Overview Monitoring and Evaluation Framework Indicators and Dashboard

Overview Monitoring and Evaluation Framework, Indicators and Dashboard for Universal Health Coverage (UHC): Asia and the Pacific 2014 Mark Landry, WHO 0 | UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia

Outline l Monitoring Universal Health Coverage (UHC) l Summarize global and regional progress on UHC monitoring and measurement l Review the proposed regional UHC M&E framework and its dimensions l Discuss UHC indicator rationalization process l Solicit feedback to incorporate in next steps 1 | UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia

UHC in Cambodia “…entire health sector and to ensure supportive environment for increased demand equitable access to quality health services in order that ALL the peoples of Cambodia are able to achieve the highest level of health…” Health Strategic Plan: 2008 -2015 2 | UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia

MONITORING UNIVERSAL HEALTH COVERAGE 3 | UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia

Universal Health Coverage l Access to good quality of needed services – Prevention, promotion, treatment, rehabilitation and palliative care l Financial protection – No one faces financial hardship or impoverishment by paying for the needed services. l Equity – Everyone, universality 4 | UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia 4

Three Dimensions of UHC 5 | UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia

Monitoring and Measuring UHC Key Messages l l l l Common global and/ore regional UHC monitoring framework? YES Common set of UHC indicators across all countries? NO Many possible processes, interventions, metrics for countries to monitor – Cambodia will make choices according to your own health priorities and capacity to monitor For many areas related to MDG and chronic conditions there is a set of agreed indicators; for many others there is none More emphasis on equity (collection, analysis and use in policymaking of disaggregated data) Specific focus on financial risk protection, and opportunity for more attention to quality and determinants of health/other sectors UHC dashboard - innovative approach for pragmatic analysis and use of indicators for evidence-based decision making 6 | UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia

GLOBAL UPDATE 7 | UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia

Measurement and monitoring of UHC Global Updates l WHO-WB Monitoring Progress towards UHC at Country and Global Levels: Framework, Measurements and Targets l Global Reference List of Core Health Indicators (300+ aiming for ‘core 100’) l UHC measurement in the post-2015 development agenda 8 | UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia WHO/WB Guidance

Outstanding Issues l What is the right mix of tracer indicators? – l What measures of equity and financial risk protection? – l Criteria for country-specific intervention coverage indicator selection Focus on bottom 40% (World Bank), disaggregation of data What approaches to measure health systems resiliency or performance? – Qualitative measures (OECD for example) What level of data reliability and which sources are appropriate? l How do we minimize data collection and reporting burden? l How do we build on the national M&E framework and core indicators that already exist? l 9 | UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia

Bringing Together Global and Country Perspectives Global Country l Common monitoring framework, l No one‐size‐fits‐all one common small set of targets approach, but use of flexible and indicators (or index) global framework and guidance l Regular standardized reporting l Country monitoring based on and review of progress using the adapted set of tracer indicators common indicators ("progressive realization of UHC") l Monitoring UHC aligned with country mechanisms of review of progress 10 | UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia

REGIONAL UPDATE 11 | UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia

Measurement and monitoring of UHC in Asia and the Pacific Regional Updates l 87 WPRO Core Indicators featured in the Health Information and Intelligence Platform (HIIP), including health systems performance dashboard l HIIP increases access to and quality of health information for the Western Pacific Region l HIIP enhances data analysis and use and improve communication of reliable information 12 | UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia

WHO Regional Office for the Western Pacific Core Indicators (2012 – 2016) Inputs and Processes Health financing • Total health expenditure per capita, as % of GDP • General government expenditure on health as % of total government expenditure • General government expenditure on health as % of total health expenditure • Private health expenditure as % of total health expenditure • External resources for health as % of total health expenditure Health workforce • Health workers per 10000 population • Physicians per 1000 population • Nursing personnel per 1000 population • Midwifery personnel per 1000 population • Number of medical school graduates • Number of nursing graduates • Number of midwifery graduates Health Infrastructure • Health facilities per 10000 population • Health posts and clinics per 10000 population • Health centres per 10000 population • District hospitals per 10000 population • Provincial hospitals per 10000 population • Regional/specialized/teaching and research hospital per 10000 population • Hospital beds per 10000 population Others (information, governance) • Civil registration coverage of deaths (%) Outputs Service access & readiness • Tracer medicines availability in health facilities (Mean availability of selected generic medicines) • Median price ratio for tracer medicines (Median consumer price ratio of selected generic medicines) • Mean number of outpatient visits person per year Service quality, efficiency & safety • TB case detection rate • TB treatment success rate (DOTS) • Malaria test positivity rate • 30 day hospital case fatality rate for AMI • Mean waiting time to elective surgery: cataract • Surgical wound infection rate (% of all operations) Outcomes Coverage of interventions • Antenatal care coverage (4+ visits) (%) • Births attended by skilled personnel (%) • % of need for FP satisfied (Contraceptive prevalence rate) • % of children with ARI taken to health facility • % children with diarrhoea receiving ORT • ITN use among children (% of population in malaria-risk areas using effective malaria preventive measures) • ARV therapy coverage among people with advanced HIV infection • ARV prophylaxis coverage among HIV+ pregnant women • % of children <5 treated with appropriate anti-malarial drugs (% of population in malaria-risk areas using effective malaria treatment measures) • DPT 3 immunization coverage • Measles immunization coverage • Hep. B 3 immunization coverage Risk factors and behaviours • Population using improved drinking water sources • Population using improved sanitation facilities • Low birth weight among newborn (%) • % infants exclusively breastfed for first six months • Children under 5 who are underweight (%) • Children under 5 who are stunted (%) • Prevalence of condom use by adults 1549 at last higher risk sex • Prevalence of smoking (youth and adults) • Prevalence of alcohol use (binge drinking) • Prevalence of heavy episodic drinking • Average intake of salt per day • Prevalence of insufficient physical activity Health Information & Intelligence Platform Impact Health status/Equity • Life expectancy at birth • Neonatal mortality rate • Infant mortality rate • Child mortality rate (under-5) • Maternal mortality ratio • Mortality rate of diabetes mellitus; chronic respiratory diseases; cardiovascular diseases; cancer • Mortality rate by major cause of death by sex and age • TB mortality rate • Malaria mortality rate • TB prevalence • TB incidence rate • Malaria incidence (total, by species) • HIV prevalence among 15 -24 (15 -49) • Incidence rate of measles • Incidence rate of neonatal tetanus • Incidence rate of diarrhoea <5 • Prevalence of anaemia among pregnant women • Adolescent birth rate Financial risk protection • Out of pocket as % of total health expenditure Note: ----- HQ indicator ----- MDG indicator not included among the HQ indicators ----- Indicators added by WPRO Updated: 04 Dec 2013

