made towards

achieving what was planned for, in the beginning of the year ( AJR,

Quarterly Review reports). The process has been decentralised to

the districts, but there is a need to capacitate districts in

producing good analytical progress reports. Among other forms of

data collection, health data are collected through surveys and

routine method. The health surveys clearly disaggregate data on

sex, income, minority and location, while the routine data covers

some aspects like age, sex, and location. Data sharing is partially

done to the public, through dissemination of data during Annual

Joint Review meetings. The Ministry is also in the process of

developing data warehouse.

Monitoring of results



Situation analysis


Notification 4 Need to be reviewed this year 2013

Policy Review and Stakeholders meeting for validation

Capacity to review and act 2.5 Strengthen National capacity through training in MDSR and data

analysis. Review of the reporting and assessor's tools and customize

the MAMMAS software. Strengthen District capacity through training of assessors and other

health workers (midwives) in MDSR

Hospitals/facilities 3 Improve reporting in hospitals by capacitating the District

committees and private institutions and health workers; Training in

ICD certification and coding.Strengthen capacity of private sector in reviewing and reporting of

maternal deaths.

Quality of care 2 Support accreditation exercise and data analysis to improve quality

Community reporting & feedback 1 Capacitate the community structures in reporting of maternal

deaths occurring at the community

Strengthen communication at community level( Village Health

Workers (VHW)) for reporting maternal deaths that occur at

community level

Review of the system 1 Link the MDSR secretariat to the IDSR.

Review The MDSR annually in order to implement the

recommendations arising from the maternal death reports in order

to improve quality of care through AJR meeting

Maternal death surveillance &

response

There Policy is in place (National Reproductive Health Policy -

2009). Maternal deaths are a notifiable event in this policy

document. There is a National LCCEMD (Lesotho Committee on

Confidential Enquiry into Maternal Deaths) which sits quarterly or

as necessary. There is a secretariat for capturing all deaths

occurring at facility level. Capacity for data analysis is still a

challenge. There is a District Maternal Death Review Committee

which sits immediately when a death has occurred to review and

notify the LCCEMD within 7 days. At Hospital level there are

trained Maternal Death Assessors who participate in the Maternal

Death Reviews. There is a high turn over of the trained assessors

and other health workers. Reporting is taking place telephonically

within 24 hours, a written report is submitted within sven days

using ICD 10, however there is high attrition rate among trained

health workers and assessors. Only maternal deaths occurring in

the public hospitals are reviewed.

Quality of care assessments are conducted through accreditation

of facilities by Quality Assurance of the Ministry of Health

however there are limited resources to carryout this activity.

There is no tool developed for reporting community maternal

deaths, however the plan is in place to establish a system by end

of 2012. No electronic devices are used at community level for

reporting. A Verbal Autopsy tool has been developed for piloting

in 2013. Communities do not receive feed back yet. The gaps in

completeness and quality of care have been identified and are

being addressed, but there is need to link IDSR and MDSR

reporting.



Situation analysis


Policy 3 Advocate the Government buy in into making e-health a reality

Capacity building for health workers in IT application

Infrastructure 2 Deploy IT personnel at district level to support and supervise

Services 2 Discussions are on-going for inclusion of MNCH data capturing into

the pilot phase of EMR

Establish the linkages between health workload data and facility

data

Establish the linkages between health workload data and facility

data

Standards 2 Determine the eHealth standards and interoperability components

required to support eHealth services, applications and

infrastructure, as well as to support broader changes to health

information flows.

Governance 1 Develop and support a strong effective coordination mechanism

(coordination committee)

Mobilise financial and human resources for implementation of e-

Health

Protection 2.5 Strengthen enforcement of the data protection law

Enforce compliance to data protection policies

Innovation and eHealth

The national ehealth strategy is integrated in the National Health

Policy and strategy. At district level (DHMT and Hospitals) there is

mobile and internet connectivity, while in in the Health Centres

there is an on-going programme for installation of ICT

infrastructure. There is need for training on IT application.

