Implementation objectives for this ingredient:

2_Untitled-3Robust  accountability processes

Effective civil registration and vital statistics systems

Accountability is the process of monitoring, review and remedial action to achieve results and ensure the respect, protection and fulfilment of human rights. The Global Strategy calls for “robust country-led, multi-stakeholder accountability; independent review and unified reporting; and follow up action at all levels for women, children and adolescents.” To realize this vision, there is a need to build and strengthen country and global accountability frameworks at subnational, national, regional and global levels, building on existing initiatives and aligning with SDG reporting. This includes building on the work of the Commission on Information and Accountability for Women’s and Children’s Health (CoIA) and aligning with the Global Accountability Framework under development by the Independent Accountability Panel (IAP). There is also a need to monitor the impact of the Global Strategy itself through review of progress on agreed milestones (see Table 2). Overall, global accountability will need to be built up from country-level measures and milestones.

Table 2 Global milestones to track the Global Strategy’s impact (2016-2020)


4.1 Robust accountability processes

Inclusive, transparent, diverse and regular reviews of plans, resource utilization and results are key to accountability. Country platforms (discussed in the section on country leadership) can play an important role in undertaking reviews, publishing their outcomes and acting on their results. Key steps include:

  1. determining when and how often to conduct reviews
  2. ensuring broad stakeholder engagement in the process
  3. identifying key data, evidence,  source documents and processes to review
  4. relating findings from reviews to SDG-related commitments for health, human rights, gender and equity, including the incorporation of sectoral reviews into the National Voluntary Reviews of the High-level Political Forum on Sustainable Development
  5. taking remedial actions as necessary.

Mechanisms to strengthen accountability include:

  • parliamentary committees on RMNCAH
  • citizens/ public hearings and inquiries
  • use of national human rights and judicial institutions and their processes
  • action by professional associations, such as health workers
  • standardisation of user-friendly scorecards, updated frequently with locally-available disaggregated data providing insights into progress at national and sub-national levels
  • citizen-led, social accountability platforms such as U Report, social audits and citizen report cards in addition to briefings or town hall meetings on tracking of results.

Health systems require particular attention in order to strengthen accountability, across the functions of monitoring, review and action. Data to inform reviews need to be disaggregated by sex, age, disability, race, ethnicity, mobility, or economic or other status, as nationally relevant, to identify women, children and adolescents facing discrimination in access to healthcare and other entitlements and services that affect their health and human rights. Regular internal review of health service coverage is required at national and sub-national levels to monitor availability, accessibility, acceptability and quality of services. This should inform the design and approach to implementation strategies.

4.2 Effective civil registration and vital statistics systems

Improved systems for civil registration and vital statistics (CRVS) are an essential part of ensuring quality data for decision making and to fulfil the ambitions of the Global Strategy. This is reflected by the inclusion of the birth identity SDG target as one of the “Transform” targets. Key considerations in improving CRVS systems include:

  • setting policies that promote free, universal and accessible birth and death registration as soon as possible after the event
  • removing fees for registration or late registration
  • reducing barriers such as discrimination, harmful social norms, distance and complicated registration processes
  • designing policies for non-residents, for example people with nomadic lifestyles or displaced persons
  • expanding eligibility for those who can be notifiers and verifiers of births and deaths (while taking into account the particular technical challenges of death verification)
  • creating user-friendly forms in relevant languages
  • protecting confidentiality
  • removing criteria that hinder registration such as the presence of both parents
  • using community-based providers and resources can promote birth and death registration
  • documenting the cause of death using standard definitions, e.g. for maternal deaths ICD-MM, to allow countries to plan, prioritize, and implement strategies targeted to preventing deaths from those causes
  • ensuring public availability, free and open access to regularly updated CRVS data to foster accountability mechanisms
  • developing guidelines on the integration of CRVS data into policy-making processes in various sectors and policy levels
  • digitizing CRVS systems and scaling up the use of mobile health applications.


An RMNCH Scorecard and political accountability for health service improvement in Tanzania

In May 2014, the Tanzanian Ministry of Health and Social Welfare created a “Reproductive, Maternal, Newborn and Child Health” (RMNCH) Scorecard to promote accountability for improved health services. The national scorecard provides information on 18 different indicators for each of Tanzania’s 25 regions. Regional scorecards display the same indicators by district. Nearly all data included come from the routine health information system, enabling quarterly updates. Scorecards are color coded, representing indicators that are on track (green), somewhat below targets (yellow) or poorly performing (red). This colour-coding makes interpretation easy for those not familiar with specific health programmes or indicators.

As such, use of the Tanzanian scorecard is not limited to use by health officials, but is shared regularly with political leaders: the Prime Minister, President, regional commissioners and health teams. At the launch of the first scorecard by the President to an audience including regional commissioners, members of parliament, multisectoral government officials, civil society and others, he stated: “These are your working tools. We will use them to track your commitment, leadership and accountability for the lives of mothers and children at national and regional levels.”

A January 2015 review found that most commissioners hold meetings as least quarterly with their regional and district health staff to review the scorecards and encourage them to find ways to improve their health programmes and scores. The regions, in turn, meet with district health teams who create specific action plans for targeted programmes and indicators. Following the first year of implementation, information system reporting rates (and the timeliness of reporting) increased substantially. The scorecard has been incorporated in Tanzania’s new One Plan II for RMNCH and in the Health Sector Strategic Plan IV (2016-2020) (HSSP IV). The HSSP IV also calls for the creation of “community scorecards” to encourage accountability at the health facility level.

Source: John Quinley, A Promise Renewed Secretariat, incorporating information included in a PowerPoint presentation made by Clement Kehinga from the Tanzania MOHSW during the Uganda scorecards meeting.