Iraq. COUNTRY ACCOUNTABILITY FRAMEWORK: Assessment*

Transcription

1 COUNTRY ACCOUNTABILITY FRAMEWORK: Assessment* Policy Context Global strategy on women and children/ commitment National Health Sector Plan and M&E Plan Situation Analysis The general objective of the accountability framework for health roadmap is to accelerate the reduction of maternal and newborn mortality towards the attainment of the MDGs 4 &5 in.(goal 4: to Reduce by two thirds, between 1990 and 2015 the under-five mortality rate and Goal 5 :reduction of maternal mortality by three- quarters in 2015). Its specific objectives are to: (i) provide skilled attendance during pregnancy, childbirth, and the postnatal period, at all levels of the health care delivery system, and (ii) strengthen the capacity of Individuals, Families, and Communities to improve maternal and newborn health (MNH). National Plan to Accelerate the Reduction of Maternal and Neonatal Mortality for The National Development Plan has put health as a priority agenda and paved the way to incorporate health in policies and practice of related sectors. The health care system is in transition from hospital oriented model to preventive primary Health care (PHC) model, the policy adopted by the i Ministry of Health (MoH). Family medicine has been adopted as the model of PHC and MoH is advancing the initiative by: training the general practitioners to be family physicians, reconstructing and equipping PHC centres all over the country. Basic Health Service Package (BHSP) has been adopted in 2011, which integrates maternal, neonatal and child health services, to be implemented through PHC network and district hospitals. National Maternal, Child and Reproductive Health (MCH/RH) Strategy and a plan of for has been adopted. Successful implementation of MCH/RH should support the country in accelerating progress towards achieving MDGs 4 and 5 by Country team present at the National Accountability Workshop, 10/12 December 2012 Please refer to workshop report. * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 1/32

2 COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard* KEY: 1 Not present, needs to be developed 2 Needs a lot of strengthening 3 Needs some strengthening 5 Already present/no needed Civil registration & vital statistics systems Situation analysis (strengths, weaknesses/gaps) Actions Assessment & Plan 3 Strength: A rapid assessment was conducted by Ministry Of Health Use of the results of the second rapid CRVS assessment for advocacy /mobilization key stakeholders. Technical committee will review the assessments tools used by for comprehensive assessment and the tool used by MOP/CSO in the assessment that was conducted in July 2011, especially to check for the presence of main elements with regard to CRVS and recommend whither to conduct comprehensive assessment based on tools or not. with the involvement of all partners in July 2011 using rapid assessment tool. A comprehensive assessment was conducted by Ministry Of Planning in July 2011 in close collaboration with MOH using Global CRVS assessment tools with the technical assistant of and other relevant stakeholders as part of bigger exercise assessment of IPSM. The comprehensive assessments conducted by MOP have been found to be sharing almost all main elements of comprehensive CRVS assessment tool thus there will be no need to conduct a second comprehensive assessment. it is worth mention that a second rapid assessment has been conducted by MOH in December 2012 and the results were shared with related ministries and stakeholders. Weaknesses: inadequate coordination among other related ministries working CRVS. Absence of focal structure of CRVS assessment. Weak compliance to the nomination criteria of technical representative to the Establish a steering committee from relevant departments in MOH which will guide and oversee in close collaboration with MOP/CSO and other stakeholders the initiative and implementation of CRVS plan. Develop and agree on strong coordination mechanism among all stakeholders responsible for CRVS. national and regional technical forums and weak follow up and Coordinating Mechanism 3 Strengthen interagency coordinating committees involving all key information sharing by the nominated individuals. An interagencies coordinating committee does exist at both MOP and stakeholder and make sure they meet periodically and share information on the main conclusions. MOH with involvement of main stakeholders. However, there is a There is an urgent need to review the currently existing committees need to improve coordination and representation of all relevant and mechanisms used for CRVS in order to bring more harmony stakeholders. In addition to the main committee there is several among the agencies and entities working for CRVS. other committees working for CRVS in ministry of Health with no clear terms of reference and membership criteria. Both public and private hospitals do report on deaths to the DOHs on regular basis Hospital reporting 1.5 Strengthening the hospital recording system through the introduction of tools of quality assurance and the computerized system for record keeping. however, more work need to be done to improve the quality of death registration and causes of death. The hospitals do use ICD10 while reporting on cause of death however, there is no system to determine the quality of data collected from hospitals. Enhance the capacity of the ministry of health at different levels in the use of ICD 10 and work up the mechanism for developing and sustaining the core capacities. * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 2/32