Maternal Deaths are captured at district level using computerised

registers, while immunisation data is still paper based. The

Electronic Medical Record which will be capturing data

electronically is being piloted in one district. There are no links

between health workload and facility data. There are means of

storage of data in the central level, but there is need introduce

means of data storage at district level. There is no coordinating

committee for e-Health with the involvement of other

stakeholders. There is data protection, legislation and regulatory

frameworks for sharing of health information. Data protection

policies are not enforced.



Situation analysis


National health accounts 1 Sensitize the stakeholders about the importance of developing NHA

framework

Assess the potential link of the current system and NHA

Compact 2 Organize a meeting to engage government and development

partners and work towards "compact"

Coordination 1 Set up a steering committee, officially approved, with institutional

support, and functioning using results-based management methods

Ensure inclusion of all key stakeholders in resource tracking/NHA

Production 1 Train staff on system of health accounts 2011; train district and

regional staff

Map government codes to NHA codes and develop IT conversion

tool for NHA

Develop/strengthen database for production of NHA

Analysis 1 Develop SHA

Introduce the SHA 2011 system

Data Use 1 Advocate for/promote use of NHA data in policy making process

There is no system and Government commitment to introducing

the NHA framework. There is IFMIS for Government budget

allocation and tracking of resources, but it is not able to clearly

capture the health sector expenditure. There is individual

agreement between the partner and the Government for

reporting commitments and disbursements. There is no NHA

steering committee in place, and there is no human capacity to

produce NHA tables and core indicators. No analytical summaries

are produced on SHA 2011 health accounts.

Monitoring of resources



Situation analysis


Reviews 3.5 Operationalize implementation of the recommendations

Consolidate and harmonise the PHC review meetings and the district

quarterly review meeting to form one district review meeting

Synthesis of information & policy context 2.5 Strengthen the capacity of Health centre nurses and district health

information office to prepare analytical reports prior to the reviews

Strengthen mechanism to compile all policy/qualitative information

to inform annual reviews

From review to planning 2.5 Strengthen the use of review results for planning purposes

Ensure greater involvement of all stakeholders

Compacts or equivalent mechanisms 2.5 Ensure the existence of a single national M&E framework that

national health plan will fit into

Establish Partner's coordination focal person and Develop Swap

ToRs

Review processes

The Annual Joint Review meeting is conducted annually to review

health sector performance against set targets and goals however

the recommendations from the meeting are not being closely

followed

Key stakeholders are actively involved in the preparation and

execution of the reviews. RMNCH programme reviews are

included in the Annual Joint Review report. The Primary Health

Care quarterly review meetings are held at the district level but

there is a need for strengthening. Health Sector reviews are

informed by a good synthesis of health data including RMNCH.

The health sector reviews are informed by a systematic analysis of

qualitative data, where the mini survey is administered over and

above the performance of the key indicators to captured public

opinions about service delivery. There is a mechanism, whereby

after the reviews the recommendations are translated into the

priorities of the Ministry but there is no follow up on the

recommendations implementation. Key stakeholders are involved

from the process of priority setting, target setting and during

development of operational plans. A country compact or similar

mechanism (a government-led process of planning, coordination

and facilitation of all development partners, including funding

flows) exists and the Minister of Finance chairs the meeting. The

partners coordination is not as expected but the Ministry has

engaged a SWaP consultant for developing partner coordination

mechanism.



Situation analysis


Parliament active on RMNCH issues 3 The new members of the Parliament need to be sensitized.

Integration of RMNCH issues in Parliaments' speeches.

Civil Society Coalition 2 Capacity building for civil society coalition on RMNCH to produce

evidence based advocacy messages and materials.

Media role 3 Capacity building for media personnel on RMNCH related issues to

produce evidence based advocacy messages and materials.

Sensitise the community on RMNCH through the radio sessions.

Work with the media to strengthen monitoring and reporting on

RMNCH.

