PRESENTATION: Accountability for health - The role of data, ICT and civil society

8/15/2019 PRESENTATION: Accountability for health - The role of data, ICT and civil society

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Accountability for HealthThe role of data, ICT and civil society

06 June, 2016

Kirthi Ramesh

Social Development Specialist, ADB

Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect the

views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent.

ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any

consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.


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Outline

1Importance of accountability now

2

Unpacking the concept of Accountability

3Interventions to strengthen accountability


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Outline


2




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Why talk about Accountability

for health results now?

Poor and marginalized have been

“left behind”

Donors under pressure to show

results /use of resources

Fragmentation of health

information systems

Achieving Universal Health

Coverage, Health-related SDGs

Results-based financing

Digital and data revolution

https://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjUmfOggInNAhWBqqYKHRNrDc0QjRwIBw&url=https%3A%2F%2Fthetomatos.com%2Ffree-clipart-2596%2F&bvm=bv.123325700,d.dGY&psig=AFQjCNEohbzoS_qdYdfpnFGEgfXi8GIpow&ust=1464945060718668


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Outline


2




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Accounta

bility

mechanis

ms

IMPROVEDHEALTHOUTCOMES

Informationabout rights/entitlements

Information onproviderperformance

Informationon mandate/expectations

The Accountability promise

?

Government

/

Provider

Response

http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiT2tDqyYHNAhUFFJQKHWovAyAQjRwIBw&url=http://clipart.me/premium-business-finance/illustration-of-set-of-bar-graph-line-graph-and-pie-chart-on-an-isolated-background-253498&bvm=bv.123325700,d.dGo&psig=AFQjCNFGvkjf-WY9MT3-hjFgt2qVBzAjMg&ust=1464690047945955http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiT2tDqyYHNAhUFFJQKHWovAyAQjRwIBw&url=http://clipart.me/premium-business-finance/illustration-of-set-of-bar-graph-line-graph-and-pie-chart-on-an-isolated-background-253498&bvm=bv.123325700,d.dGo&psig=AFQjCNFGvkjf-WY9MT3-hjFgt2qVBzAjMg&ust=1464690047945955http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiT2tDqyYHNAhUFFJQKHWovAyAQjRwIBw&url=http://clipart.me/premium-business-finance/illustration-of-set-of-bar-graph-line-graph-and-pie-chart-on-an-isolated-background-253498&bvm=bv.123325700,d.dGo&psig=AFQjCNFGvkjf-WY9MT3-hjFgt2qVBzAjMg&ust=1464690047945955http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiT2tDqyYHNAhUFFJQKHWovAyAQjRwIBw&url=http://clipart.me/premium-business-finance/illustration-of-set-of-bar-graph-line-graph-and-pie-chart-on-an-isolated-background-253498&bvm=bv.123325700,d.dGo&psig=AFQjCNFGvkjf-WY9MT3-hjFgt2qVBzAjMg&ust=1464690047945955


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Accountability actors



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Accountability relationship

Principal Agent

Mandates/Delegates

Equips with resources

Sanctions/rewards

Monitors/Investigates

Performs /Informs

Answers/Justifies



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Mandates/Delegates

Equips with resources

Enforces

Monitors/Investigates

Informs/Answers/Justifies

Prerequisites for Accountability

Principal Agent

Information (data)and transparency,institutionalmechanisms

Human & financialresources, skills,knowledge, data

Job descriptions, Servicestandards, licensing andaccreditation, SDGs/UHC

Sanction/reward:elections, market,

public pressure, results-based financing



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Accountability mechanisms

DEMAND SIDE (citizen led)

• “Traditional” vertical forms ofaccountability

– Elections, demonstrations,

investigative journalism,media

• Social Accountabilitymechanisms (developmentcooperation)

– Citizen report cards,

community basedmonitoring, social audit,grievance redressmechanisms, complaintboxes

SUPPLY SIDE (state centered)

• “Traditional” horizontal forms ofaccountability

– Checks and balances

– Regulatory agencies – Command chains

• Mechanisms that enablevoice/facilitate demand side

– Information Act

•

Mechanisms that shaperesponsiveness

– Incentives, rewards, sanctions

– Performance-based pay,results-based management,greater autonomy, ….

…are mutuallyreinforcing


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Context matters


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Accountability ecosystem

Legislative(Parliament,Local Council)Politicians

High rankingcivil servants

Lower rankingcivil servants

Government

Public andprivate healthcare facilities

question

Defend/explain

Sanction/overrule

Judiciary

Whole-of-governmentapproach

Governancefor Health

Regulatorybodies

Auditorgeneral

Anticorruption

bureau

Bureaucracy

Ministry ofHealth

DecentralizedHealth unit

Frontlineservice providers

(nurses,midwives)


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Outline


2




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Tacklethe Data Challenge


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Challenges

• Data fragmentation

• Low data quality and

availability• Data duplication

Results

• No timely information onhealth needs and provider

performance• Inefficiencies and

reporting burden

Leveraging data for accountability requires:

Actionability and

relevance of data

Data security,

protection/responsible use

Comprehensibility/

Visualization of data

Integration orinteroperability of HIS

Robust Health Informationsystems (HIS)

Independentverification of data

Strengthening Accountability requiresaccess to information and transparency


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Examples

Health Data

Collaborative

ADBinvolvement

DataIntegration,Bangladesh

AeHIN – Interoperability

labs

Dataintermediaries,

Indonesia


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MaximizeICT Solutions


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Timely datacollection andprocessing(e.g. HIS)

Covering hard-to-reach populations(e.g. Mobile data collection)

Data visualizationand dissemination(e.g. Dashboards, GIS maps)

Enabling voice

(e.g. complaints via SMS)

A cost effective tool to enable citizenvoice and make information available


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ICT Examples

SMScomplaints,Bangladesh

Mobile datacollection,

Bangladesh

UHCDashboards,Philippines

PorMiBarrio,Uruguay


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ICT Examples


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Engagecitizens


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3 - Engage citizens

Consultations

Collaborativedecision

makingData

verification

Citizen-ledmonitoring

and

oversight

Citizen andbeneficiary

feedback

Get patient’s views in

decisions that impact theirlives

Receive patient’s feedback

on whether their needs are

met

Find solutions to challenges

jointly

Empowerment and building

citizen capacity

http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=&url=http://www.volunteeringhb.org.nz/&bvm=bv.123325700,d.dGo&psig=AFQjCNGY0ZfUHXuNXlfvnRftlaeUOn1oTA&ust=1464752431643339http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=&url=http://www.volunteeringhb.org.nz/&bvm=bv.123325700,d.dGo&psig=AFQjCNGY0ZfUHXuNXlfvnRftlaeUOn1oTA&ust=1464752431643339http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=&url=http://www.volunteeringhb.org.nz/&bvm=bv.123325700,d.dGo&psig=AFQjCNGY0ZfUHXuNXlfvnRftlaeUOn1oTA&ust=1464752431643339http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=&url=http://www.volunteeringhb.org.nz/&bvm=bv.123325700,d.dGo&psig=AFQjCNGY0ZfUHXuNXlfvnRftlaeUOn1oTA&ust=1464752431643339http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=&url=http://www.volunteeringhb.org.nz/&bvm=bv.123325700,d.dGo&psig=AFQjCNGY0ZfUHXuNXlfvnRftlaeUOn1oTA&ust=1464752431643339http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=&url=http://www.volunteeringhb.org.nz/&bvm=bv.123325700,d.dGo&psig=AFQjCNGY0ZfUHXuNXlfvnRftlaeUOn1oTA&ust=1464752431643339http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=&url=http://www.volunteeringhb.org.nz/&bvm=bv.123325700,d.dGo&psig=AFQjCNGY0ZfUHXuNXlfvnRftlaeUOn1oTA&ust=1464752431643339http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=&url=http://www.volunteeringhb.org.nz/&bvm=bv.123325700,d.dGo&psig=AFQjCNGY0ZfUHXuNXlfvnRftlaeUOn1oTA&ust=1464752431643339http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=&url=http://www.volunteeringhb.org.nz/&bvm=bv.123325700,d.dGo&psig=AFQjCNGY0ZfUHXuNXlfvnRftlaeUOn1oTA&ust=1464752431643339http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=&url=http://www.volunteeringhb.org.nz/&bvm=bv.123325700,d.dGo&psig=AFQjCNGY0ZfUHXuNXlfvnRftlaeUOn1oTA&ust=1464752431643339http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=&url=http://www.volunteeringhb.org.nz/&bvm=bv.123325700,d.dGo&psig=AFQjCNGY0ZfUHXuNXlfvnRftlaeUOn1oTA&ust=1464752431643339


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Examples

KINJERA,Indonesia

Communitybased

monitoring,Uganda

UGIIP-3,Bangladesh

Participatorybudgeting,

Brazil


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Strengthenthe “supply” side

A t bilit h i


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DEMAND SIDE

(citizen led)

SUPPLY SIDE

(state centered)

“Traditional” horizontalforms of accountability

Mechanisms that enablevoice/facilitate demandside

Mechanisms that shape

responsiveness

Accountability mechanism


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Examples

InformationAct, India

Strengtheningof regulatory

bodies,

Malawi

Freedom ofInformation

Act,Indonesia

CitizenCharters,

Bangladesh


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LeverageResults-basedlending

R lt b d l di d t bilit


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Results-based lendingstrengthensaccountability:

• Incentivize service

providers/

governments

(enforcement)

• Equip them with

resources to fulfill

their mandate

Strengtheningaccountability supports

results-based lending:• Better data for information

about performance

(information/monitoring)

• ICT solutions improve datacollection, processing and

visualization(information/monitoring)

• Community based

monitoring/datacollection/feedback for

verification of

results/performance• Community feedback for

improved health outcomes

Results-based lending and accountability


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Invest in Health for All

For more Information:

Kirthi Ramesh – [email protected]

Health Sector Website:

http://www.adb.org/sectors/health/main

PRESENTATION: Accountability for health - The role of data, ICT and civil society

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