3 COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard* Community reporting 1 Paper based system is existing with no proper reporting for deaths Establish community reporting of births deaths,implement and births at community level using the ICT and Verbal autopsy at community level. Regular Annual reports developed and published by MOH with information at the national and innovative approach. Strength establish community reporting through use of VA by community workers. subnational levels. These report are widely shared with all Vital statistics 3 stakeholders. There is an established system for CRVS in. Strengthen the analytical capacity of vital statistics office, including data quality Strengthen the analytical and reporting capacity of vital statistics offices at different levels. However, several measures have to be undertaken to improve the quality of data. There is no well defined health and demographic surveillance sites which Provide regular information in for all programs. Establish data quality assessment system inline with international standards. Local studies for mortality 1 Establish the (HDSS) IN IRAQ for all programs. * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 3/32

4 COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard* Monitoring of results Situation analysis (strengths, weaknesses/gaps) Actions M&E Plan 2.5 There is a M&E plan for National Health Strategy but it is not comprehensive. The M&E plan for RMNCH is aligned with the Update and further strengthen the M&E component of the NHS during the revision process of the NHS. national health strategy M&E plan to a major extent as well as the Review the RMNCH M&E plan(s) and align with the M&E of the 11 indicators of accountability framework are reflected with the revised NHS. exception of few indicators which are not mentioned. The monitoring of various programs is conducted on adhoc basis by M&E Coordination 2 Strengthen further the M&E coordinating body at National and various relevant departments and there is an established Governorate level which will make sure to bring all stakeholders to mechanism responsible to carry out regular monitoring of all the common platform and thus facilitate the review of the progress programs. The nationally approved mechanisms for monitoring on various dimensions of the health programs. has to be strengthened further and to be followed by all departments during their monitoring and evaluation work. Regular reports are produced by officials who undertake Health Surveys 2 monitoring visits however there is no agreed upon mechanism for Develop 10 year health survey plan. dissemination of information from various monitoring visits and Plan for a national coverage survey , that includes RMNCH overviews by MOH at National and Sub- National level. A common interventions. national household health survey plan does not exist which will Facility data (HMIS) 2 guide all stakeholders about the need on when and what survey Strengthen analytical capacity, annual compilation of statistics from facilities with data quality assessment. to conduct which will meet the need of the country. However several surveys have been conducted in the past years including the recently completed household Socio-Economic Survey phase II (IHSESII) and MICS 4 as well as the i women Integrated Social and Health Survey (IWISH). The household expenditure survey may be conducted as part of the 2n round of NHA in There is no plan to conduct the national coverage survey which will cover RMNCH interventions in year However it is imperative to note that the verbal autopsy will be conducted as part of the larger exercise of i poverty maternal mortality map (I-PMMM). There is a functioning facility reporting system however it needs further improvement to ensure the completeness and other aspects of data quality management are adhered to. The data submitted by the DOHs does not include a report on quality. The data is being shared with all concerned departments for review and further improvements. Conduct annual facility survey for data verification and service readiness. * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 4/32

5 COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard* Analytical capacity 2 Annual reports are produced annually to measure and review Strengthen analytical capacity of the departments responsible for review of the progress and performance and involve key institutions/ partners in the review. progress and performance. However, the analysis part and quality of the report has to be strengthened and improved further. The analysis has to involve all stakeholders working for health sector in order to enrich the findings and facilitate the implementation by all partners. There is also a mid term review of the progress which use a specific set of indicators and is used to bring improvements Promote the use of findings from the progress and performance to inform mid term and annual reviews and make them more evidence and context oriented. in the programs. The data is disaggregated by age, sex and Equity 3 Review equity analyses taking equity aspects into consideration geographical location. However the data has not been according to the existing policy guidelines in order to ensure access disaggregated taking and minority into considerations. There is a of all parts of the population to health services. well functioning health data repository and there is a website of MOH which ensure the access of all partners to health information and data. Data sharing 3 Strengthen national data repository with al relevant data and reports. * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 5/32

6 COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard* Maternal death surveillance & response Situation analysis (strengths, weaknesses/gaps) Actions Notification 3 There is a national policy requiring notification for all maternal death within 24 hours. However, the comprehensive reporting on Improve the promptness of maternal death reporting system especially in rural remote areas. maternal death roughly takes 48 hours to be completed and shared with the relevant authorities. There are two national Capacity to review and act 3 Strengthen the managerial and technical capacity of health committees (steering and technical) at central MOH. the steering professionals at national and subnational levels in the MDSR. In committee is providing guidance and policy advice in relation to addition capacity of national staff responsible of MDSR has to be maternal deaths while the technical committee is charged to take enhance on the most updating tools for reporting. of technical details of maternal death. at subnational level there is a common committee which take care of both policy and technical level issues. There is no structure responsible for reporting on Hospitals / facilities 2 maternal death at district level however, there is a committee at the hospital level which is responsible to report on all maternal deaths to the concern committees at DOHs. The reporting from Improve reporting by all hospitals especially from non - maternity departments of general and private hospitals in line with ICD requirements. maternity hospitals is encouraging and is reported to be over 90%. Develop and enforce regulation requiring private hospitals to report however the reporting from general hospitals need improvement and review all maternal deaths to the nearest official structure which is currently less than 60%. The maternal death from general responsible for MDSR. hospitals especially from surgical, medical, emergency and CCU Quality of care units are not reported correctly which need further review and 1 Establish a regular system of QoC assessments and orient the health improvement. The private hospitals usually does not accept professionals about its use. The Health Information Strategy is in patients who are complicated and usually refer them to public hospitals for management. there is a big problem in recording the cause of death based on ICD10 and thus system should be process of development which will clearly delineate the use of the results from the Quality and all other conducted assessments for policy and decision making. updated in order to be able to catch the true cause of death. Majority of the deaths are reported and taking care of by public hospital and all reviewed based on the mentioned structure. Community reporting & feedback 1 Develop a community system of maternal death reporting and response, using ICT in collaboration with Ministry of Planning and other relevant stakeholders. However, few deaths occur in the private hospital which are not been reviewed but they are given the death certificate. Currently there is no established system of regular assessment using standard tools however regular monitoring visits are conducted and the findings and recommendations are reported and being used in reviews and decision making. There is no reporting system for maternal deaths at the community level and therefore the community does not report on maternal deaths. No reporting is done by community on maternal deaths through the electronic devices as there is no such a system currently established there. In addition the verbal autopsy is not carried out to report or verify maternal deaths and as a result no feedback is given to communities. Develop a system of maternal death reporting and response initiation by electronic devices in collaboration with Ministry of Planning and other relevant stakeholders. Develop VA for maternal deaths in communities in collaboration with Ministry of Planning and other relevant stakeholders. Develop system of involving communities in review and response in collaboration with Ministry of Planning and other relevant stakeholders. * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 6/32

7 COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard* Review of the system 2 There is a system of review of maternal death Surveillance and A regular system for assessing the quality of maternal deaths review Response however there is need for further improvement in order and surveillance should be established soon. In addition the tools to make the system compatible with the current standard for quality assessment should be introduced and the capacity of requirements. The standard tools for regular review of the health professionals built on the use of tools and the overall review mentioned system should be introduced and the capacity of the process in line with the standard procedures for such a system. staff built. However it is imperative to mention that all the deaths recorded by central MOH is reviewed on monthly basis and the reasons contributing to the deaths are reviewed based on the 3 delays checklists and all the necessary s during the reviewed are recorded and actively followed up during the subsequent visits. In addition a 3 years review is undertaken to assess the situation and capacity of maternal deaths review system however this review is not done based on standard tools. The 3 years review report on their findings and identify all the areas which needs further improvement by the relevant departments. * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 7/32

8 COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard* Innovation and ehealth Situation analysis (strengths, weaknesses/gaps) Actions Policy 2 The ehealth strategy has been developed but it has not been implemented yet. Since many infrastructure related requirement and human recourse capacity has to be in place in order to fully implement E-health. The minimum required infrastructure is in Explore the need both in terms of workforce capacity and the physical infrastructure necessary for successful implementation of E- Health Strategy in collaboration with relevant partners. place and most facilities have access to internet however in order Ensure MNCH component is clearly articled in the strategy. to share reports and other information there is no access to intranet facilities. ICT is extensively being used for reporting, Infrastructure 2 analysis of information with varying level at different parts of health system. The reports including MNCH is sent via hard copy Conduct assessment of infrastructure coverage and availability. completed manually to the DOHs and at the DOH levels the information is collected, analysed and shared with central MOH Based on health priorities and identified gaps, identify priority needs in terms of infrastructure acquisition and deployment. for further analysis. Currently there are trained IT specialists however in order to meet the current need more comprehensively Identify/allocate appropriate resources to update all identified there is an urgent need to have higher number of IT specialists infrastructure gaps. who are oriented with the advanced knowledge of the use ICT in Services 2 Health. There are standards used for compilation storage and Conduct assessment of existing ICT applications and services Determine the ICT applications required to support the MOH priority programs and gaps. transfer of data however they need further review in order to meet the currently available international standards. There is good level of co-ordination among stakeholders on ehealth especially in planning however in implementation of various ehealth initiatives there is need for more close co-ordination. There is currently no clearly established regulatory framework on protection of data. However it needs to be re-developed to provide clear guidance to all those who are involved with use and generations of information at various level of health systems' there is weak adherence to the data protection guidelines. Identify/allocate appropriate resources to establish implementation of required ICT applications. Assess the available capacity of ICT specialists in support of health. Identify potential HR based on the identified need and allocate resources to upgrade the level of ICT for health. Standards 3 Based on the identified priority areas and used ICT applications, align the currently available core set of standards with the internationally recommended standards. Governance 2 Develop and support a strong effective coordination mechanism with relevant stakeholders especially when it comes to implementation of E- Health initiatives. Protection 2 Develop a new regulatory framework on protection of data in collaboration with relevant government partners. Enforce compliance to data protection policies. * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 8/32

9 COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard* Monitoring of resources Situation analysis (strengths, weaknesses/gaps) Actions National health accounts 2 The NHA has been conducted in in 2010 using the data from Develop NHA framework based on the new system of health 2008 and The 2nd round of NHA using the new system of accounts. health accounts will be conducted in early 2013 which will Organize a meeting with decision makers and technical staff to establish the framework based on new system of health accounts. develop institutional arrangements and governance mechanism that There is no formal governance mechanism that specifies specifies coordination, management, national indicators and budget coordination, management, national indicators and budget for for implementing health accounts and tracking resources on key implementing health accounts and tracking resources on key policy issues such as financial flows for RMNCH. policy issues such as financial flows for RMNCH. There is a formal agreement (or compact) between government and partners that report on partner commitments and disbursements, and donor Compact 2 funded expenditures on health. Its progress has been reviewed in Organize a meeting to engage government and development several international for as there is a NHA steering committee that partners and work towards "compact". provides technical oversight on data needs, methods of Coordination production. Key stakeholders are actively involved in the 2.5 Re-activate a steering committee, officially approved, with production of NHA (including government stakeholders at national institutional support, and functioning using results-based and subnational level, CSOs, NGOS, partners, health insurance. management methods. There is no adequate human capacity at national levels and there Ensure inclusion of all key stakeholders in resource tracking. is no capacity at sub national level to produce NHA tables and core indicators, including on expenditure by beneficiaries for tracking RMNCH. Government expenditure data conversion into Production 1.3 Train staff on system of health accounts 2011 at all level especially NHA format is not automated, including for expenditure by at governorate level. beneficiaries for tracking RMNCH. The central database for automated production of standard NHA tables does not exist. No Map government codes to NHA codes and develop IT conversion analytical summaries are produced annually on SHA 2011 health tool for NHA. accounts. Few staff have been oriented to the new SHA 2011 and Develop /strengthen database for production of NHA. it has yet to be introduced and implemented. The 2nd round of Analysis NHA is being planned for 2013 which will be implemented based 1 Strengthen analytical capacity in government and other relevant on the new system of health accounts. SHA 2011 NHA (including institutions. beneficiaries for tracking RMNCH) will be considered as an Disseminate report and analyses on public website. essential element of annual reviews once the governance framework is established and being based on the new system of Data Use 1 accounts. Once the NHA framework based on SHA is agreed upon Advocate for/promote use of NHA data in policy making process. it will be used in the development of national policies, including RMNCH-specific policies. * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 9/32

10 COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard* Review processes Situation analysis (strengths, weaknesses/gaps) Actions Reviews 2.7 Multi stakeholders review meetings are being convened with Agree on a structured tool and guidelines to be followed by all departments involved in the review process which will lead to better alignment and integration among the various review processes. involvement of key stakeholders whenever they are needed. All reviews had participation of key stakeholders. The annual reviews of RMNCH program has been carried out and will be repeated when the revised strategy of RMCH will be implemented. The health sector performance review which took place as part of the public sector modernization program was based on good synthesis of all relevant information including RMNCH. The annual report which is regularly produced by MOH includes relevant information including RMNCH and the information and analysis is available at national and only information at sub national level Identify all the reviews which are planned to take place in a year and reflect them in a calendar of events entailing different activities which will facilitate the process of annual and mid term review processes. Ensure that the RMNCH appraisals are held and that findings feed into the health sector reviews. since the information are not analysed at the governorate level. Synthesis of information & policy context 2.5 Strengthen the capacity to prepare analytical reports prior to the The client satisf has been assessed in the past years through reviews. the conduction of 3 separate surveys however the qualitative Ensure the mid term and annual review process focus on qualitative aspect is not addressed by the annual report of MOH since the aspects of information. mentioned surveys were conducted on a small level and the findings could not have been generalized. The findings of review From review to planning 2 process are used are translated into which fit in the plans. Agree on a well established mechanism for making sure that the However a clear mechanism which will oblige all those who works evidence from the review is used in the planning process and on the operational planning and make sure that evidence resource allocations. generated by the various review process is used in planning and Ensure greater involvement of all stakeholders. resource allocation process has to be established. Annual operational meetings includes participation of key stakeholders. Compacts or equivalent mechanisms 3 M&E plan is in place but lack integration between inter related Ensure the existence of a single M&E framework that fits into the sectors and stakeholders to be completed in consultation with single national health plan. MoH key persons. * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 10/32

11 COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard* Advocacy & outreach Situation analysis (strengths, weaknesses/gaps) Actions Parliament active on RMNCH issues 4 The parliament has established a Health and Environment Committee responsible to liaise with Ministry of Health and advocate on health issues on behalf of government and the people. There is a strong collaboration between the mentioned committee and MOH especially on RMNCH programs. a)there is collaboration with civil society organizations with no regular mechanism for co-ordination. The CSOs are participating in most of the policy level forums organized by MOH however this is done on adhoc basis and is not supported by a regular co-ordination Parliamentarians are mobilized to engage in RMNCH accountability, especially on financing. Enhance the frequency of public hearings/forums by parliament for sharing information on RMNCH especially the financing and accountability aspect. Advocate on behalf of MOH with Ministry of Finance and Planning for more resources and with other relevant Ministries for expediting the approval and review process of policies and regulations with regard to RMNCH programs. framework. The CSOs produce advocacy materials without being based on evidence. The advocacy materials are disseminated Civil Society Coalition 2 widely in the absence of well defined strategy. Media broadcast Establish a high level co-ordination platform for bringing all CSOs especially NGOs working for health sector to ensure joint work under the same policy framework and contribute to implementation of priorities which has been agreed in the National MoH Strategy. programs are available on RMNCH however, there is no regular mechanism for such reporting. The information is shared mainly on events with media. There is no mechanism to monitor media coverage and there is no strategy on public relations and media. There have been series of discussion in various high level for as to shed light on the progress of towards the accomplishments if no formal countdown event has been conducted yet. However, in the year 2013 there will be events which will focus on the progress of the countries in terms of their achievement toward the Support capacity of civil society to synthesize evidence and disseminate messages according to the current evidence and using a proper dissemination strategy. Media role 3 commitment in the country accountability framework.. Work with the media to strengthen their capacity to report on RMNCH related issues. Work with the media to strengthen their capacity to facilitate information sharing on the monitoring and implementation of the Global Strategy. Establish a proper mechanism for sharing the information with media and set out the mechanism for monitoring the coverage of information by media. Countdown event for RMNCH 4 Countdown Coordinating Committee, UN agencies (H5), and other partners encourage/support national stakeholders to plan national Countdown. Prepare Countdown report/profile using all evidence. * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 11/32

12 COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard* Child and maternal health Policy and strategy 2.5 Situation analysis (strengths, weaknesses/gaps) Actions There is a maternal/reproductive health strategy which addresses Initiate implementation of the recently revised plan of of the all elements of child health and maternal and reproductive health. national Reproductive,child and maternal health strategy. the strategy has recently been updated reflecting all the priorities. There are plans to undertake the costing of the mentioned strategy. The national child and maternal health strategy is consistent with the National Health Strategy. The recently revised MCH strategy has been based on a comprehensive situation analysis. Child and maternal health interventions 2.5 The official statement in relation to UN Global Strategy for is yet to be declared. The recently revised MCH strategy contains cost effective interventions that address priority child and maternal health problems e.g. IMCI and immunization etc. which has been found globally to be cost effective interventions. Most of the interventions are implemented at facility level and few are implemented at the community level. Advocate for a formal commitment to be made to the UN global strategy for women's and children's health. Expedite the implementation of the interventions with special focus to the rural remote areas. Implementation coverage of IMCI at facilities level exceeds 50% while at the community level it is less than 35%. The adaptation of the of IMPAC guidelines was completed in 2010 and an implementation plan was developed)the first national ToT for doctors and nurses using the guide was conducted followed by the implementation of the IMPAC at health facilities using the national adapted version. Plan for the implementation of the cost effective interventions at both health facility and community levels. Plan for universal coverage of IMCI at health facilities level and expand coverage at community level and mobilize resources to achieve the target of the plan. Plan for universal coverage of IMPAC at health facilities level and introduce IMPAC at community level. Mobilize resources to achieve the target of the plan. * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 12/32