Countdown event for RMNCH 2 Establish Countdown Coordinating Committee

Prepare Countdown report/profile using all evidence

There is a portfolio on Health issues inclusive of RMNCH. Public

forums for information sharing and discussions on RMNCH issues

are starting on a small scale. A civil society coalitions exist but are

not focusing on RMNCH. Evidence-based advocacy messages and

materials with exist but are not focusing on RMNCH. There are

some TV and radio programmes focusing on RMNCH, but it is not

systematic. There is a representation of media in the LCCEMD and

PMML(Prevention of Maternal Mortality in Lesotho). The media is

interested in the issues of RMNCH but the areas of accountability,

reporting towards implementation of national commitments still

has some challenges. Media covers the annual reviews. A national

countdown event for RMNC is planned to be undertaken before

the end of 2012/2013 and there is no countdown committee in

place. A country Countdown report or profile is not available yet.

Advocacy & outreach


Actions Priority

(1-2=high,

3=medium,

4=low)

Approach/actions Lead govt/ national

institute

Partners 2012 2013 2014 2015 Total

Estimated

Cost per

action

2012/13

Catalytic

funding

Unfunded

balance

Potential

sources for

funding unmet

balance

Advocacy /mobilization key

stakeholders

1 Meeting Ministry of Home Affairs UNICEF X X $1,200 $1,200 MOHA

Conduct full CRVS assessment and

develop improvement plan

1 Survey Ministry of Home Affairs

(MOHA)

UNFPA x $50,000 $44,500 $5,500 MOHA/CoIA

Establish interagency coordinating

committee involving all key

stakeholders

1 Meeting MOHA WHO $1,200 $1,200 MOHA

Establish a system which will link

Ministry of Health and NICR for

ease of reporting births using

hospital birth certificate

1 Inter Ministerial/Agencies

coordinating committee

MOHA/MOH UNFPA X X $11,000 $11,000 UNICEF/UNFPA

Strengthen community reporting of

births and deaths, implement

innovative approaches. Mobilise

Councillors and Village Health

Workers to work together with the

Chiefs so that every birth or death

occurring in their communities is

registered once they occur .Training

workshops to be conducted to

equip them with the requirements

and better appreciation of all the

NICR activities

1 Workshop MOHA/MOH UNICEF/WHO X X $60,000 $60,000 UNICEF/UNFPA

Strengthen community reporting

through use of VA by community

workers

1 Workshop MOH WHO/UNFPA X X X $25,000 $15,000 $10,000 UNFPA/CoIA

Strengthen the linkages between

Health Facilities and the community

in terms of reporting deaths and

births

1 Workshop MOH UNFPA/WHO/

UNICEF

X X $25,000 $15,000 $10,000 UNFPA

Adaptation of Verbal Autopsy tools

and capacity building at different

levels

2 Workshop MOHA WHO/UNFPA X X $1,200 $1,200 MOHA

Increase the resources mobilization

by all programs for dissemination

of vital statistics

2 Proposal for funding MOHA/BOS x x

Develop the HDSS system 3 BOS/MOH UNFPA X $37,000 $37,000 BOS/MOH/

UNFPA

COUNTRY ACCOUNTABILITY FRAMEWORK: Roadmap* Lesotho

CIVIL REGISTRATION AND VITAL STATISTICS SYSTEMS (CRVS)


Actions Priority

(1-2=high,

3=medium,

4=low)


institute

Partners 2012 2013 2014 2015 Total

Estimated

Cost per

action

2012/13

Catalytic

funding

Unfunded

balance

Potential

sources for

funding unmet

balance



Finalise the National Health

Strategy and update the M&E

framework

2 Workshop MOH WHO X X $15,000 $7,500 $7,500 MOH/CoIA

Finalise and align the Child Survival

M&E plan with the National Health

Strategic Plan

2 Workshop MOH HMIS X X $1,200 $1,200 $0 CoIA

Strengthen the Strategic

Information coordination team, by

reviewing the ToRs, and

incorporate relevant stakeholders

(statistics, academia and civil

society) in to the SI coordination

committee

2 Meeting MOH HMIS/CDC X X $1,000 $1,000 $0 CoIA

To have a comprehensive survey

plan within the M&E plan

2 Workshop X X $1,500 $1,500 $0 CoIA

Resource mobilisation 2 Strategic Information (SI) TWG MOH X X X

Strengthen district information

officers in data collection, collection

and analysis and integrate different

data sets. Carryout data quality

baseline which will inform routine

data quality assessment

Enhance data analysis and advocate

for data usage at district level for

informed decision making

2 Workshop MOH IHM/CDC $56,000 $12,000 $44,000 MOH/IHM/CoIA

Strengthen analytical capacity at

district level

1

Strengthen national data repository

with all relevant data and reports

and share information with the

public

2

MONITORING OF RESULTS


Actions Priority

(1-2=high,

3=medium,

4=low)


institute

Partners 2012 2013 2014 2015 Total

Estimated

Cost per

action

2012/13

Catalytic

funding

Unfunded

balance

Potential

sources for

funding unmet

balance



Policy Review and Stakeholders

meeting for validation

3 Workshop MOH WHO/UNFPA/UNI

CEF

X $12,000 $12,000 UNFPA

Strengthen National capacity

through training in MDSR and data

analysis. Review of the reporting

and assessor's tools and customize

the MAMMAS software

1 Workshop MOH UNFPA/WHO/ X X $12,000 $12,000 UNFPA

Strengthen District capacity

through training of assessors and

other health workers (midwives) in

MDSR

1 Workshop MOH UNFPA/WHO X X $24,000 $24,000 $0 CoIA

Improve reporting in hospitals by

capacitating the District committees

and private institutions and health

workers; Training in ICD

certification and coding

1 Workshop MOH UFPA/WHO X X $24,000 $24,000 CoIA

Strengthen capacity of private

sector in reviewing and reporting

of maternal deaths

1 Workshop MOH UFPA/WHO X X $12,000 $12,000 UNFPA

Support accreditation exercise and

data analysis to improve quality

2 Survey MOH X X $476,000 $24,000 $452,000 CoIA/MOH

Capacitate the community

structures in reporting of maternal

deaths occurring at the community

1 Workshop MOH WHO X X $12,000 $12,000 MOH

Strengthen communication at

community level( Village Health

Workers (VHW)) for reporting

maternal deaths that occur at

community level

1 Procurement MOH/WHO WHO X $36,000 $36,000 $0 CoIA

Link the MDSR secretariat to the

IDSR

1 Meeting MOH WHO X $1,200 $1,200 WHO/UNFPA

Review The MDSR annually in order

to implement the

recommendations arising from the

maternal death reports in order to

improve quality of care through AJR

meeting

1 Meeting MOH UNFPA x $12,000 $12,000 UNFPA

MATERNAL DEATH SURVEILLANCE AND RESPONSE


Actions Priority

(1-2=high,

3=medium,

4=low)


institute

Partners 2012 2013 2014 2015 Total

Estimated

Cost per

action

2012/13

Catalytic

funding

Unfunded

balance

Potential

sources for

funding unmet

balance



Advocate the Government buy in

into making e-health a reality

1 Meeting MOH x x x $12,000 $12,000 $0 CoIA

Capacity building for health workers

in IT application

2 Workshop MOH X $138,889 $6,000 $132,889 CoIA/MOH

Deploy IT personnel at district level

to support and supervise

1 Office/Procurement MOH X $22,000 $22,000 MOH

Discussions are on-going for

inclusion of MNCH data capturing

into the pilot phase of EMR


Establish the linkages between

health workload data and facility

data

2 Workshop MOH x x $166,666 $1,200 $165,466 MOH

Determine the eHealth standards

and interoperability components

required to support eHealth

services, applications and

infrastructure, as well as to support

broader changes to health

information flows.

1 Meeting MOH x x $12,000 $1,200 $10,800 MOH/CoIA

Develop and support a strong

effective coordination mechanism

(coordination committee)



MOH x x $1,200 $1,200 $0 CoIA

Mobilise financial and human

resources for implementation of e-

Health

2 Proposal for funding MOH x x $500 $500 MOH

Strengthen enforcement of the

data protection law

2 Meeting MOH x x $10,000 $7,700 $2,300 MOH/CoIA

Enforce compliance to data

protection policies

2 Meeting MOH x x

INNOVATION AND E-HEALTH


Actions Priority

(1-2=high,

3=medium,

4=low)


institute

Partners 2012 2013 2014 2015 Total

Estimated

Cost per

action

2012/13

Catalytic

funding

Unfunded

balance

Potential

sources for

funding unmet

balance



Sensitize the stakeholders about

the importance of developing NHA

framework

1 Workshop MOH x x

Assess the potential links of the

current system and NHA

1 Meeting MOH x

Organize a meeting to engage

government and development

partners and work towards

"compact"


Set up a steering committee,

officially approved, with

institutional support, and

functioning using results-based

management methods



MOH X $1,200 $1,200 $0 CoIA

Ensure inclusion of all key

stakeholders in resource tracking

/NHA

MOH

Train staff on system of health

accounts 2011; train district and

regional staff

2 Training Workshop MOH X X $72,000 $12,000 $60,000 CoIA/MOH

Map government codes to NHA

codes and develop IT conversion

tool for NHA

2 MOH

Develop /strengthen database for

production of NHA

3 MOH X

Develop SHA 2 MOH

Introduce the SHA 2011 system 2 MOH

Advocate for /promote use of NHA

data in policy making process

2 MOH

MONITORING OF RESOURCES


Actions Priority

(1-2=high,

3=medium,

4=low)


institute

Partners 2012 2013 2014 2015 Total

Estimated

Cost per

action

2012/13

Catalytic

funding

Unfunded

balance

Potential

sources for

funding unmet

balance



Operationalize implementation of

the recommendations

1 MOH x x x

Consolidate and harmonise the PHC

review meetings and the district

quarterly review meeting to form

one district review meeting

2 Meeting MOH x $30,000 $10,000 $20,000 CDC/CoIA/MOH

Strengthen the capacity of Health

center nurses and district health

information office to prepare

analytical reports prior to the

reviews

1 Workshop MOH x x x $44,000 MOH/IHM/CDC

Strengthen mechanism to compile

all policy / qualitative information

to inform annual reviews

1 Workshop MOH x x

Strengthen the use of review

results for planning purposes

1 MOH x x

Ensure greater involvement of all

stakeholders

1 MOH x x x

Ensure the existence of a single

national M&E framework that

national health plan will fit into

1 MOH x x x

Establish Partner's coordination

focal person and Develop Swap

ToRs



MOH x x x $1,200 $1,200 $0 CoIA/MOH

REVIEW PROCESSES


Actions Priority

(1-2=high,

3=medium,

4=low)


institute

Partners 2012 2013 2014 2015 Total

Estimated

Cost per

action

2012/13

Catalytic

funding

Unfunded

balance

Potential

sources for

funding unmet

balance



The new members of the

Parliament need to be sensitized

1 Meeting MOH WHO X $1,200 $1,200 $0 CoIA

Integration of RMNCH issues in

Parliaments' speeches

1 Public gatherings MOH WHO/UNPA X X X $10,000 $10,000 UNFPA

Capacity building for civil society

coalition on RMNCH to produce

evidence based advocacy messages

and materials

1 Workshop MOH WHO/UNFPA/UNI

CEF

X X $20,000 $6,000 $14,000 UNICEF/CoIA

Capacity building for media

personnel on RMNCH related issues

to produce evidence based

advocacy messages and materials

1 Workshop MOH UNICEF X X $10,000 $10,000 UNICEF

Sensitise the community on RMNCH

through the radio sessions

X X $47,000 $5,000 $42,000 UNICEF/CoIA

Establish Countdown Coordinating

Committee

3 Meeting MOH WHO X $1,200 $1,200 WHO/UNFPA

Prepare Countdown report/profile

using all evidence

3 Workshop MOH WHO X $12,000 $12,000 UNFPA

TOTALS 1,522,955 250,000 1,272,955 -

Needs Catalytic request Unfunded balance

CRVS $211,600 $74,500 $137,100

Monitoring of results $74,700 $23,200 $51,500

MDSR $621,200 $84,000 $537,200

eHealth & Innovation $364,455 $30,500 $333,955

Monitoring of resources $74,400 $14,400 $60,000

Reviews $75,200 $11,200 $64,000 Advocacy $101,400 $12,200 $89,200

TOTAL $1,522,955 $250,000 $1,272,955

ADVOCACY & OUTREACH


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