Health. Informationand and. Intelligence. Platform (HIIP) forthe the. Western. Pacific 14

Health Information and Intelligence Platform (HIIP) for the Western Pacific Features of HIIP – Data and analytics § Access to national data and international estimates • health-related indicators • across countries • across years • disaggregated when possible 15

Health Information and Intelligence Platform (HIIP) for the Western Pacific Features of HIIP – Data and analytics § Smart data visualizations for comparisons across countries, exploration and analysis of trends 16

Health Information and Intelligence Platform (HIIP) for the Western Pacific Features of HIIP – Data and analytics § Smart data visualizations for comparisons across countries, exploration and analysis of trends 17

Health Information and Intelligence Platform (HIIP) for the Western Pacific Features of HIIP – Data and analytics § Smart data visualizations for comparisons across countries, exploration and analysis of trends • Sample subnational map 18

Health Information and Intelligence Platform (HIIP) for the Western Pacific Features of HIIP – Country profiles § Enhanced country profiles 19

Health Information and Intelligence Platform (HIIP) for the Western Pacific Features of HIIP – Country profiles § Enhanced country profiles • Structured • Interactive • Dynamic 20

Health Information and Intelligence Platform (HIIP) for the Western Pacific Features of HIIP – Dashboards § Regional view of health status and trend by topic Road safety dashboard 21

Health Information and Intelligence Platform (HIIP) for the Western Pacific Features of HIIP – Dashboards § Regional view of health status and trend by topic Immunization 22

Health Information and Intelligence Platform (HIIP) for the Western Pacific Features of HIIP – Dashboards § Regional view of health status and trend by topic Millennium Development Goals 23

Health Information and Intelligence Platform (HIIP) for the Western Pacific Features of HIIP – Dashboards § Regional view of health status and trend by topic Noncommunicable diseases 24

Health Information and Intelligence Platform (HIIP) for the Western Pacific Features of HIIP – Dashboards § Regional view of health status and trend by topic Tobacco control 25

Health Information and Intelligence Platform (HIIP) for the Western Pacific Features of HIIP – Dashboards § Regional view of health status and trend by topic Women’s health 26

Health Information and Intelligence Platform (HIIP) for the Western Pacific Features of HIIP – Reports and Publications 27

Health. Informationand and. Intelligence. Platform (HIIP) forthe the. Western. Pacific § HIIP ongoing enhancements/development • Dashboard development Health systems strengthening review (draft) 28

Health. Informationand and. Intelligence. Platform (HIIP) forthe the. Western. Pacific § HIIP ongoing enhancements/development • Dashboard development Assessing national capacity for prevention and control of NCDs (draft) 29

Health. Informationand and. Intelligence. Platform (HIIP) forthe the. Western. Pacific § HIIP ongoing enhancements/development • Dashboard development Malaria (draft) MDG 4 enhancement (draft) 30

The Philippine Example Platform Health Information and Intelligence (HIIP) for the Western Pacific 31

The Philippine Example Platform Health Information and Intelligence (HIIP) for the Western Pacific 32

The Philippine Example Platform Health Information and Intelligence (HIIP) for the Western Pacific 33

The Philippine Example Platform Health Information and Intelligence (HIIP) for the Western Pacific 34

The Philippine Example Platform Health Information and Intelligence (HIIP) for the Western Pacific 35

REGIONAL UHC M&E FRAMEWORK 36 | UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia

Long-term UHC Measurement and Monitoring Efforts in the Region Service, Programme, and Policy Planning and Delivery Assessment of health systems performance and UHC status 2014 Development of UHC M&E Framework & Dashboard Prioritization and planning for service, programme and policy Progressive delivery of enhanced services, programmes and policies Assessment of health systems performance and UHC progress 2015 Identification of UHC M&E requirements and gaps in existing M&E systems Collection of required UHC M&E data elements Planning for HIS strengthening to meet UHC M&E requirements HIS strengthening including development of new tools 2014, and Phnom Penh, Cambodia 37 | UHC Dashboard Consultation, 17 September Monitoring Evaluation Review of UHC M&E Framework

M&E Framework for UHC in WPR Input and processes Output Health sector Health System Policies and Resources Governance and policies Health care financing Health care resources Health care finance Risk pooling Funding, purchasing Health Service Delivery Health Service Utilization Promotive Household health-related financial security Preventive OOP expenditure Treatment Catastrophic expenditure Palliative and Rehab Health information system Health Goals Availability Non-health sector Impact Coverage and outcomes Readiness Health System Performance Economic, social & public policies Accessibility Financial risk protection coverage mechanism Enabling environment for health Quality and safety Responsiveness Determinants of health Continuity of care Efficiency and sustainability Well-being Mortality Morbidity Disability Environmental factors Health sector Living and working conditions Non-health sector actions Education, social, infrastructural, support Health Behaviors Substance, diet & lifestyle factors Social Goals Inclusion, participation, awareness, satisfaction Behavior and social factors Equity in non-health sector inputs Equity in service delivery Equity in Coverage Equity in Health

M&E Framework for UHC in WPR 39 | UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia 39

Mapping of WHO HQ basket for indicator & data availability in HIIP WHO HQ proposed basket of UHC indicators For each WHO HQ indicator determine availability in HIIP Identify related HIIP indicators, potential proxy indicators Not. Available available, Available but similar with recent with data available data Not available, Available butold similar but data with data available Not available, Available Not available but similar with or no data available 40

Indicator rationalization 1 Available in HIIP Not available in HIIP 2 Include in initial WPRO core set WHO HQ indicators into framework dimensions Identify dimensions with insufficient / no indicators Identify related / proxy HIIP indicators with data Identify appropriate alternative indicators in consultation with TAG and Technical Units Rationalize according to: Significance Alignment with SDGs / other global priorities Availability / feasibility Size of core set Balance across levels Identify remaining dimensions with insufficient / no indicators WPRO core set of UHC M&E indicators 3 41

Indicator selection criteria Combined, the set should: • encompass all M&E levels • include a broad range of populations, programme areas, health and non-health sectors • be sensitive to developments and progress towards UHC Individually, indicators should meet predefined criteria: • They are significant / relevant • Relate to illnesses / services / programmes & policies of high epidemiological and public health importance • Aligned with SDGs and other global priorities • Data are or will be available - including disaggregated data • Or data collection can be implemented with reasonable resources World Health Organization 42

The WHO-ADB Initiative: Develop UHC M&E Framework, Indicators & Dashboard Main outputs l Initial UHC M&E Framework and Dashboard – Regional and select country levels (KHM, LAO, PHL, BGD) l Learnings in the process, content, platform and tools 43 | UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia

The WHO-ADB Initiative: Development of UHC M&E Framework and Dashboard Partners l ADB, SEARO, University of Oslo and HISP VNM, Ae. HIN, UP National Tele. Health Center, Partnership for Better Health Timeline l Start: July 2014 l Sharing of outputs: 2 -5 December 2014 at the Conference on Measuring and Achieving UHC with ICT in Asia. Pacific in Manila 44 | UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia

The WHO-ADB Initiative: UHC M&E Framework. Dashboard and Tools § Regional UHC M&E Framework § HIIP (and GHO) databases § HIIP tools § Country UHC M&E Frameworks § Country M&E systems and databases § Country platforms and tools (DHIS 2 Tableau, others) 45 | UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia

The WHO-ADB Initiative within the Regional UHC Monitoring Efforts Service, Programme, and Policy Planning and Delivery Assessment of health systems performance and UHC status 2014 Development of UHC M&E Framework & Dashboard Prioritization and planning for service, programme and policy Progressive delivery of enhanced services, programmes and policies Assessment of health systems performance and UHC progress 2015 Identification of UHC M&E requirements and gaps in existing M&E systems Collection of required UHC M&E data elements Planning for HIS strengthening to meet UHC M&E requirements HIS strengthening including development of new tools 2014, and Phnom Penh, Cambodia 46 | UHC Dashboard Consultation, 17 September Monitoring Evaluation Review of UHC M&E Framework

The WHO-ADB Initiative: Development of UHC M&E Framework and Dashboard Anticipated learnings �Processes § Stakeholder engagement and defining priorities § Indicator rationalization § Linking M&E systems to populate UHC M&E requirements �Contents § Regional and country UHC situations and understanding potential country-specific priorities and indicator sets for monitoring progress towards UHC § Current capacities and gaps in M&E systems for UHC monitoring 47 | UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia

THANK YOU 48 | UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia