Warning: Parameter 1 to wp_default_scripts() expected to be a reference, value given in /home/everywo1/public_html/opf/wp-includes/plugin.php on line 601

Warning: Parameter 1 to wp_default_styles() expected to be a reference, value given in /home/everywo1/public_html/opf/wp-includes/plugin.php on line 601
COUNTRY LEADERSHIP – EWEC

01 COUNTRY LEADERSHIP


Implementation objectives for this ingredient:


A strong multi-stakeholder country platform for women’s, children’s and adolescents’ health

National and subnational SDG targets

A single prioritized, costed, national plan for women’s, children’s and adolescents’ health

Effective stewardship and monitoring of implementation across sectors

“The SDGs and targets are integrated and indivisible, global in nature and universally applicable, taking into account different national realities, capacities and levels of development and respecting national policies and priorities. Targets are defined as aspirational and global, with each government setting its own national targets guided by the global level of ambition but taking into account national circumstances. Each government will also decide how these aspirational and global targets should be incorporated in national planning processes, policies and strategies.”

The 2030 Agenda for Sustainable Development

 

The first action area of the Global Strategy is country leadership – which encompasses all of the other action areas. As the above quotation from the 2030 Agenda for Sustainable Development notes, national governments will need to decide how to incorporate the SDG targets and Global Strategy action areas into their implementation efforts through national and subnational plans, strategies, policies and programming, in partnership with civil society, the private sector and development partners.

Facilitating country leadership is also an overarching ingredient for operationalizing the Global Strategy across its action areas. Countries will need to adapt and integrate existing plans for women’s, children’s and adolescents’ health, themselves subsumed into existing national health plans and strategies, to incorporate the SDGs and the action areas of the Global Strategy, while developing new strategies for areas that are currently missing.

Challenges that have arisen with respect to planning in the MDG era need to be overcome. Some national plans for women’s, children’s and adolescents’ health have been insufficiently integrated into national health sector plans and paid insufficient attention to the determinants of health, fostering fragmented implementation. Large portions have remained under-funded and critical aspects such as adolescent health, family planning, equity, or multisectoral dimensions were often overlooked. Accountability for results has varied both across and within countries. In addition, civil society engagement and mobilization around results remains nascent.

 

1.1 A strong multi-stakeholder country platform for women’s, children’s and adolescents’ health

Led by the Ministry of Health, the process of improving national health plans is an in-depth stocktaking exercise in which policymakers, civil society (including adolescents), the private sector and technical experts review the situation of women, children and adolescents, identifying the high-impact interventions and fundamentally new strategies needed to accelerate results. This requires a strong multi-stakeholder country platform for women’s, children’s and adolescents’ heath that brings together all essential stakeholders – government, communities, civil society, the private sector and development partners.

Country platforms can take different forms and should build on existing governance processes within countries. Country platforms need to:

  • be transparent and inclusive of groups normally excluded from decision-making (including youth and adolescents)
  • bring together crucial sectors for health beyond the health sector
  • integrate with and build on existing mechanisms for planning and coordination, including other planning processes relevant to the SDGs
  • be used for monitoring and reviewing progress in addition to initial planning
  • have clear performance metrics and accountability mechanisms for their functioning, in line with International Health Partnership (IHP+) guidance and the Global Strategy accountability framework
  • include consultations at subnational and local levels to strengthen coordination between different administrative levels within countries.

RESOURCES

Detailed guidance note for Country Platforms for the GFF (under development)

1.2 SDG targets translated into national and subnational strategies and targets

The Global Strategy includes 17 key targets drawn from the SDGs which are crucial to the health of women, children and adolescents (see Table 1 above). SDG goals and targets require translation for countries’ own contexts, with the setting of country-specific goals and targets, linked to national and global accountability frameworks through the following steps to be undertaken by the country platform:

  1. Compare SDG targets to current targets already set in existing national plans and strategies
  2. Analyse current progress against both national and SDG targets (for example, by analysing the distribution of reproductive, maternal, neonatal, child and adolescent health (RMNCAH) mortality and morbidity (including stillbirths) as well as underlying causes and determinants) Accountability – Reinforcing global and national accountability mechanisms
  3. Establish country baselines for SDG targets related to RMNCAH, disaggregating data by key stratifiers to identify geographical areas and/or specific populations and communities of greatest need
  4. Model the current national and subnational trajectory towards the 2030 SDG targets
  5. Set or reaffirm national targets for 2030 for the SDGs related to the Global Strategy for joint monitoring of national health and RMNCAH strategies across different sectors
  6. Identify subnational targets tailored to regional and local populations, focused on reducing inequities and gaps in data for monitoring these targets.

 

Example of a Logical Framework for the Process of Setting Targets
(Source: UNECE & WHO 2010)

1_Untitled-2

 

 

Like the MDGs, the SDG targets highlighted in the Global Strategy mostly focus on outcomes, rather than what is required to achieve them – this reflects that country contexts vary, and different paths will be required to achieve these targets to account for this diversity. Countries may find it useful to set additional targets, either on the key interventions and strategies in health and other sectors required, or intermediary milestones (e.g. for 2020 and 2025) to guide progress towards the 2030 deadlines.

RESOURCES

Scanning the landscape of existing strategies and plans: UNITAR Module 6, slides 55-60 and Comparative analysis of SDGs and existing goals (goal level): UNITAR Module 6, slide 64

1.3 Strengthening prioritized, costed, national and subnational plans

Setting national SDG targets and considering the Global Strategy provides an opportunity for countries, via the country platform, to review existing strategies, identify and eliminate implementation constraints, prioritize interventions and consolidate plans into a single prioritized, costed strategy for women’s, children and adolescents’ health. Such a plan clearly focused on results (“investment case”) aims to guide and attract additional financing from national and global partners over a three-to-five-year period, and can be further developed iteratively depending on the mobilization of resources. Consolidation and review of plans also provides an opportunity to prioritize key interventions in both health and non-health sectors, integrating with national strategies in key areas such as nutrition, education and social protection. Countries may draw from the overarching interventions presented in the Annexes of the Global Strategy and existing country programmes. Thus, priority interventions for scale-up can be identified, taking into account the country situation, coverage and human rights principles.

A prioritized, costed plan can drive agreement among key stakeholders on the set of priorities that can feasibly be implemented given the resources available. It can thus help shape the financing of such priorities. Such a plan should ideally be finalized as early as possible in the SDG era, drawing upon, integrating and clarifying existing planning processes and documents. Steps in the development process include:

  1. agreement on what basis and what form the investment case should take
  2. situation analysis (taking into account modelling undertaken in setting national targets)
  3. selection of interventions and strategies
  4. assessment of costs, cost-effectiveness of strategies and mapping of available resources
  5. definition of priorities
  6. agreement on who will finance each part of the plan among national and global partners (for more detail see section on “Aligning and Mobilizing Financing”)
  7. publication and dissemination of draft plan to seek feedback
  8. finalization of plan
  9. implementation.

RESOURCES

Detailed guidance for investment cases for the GFF (under development)

Human Rights and Gender Equality in Health Sector Strategies: How to Assess Policy Coherence (OHCHR, WHO, SIDA 2011)

Technical Guidance on the Application of a Human Rights-based Approach to the Implementation of Policies and Programmes to Reduce and Eliminate Preventable Mortality and Morbidity of Children Under 5 Years of Age. OHCHR (2014)

Technical Guidance on the Application of a Human Rights-Based Approach to the Implementation of Policies and Programmes to Reduce Preventable Maternal Morbidity and Mortality (OHCHR 2012)

1.4 Effective stewardship and monitoring of implementation across sectors

Country leadership extends beyond planning – even more important is stewarding and coordinating effective implementation across key sectors. Other parts of this Operational Framework consider key aspects of this, in particular the crucial contribution of an accountability framework that enables rapid action to address data revealing poor progress on national plans and strategies, or unforeseen consequences.

 

Strengthening of subnational platforms, similar to the country platform, is required for subnational coordination and monitoring the plan’s implementation. Decentralized implementation may also improve its responsiveness to marginalized communities.

 

Effective implementation also requires strengthening of management capacity in health and other social services, particularly at the decentralized level, including:

  • building local level evidence for investing in the health and opportunities for women, children and adolescents
  • engaging decision-makers at subnational level on the need to adequately finance and implement interventions that improve the health and wellbeing of women, children and adolescents.

CASE
STUDY

Nigeria’s Saving One Million Lives Initiative: A case study of country leadership to achieve results

The Saving One Million Lives (SOML) Initiative was launched in Nigeria by the President in October 2012, focusing on results and outcomes across six priority ‘pillars’: 1) strengthening RMNCH delivery platforms, 2) routine immunization coverage and polio eradication, 3) mother to child transmission of HIV, 4) access to essential RMNCH commodities, 5) malaria control and 6) child nutrition. In its original incarnation, SOML had a deadline of 2015 to match the MDGs as well as the 2015 presidential elections. The Federal government extended the initiative in 2015 with new World Bank funding for a linked four-year performance-based Programme for Results (P4R). Going forward, states will receive additional resources through P4R based on their performance on five process and outcome-related indicators.

SOML became a national priority initiative in Nigeria under the leadership of the Minister of State for Health. It has focused national attention on the basics of a primary health care approach, articulated strategic priorities for the Federal government and the health sector, and re-oriented service delivery discussions to results rather than inputs.

Further, the SOML team at the Federal level emphasized frequent and robust monitoring. Ongoing programme success was tracked using service coverage rates and related estimates of changes in mortality. A national scorecard was developed to compare states and encourage improvements. The Nutrition and Health Survey (NHS), which originally focused solely on northern Nigeria, was expanded to cover the entire country, explore additional RMNCH-related services and produce state-level data on an annual basis. This survey is now the main source of data for the new P4R to determine state financial incentives.

The Federal government also undertook specific actions to coordinate existing programmes to achieve better results. This national level coordination encouraged various state-level actors across HIV and maternal care programmes to use resources more effectively to make progress in PMTCT. The SOML team also worked to bolster accountability of managers and health workers through engagement, encouragement and incentives. In addition, the Federal SOML office put together coalitions of private sector companies and philanthropies to support the initiative. Compared to the usual focus on public services only, this emphasis on partnerships was an innovation to accelerate progress towards results. The Ministry of Health also tapped into special Federal accounts with resources to fund and manage large scale programmes outside of the regular Ministry of Health budget.

Programme areas that the country leadership prioritized and that have shown promising results include polio eradication, malaria control, routine immunization (particularly in northern Nigeria) and community management of acute malnutrition.

Sources: John Quinley; Loevinsohn BP (2015) Nigeria - Programme to Support Saving One Million Lives : P146583 - Implementation Status Results Report: Sequence 01. Washington, DC: World Bank Group. Federal Government of Nigeria and World Bank (2014) Saving One Million Lives. Programme for Results. Brochure
INTRODUCTION
ROLE OF PARTNERS