13 COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard* Planning 2.8 There is a national child and maternal/ reproductive health plans to which all partners contribute. The plan contains targets about universal coverage of child and maternal health interventions. all the main activities, indicators and targets of the child and maternal health plans are included into the national health plan. Already achieved. Already achieved. Already achieved. There are annual plans which include intermediate indicators and target to measure the progress in line with the long-term plan for universal coverage. The mechanism on how to measure the progress of the given indicators has to be elaborated Review and improve the plan to include targets, indicators and monitoring plan. The recently updated MCH plan has not been costed yet. It will be costed shortly with the assistant of relevant partners. Carry out costing of the recently revised MCH plan with technical assistance of partners. The child and maternal health plans are partially implemented. Strengthen the monitoring process for implementation of the plan. Monitoring and evaluation 4 RH/MCH strategy annual workplan have set list of indicators with baseline and target coverage. Not all the 11 selected CoIA indictors are identified(only 6 out of 11). Intermediate indicators have to be agreed upon and reflected in the updated strategy. Incorporate the 5 missing indicators of COIA in the revised MCH strategy by the committee who were involved in the revision of the MCH strategy. Build capacity at all levels of health system with special focus at the governorate level in the reporting of intermediate indicators. Child and maternal health reviews are conducted at the national level on annual basis. Supervisory visits are being conducted from time to time however a regular systematic process has not been followed especially in relation to supportive supervision. IMCI health facility survey has not been conducted. IMCI assessment is conducted at PHC centres level by DoH and MoH IMCI focal points to evaluate the quality provided to children under 5 and mothers. IMCI coverage indicators are done annually at national level and the report is shared with RO/CAH. Conduct periodical reviews of the child and maternal health programme. Strengthen the supervisory system: Develop a plan, conduct visits, reports, and feedback. Capacity building of supervisors on supportive supervisory skills. Expand the coverage of health facilities assessment to the remaining facilities which are not being assessed yet. Special emphasis should be placed to evaluate the quality of child and maternal health services at PHC facilities. Conduct a national workshop to disseminate results of the assessments. Results are posted on the MOH site to be publicly accessible. * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 13/32

14 COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard* Advocacy, commitment and partnership 3 The child health activities are documented on monthly basis. Continue to document and improve the quality of reporting on child health program activities. Several activities leading to advocacy are being conducted but have not followed a regular pattern. There is a high level committee at MOH chaired by Minister of Health and 3 committees are based in Ministry of Social Affairs, Planning and Women Affairs. In addition the health and environment committee of parliament advocate on the issues of maternal and child health. Conduct advocacy activities for key stakeholders to present the maternal and child health situation and show evidence of impact of implementation. Disseminate data on the current situation of maternal and child health to the high level decision makers to obtain resources. Engage members of the various committees tasked to advocate on maternal and child health issues in the various meetings conferences organized by MOH and health sector partners. All partners in the country are supporting the child and maternal health programme technically and financially. However, there is need for high level advocacy in order to engage partners and donors. Advocate to all stakeholders and partners in the country to ensure full and integrated coordination and resource mobilization so that to support the child and maternal health programmes in the country. * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 14/32

15 areas/activities Approach/s Lead govt/national institute Total,,, unmet CIVIL REGISTRATION AND VITAL STATISTICS SYSTEMS (CRVS) Technical committee will review the assessments tools used by for comprehensive assessment and the tool used by MOP/CSO in the assessment that was conducted in July 2011, especially to check for the presence of main elements with regard to CRVS and recommend whither to conduct comprehensive assessment based on tools or not. 2 Apply full assessment tool and develop improvement plan. MoH/Directorate of Planning and Human resources. MoP/CSO, MoI, MoJ x $5,000 $5,000 Establish a steering committee from relevant departments in MoH which will guide and oversee in close collaboration with MOP/CSO and other stakeholders the initiative and implementation of CRVS plan. 2 The Steering Committee do exist however the Terms of Reference could be reviewed in order to make it more effective. MoH/Directorate of Planning and Human resources. Mop/CSO, MoI, MoJ,, and x x x $0 $0 $0 Develop and agree on strong coordination mechanism among all stakeholders responsible for CRVS. 2 Develop a coordination plan between all stakeholders. MoH/Directorate of Planning and Human resources. MoP/CSO x x x $0 $0 $0 Strengthen interagency coordinating committees involving all key stakeholder and make sure they meet periodically and share information on the main conclusions. 2 Multi-stakeholder workshop/mobilisation exercise. MoH/Directorate of Planning and Human resources. MoP/CSO x x x $10,000 $10,000 There is an urgent need to review the currently existing committees and mechanisms used for CRVS in order to bring more harmony among the agencies and entities working for CRVS. 2 Review of ToRs for existing committees and mechanisms. MoH/Directorate of Planning and Human resources. MoP/CSO x $0 $0 $0 * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 15/32

16 areas/activities Strengthening the hospital recording system through the introduction of tools of quality assurance and the computerized system for record keeping. Approach/s Lead govt/national institute Total 1 workshop hospital recording 1 TOT 3 DAYS 40 PARTICIPANTs 20 LOCAL 50 participant 3 DAYS MoH/DoP MoH,,,,, YES YES YES $800,000 $10,000 $100,000 $690,000 unmet Enhance the capacity of the ministry of health at different levels in the use of ICD 10 and work up the mechanism for developing and sustaining the core capacities. 1 Two ToT for MoH various level each one with 25 participants, ToT Traing 50 participants 5 DAYS (2 workshops ) for academic in medical colleges on ICD10 to include it with medical curriculum. MoH/DoP, MoHE,, K P $135,000 $10,000 $125,000 Establish community reporting of births deaths,implement innovative approach. Strength establish community reporting through use of VA by community workers. Strengthen the analytical capacity of vital statistics office, including data quality Strengthen the analytical and reporting capacity of vital statistics offices at different levels. 4 Identify short list of variables for birth and death reporting (HMN/). 4 Test verbal autopsy tool for mobile phones. 2 Two ToT to improve analysis capacity in vital statistic of relevant staff MoH/DoP, followed by (19 training courses) cascade training for each DoH. MoH/DoP MoH/Ministry of Communication MoH/DoP,, MoH, x $400,000 $0 $400,000 x x $10,000 $10, $200,000 $10,000 $190,000 Establish data quality assessment system in line with international standards. Establish the (HDSS) IN IRAQ for all programs 2 Hire short term consultant to assess the currently available data quality system and come up with an adapted system for data quality in. Use analytic approach include data quality score card analysis. 4 Conduct two high level workshops 5 days 30 participants for relevant staff in DoP (VHSD) to discuss the development of HDSS in. MoH/DoP MoH h h $100,000 $10,000 $90,000 MoH/DoP, MOP/CSO h $90,000 $0 $90,000 * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 16/32

17 areas/activities Approach/s Lead govt/national institute Total,,, unmet MONITORING OF RESULTS Update and further strengthen the M&E component of the NHS during the revision process of the NHS. 1 Three consensus meetings and two national level workshops to discuss and finalize M&E components of NHS. MoH/D of PH, DoP, IG, R $70,000 $10,000 $60,000 Review the RMNCH M&E plan(s) and align with the M&E of the revised NHS. Strengthen further the M&E coordinating body at National and Governorate level which will make sure to bring all stakeholders to the common platform and thus facilitate the review of the progress on various dimensions of the health programs. 2 Two meetings with one workshop 3 DAYS 30 participants. 2 Link with National Statistical Plan, mapping all health surveys. MoH/PHD, DoP, IG MoH (PHD and DoP) Other line ministries, MoHE, MoWA, MoE X $50,000 $10,000 $40,000 X $0 Develop 10 year health survey plan. 2 Assign the currently existing HIS committee to discuss and agree on 10 years health survey plan building on existing plans. MoH MoP/CSO x x $10,000 $7,000 $3,000 Plan for a national coverage survey , that includes RMNCH interventions. 3 A survey to assess low coverage rate of utilization/access and post natal care will be undertaken, conduct low birth weight study at national level. MoH,, x $200,000 $0 $10,000 $190,000 Strengthen analytical capacity, annual compilation of statistics from facilities with data quality assessment. Conduct annual facility survey for data verification and service readiness. 1 Improve analytical capacity of staff from DoP by conducting two workshops for 30 participants/5 days duration. 3 Plan sample survey of facility (about 100) prior to review using standard instrument. MoH/DoP-HVSD x $50,000 $3,000 $47,000 MoH/DoP x $250,000 $20,000 $230,000 * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 17/32

18 areas/activities Strengthen analytical capacity of the departments responsible for review of the progress and performance and involve key institutions/partners in the review. Approach/s Lead govt/national institute Total 1 Hire one international consultant and two national consultants, to build analytical capacity of the partners/institutions by conducting two training courses 5 days each for 30 participants of relevant staff from DoP-HVSD.,,, MoH/DoP, MOP x * $100,000 $10,000 $90,000 unmet Promote the use of findings from the progress and performance to inform mid term and annual reviews and make them more evidence and context oriented. Review equity analyses taking equity aspects into consideration according to the existing policy guidelines in order to ensure access of all parts of the population to health services. 2 Conduct bi annual technical consultation meeting with all stakeholders to present the findings of mid term and annual review for information sharing and policy formulation. 4 Two workshops for 30 participants each 5 days duration for the relevant staff. MoH/DoP, MOP-CSO MoH/DoP,, UNCIEF MoP,, and x x x $30,000 $5,000 $25,000 x x $100,000 $5,000 $95,000 Strengthen national data repository with all relevant data and reports. 3 MoH/DoP MoP/CSO xx x x * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 18/32

19 areas/activities Approach/s Lead govt/national institute Total,,, unmet MATERNAL DEATH SURVEILLANCE AND RESPONSE Improve the promptness of maternal death reporting system especially in rural remote areas. 1 Two ToT in Baghdad, 40 participants each and followed by cascade 20 local workshops/3 days/20 participants for each. MoH/DoP * x x $250,000 $10,000 $20,000 $220,000 and Strengthen the managerial and technical capacity of health professionals at national and subnational levels in the MDSR. In addition capacity of national staff responsible of MDSR has to be enhance on the most updating tools for reporting. 2 Training course for 20/MCH focal points working for MDSR - 20\local training courses at governorate level\3days. MoH/MoHE // J J J $200,000 $10,000 $20,000 $170,000 and Improve reporting by all hospitals especially from non-maternity departments of general and private hospitals in line with ICD requirements. Develop and enforce regulation requiring private hospitals to report and review all maternal deaths to the nearest official structure responsible for MDSR. 1 Training of 500 different level staff annually on reporting maternal death in line with ICD 10 requirements. MoH/DoP x x x $750,000 $10,000 $10,000 $730,000 2 Quarterly meetings among relevant departments of MoH and other ministries responsible for enforcement of private sector regulation especially on maternal death reporting. MoH/DoP i Medical Syndicate x x x $10,000 $10,000 Establish a regular system of QoC assessments and orient the health professionals about its use. The Health Information Strategy is in process of development which will clearly delineate the use of the results from the Quality and all other conducted assessments for policy and decision making. 2 Adaption of QoC tools and conduct three regional ToT followed by cascade trainings at governorates and districts level targeting 1500 different level staff annually. MoH/DoP x x x $1,000,000 $0 $100,000 $900,000 * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 19/32

20 areas/activities Develop a community system of maternal death reporting and response, using ICT in collaboration with Ministry of Planning and other relevant stakeholders. Approach/s Lead govt/national institute Total 4 Four technical WG meetings in order to develop national strategy on community component of maternal death reporting, conduct three regional orientation sessions to policy makers and academicians MoH/DoP MoP/CSO MoI MoC,,, unmet x x $100,000 $10,000 $20,000 $70,000 and Develop a system of maternal death reporting and response initiation by electronic devices in collaboration with Ministry of Planning and other relevant stakeholders. 4 Replicate Missan health visitor initiative to 19 districts (one district per DoH), MoH/DoP MoP/CSO MoI MoC x x x $2,500,000 $2,500,000 Develop VA for maternal deaths in communities in collaboration with Ministry of Planning and other relevant stakeholders. 4 Two technical WG meetings among all involved partners to develop VA mechanism for maternal death at community level. MoH/DoP MoP/CSO MoI MoC x x x $20,000 $5,000 $15,000 Develop system of involving communities in review and response in collaboration with Ministry of Planning and other relevant stakeholders. A regular system for assessing the quality of maternal deaths review and surveillance should be established soon. In addition the tools for quality assessment should be introduced and the capacity of health professionals built on the use of tools and the overall review process in line with the standard procedures for such a system. 4 Four technical WG meetings in order to develop system for review process and feedback/interpretation of data. 1 Hire international consultant for tool development, 2 training courses for central technical committee 3 days duration each with 15 participants. MoH/DoP MoP/CSO MoI MoC x x x $60,000 $5,000 $55,000 MoH/DoP YES YES $70,000 $10,000 $60,000 * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 20/32

21 areas/activities Approach/s Lead govt/national institute Total,,, unmet INNOVATION AND E-HEALTH Explore the need both in terms of workforce capacity and the physical infrastructure necessary for successful implementation of e- Health Strategy in collaboration with relevant partners. 2 Ensure leadership commitment and manage the process leading to development of a national ehealth strategy. MoH/DoP, ICT MoP/CSO UNCIEF x x x $100,000 $10,000 $90,000 Ensure MNCH component is clearly articled in the strategy, Conduct assessment of infrastructure coverage and availability. 2 MoH/DoP MoP/CSO x $0 $0 2 Assess infrastructure status for priority information systems coverage, status, and functioning; develop plan in line with overall national goals. This should be done with health and ICT sector participation and in the context of a national planning exercise. MoH/DoP, ICT x $250,000 $0 $25,000 Based on health priorities and identified gaps, identify priority needs in terms of infrastructure acquisition and deployment. Identify/allocate appropriate resources to update all identified infrastructure gaps. Conduct assessment of existing ICT applications and services Determine the ICT applications required to support the MoH priority programs and gaps. 2 MoH/DoP x $0 $0 $0 2 MoH/DoP x $0 $0 $0 2 Assess the services and applications being implemented across the sector, and any opportunities this provides. This should be done with health and ICT sector participation and in the context of a national planning exercise. MoH/DoP, ICT x $0 $0 $0 Identify/allocate appropriate resources to establish implementation of required ICT applications. 2 MoH/DoP, ICT x x 2013 $0 $0 $0 * This final version has been reviewed and validated through a national accountability workshop involving a broader stakeholder group. Page 21/32