Presentation on theme: "1 UNICEF’s Refocus on Equity: Results Based Management through Monitoring for Equity Equity Meeting Oslo, 10 May 2012."— Presentation transcript:
1 UNICEF’s Refocus on Equity: Results Based Management through Monitoring for Equity Equity Meeting Oslo, 10 May 2012
Monitoring Framework for Management for Results for Deprived Children Level 1: All Country Offices review the equity-focus of their situation analysis, the quality of causal and bottleneck analysis of child deprivations and the alignment of policies, strategies and plans. Level 2: Where one or more specific child deprivation are prevalent and addressed by the country programme, the Country Office monitors UNICEF inputs and outputs. Level 3: As countries show measurable progress in programme implementation, the Country Office, jointly with partners, assesses, analyses and addresses bottlenecks and barriers to estimate progress towards outcomes in representative areas or groups Supply and quality bottlenecks Financial, social bottlenecks Level 4: As countries show good progress in reducing bottlenecks, the Country Office validates the achievement of outcomes and estimates progress towards reducing child deprivations Guide programmatic adjustments and management decisions Enabling environment barriers PLANNING Inputs & outputs Intermediate Outcomes Final Outcomes/ impact EVALUATION
STRENGTHENING SERVICES, SYSTEMS & POLICIES FOR HEALTH RELATED MDG’S: STRATEGIC SHIFTS FOR UNICEF Macro – Level: Equity focused enabling environment Meso- Level: System Capacity for Service Delivery & Community Empowerment (Supply) CONDITIONS FOR REDUCING CHILD DEPRIVATIONS Preventable Diseases HIV/AIDS Child Mortality Malnutrition Illiteracy Non registration at birth Exploitation & Violence MDGs with EQUITY: child deprivations Micro- Level: empowered communities & families(Demand) Other context specific child deprivations Management/ Coordination Legislation Policies Budgets/ expenditures HUMAN RESOURCES GEOGRAPHICAL ACCESS FINANCIAL ACCESS SUPPLIES SOCIO/CULT. ACCEPTABILITY QUALITY INFORMATION PROMOTION Enabling environment for positive behaviors Social norms PREVENTION TREATMENT FINANCING COMPLIANCE Family care practices & service use Service Delivery System Building Blocks
Seven steps for level 3 monitoring of bottlenecks 1. Decide what and WHO to monitor: Ten determinants for reducing deprivations 2. Define specific indicators: Identify country-specific indicators for the ten determinants 3. Identify information sources and collect information: map, validate and complement information for the ten determinants 4. Identify bottlenecks & track changes: Select weakest links in the chain of determinants as bottlenecks, and track their evolution every six months 5.Analyze causes of bottlenecks: starting from decentralized analysis of local causes and feeding into national synthesis of cross cutting bottlenecks. 6.Decide on corrective actions at all levels: from local management actions to national strategic policy & budget adjustments. 7.Report results: report “real time” evolution of cross- cutting bottlenecks to trigger action at national/ regional /global level
Aggregate of 7 indicators: Percentage of U5 not stunted Primary net attendance rate % Children 12-23 months who received DPT3 % Deliveries assisted by (aux-nurse) midwife or physician Knowledge of HIV/AIDS prevention (women) % Population using improved sanitation Birth registration Step 1: Assessing child deprivation through Coverage Deficit Scores
Step 2. Examples of country specific indicators complementary feeding Determinants of complementary feeding Example of country specific indicators for complementary feeding Enabling Environment Social Norms supportive of good feeding practices for children Key influencers for complementary feeding (i.e. pediatricians) that support importance of a minimum acceptable diet for children Legislation/Policy supportive of good feeding practices for children Comprehensive, multi-sectorial national stunting reduction strategy (including complementary feeding) integrated into 2011- 2015 PRSP Adequate Budget/ expenditure for programmes to support complementary feeding % of districts with adequate budget allocation & utilization for infant and young child feeding programmes included in 2011-2013 MTEF Management/ Coordination mechanisms in place for comp. feeding programmes District level mechanism in place for local coordination of the implementation of the national SWaP on nutrition Supply Availability of essential commodities/inputs for comp. feeding % of health facilities with adequate availability of infant and young child feeding counseling tools and lipid based nutrient supplements Access to adequate services and information on comp. feeding % of villages with community health worker trained on infant and young child feeding counseling Demand Financial access to adequate complementary foods Proportion of households (some, most, all) visited with caretaker reporting the availability of an animal food and cooking oil for feeding a 6-23 month old child Social and cultural practices and beliefs supportive to adequate nutrition of mothers and children <2 Proportion of households (some, most, all) visited with caregivers of children aged 6-23 months reporting that an infant can be fed eggs Continuity of improved comp. feeding practices Proportion of households (some, most, all) visited with care giver reporting that their children aged 6-23m received lipid based nutrient supplements at least 3 times a week Qty Quality of complementary feeding practices according to standards Proportion of households (some, most, all) visited with caretaker reporting that their children aged 6-23 m did consume oil, an animal food, and a vegetable/fruit yesterday.
7 Step 3: Information Sources “Mixed methods approach” that combines quantitative and qualitative research methods best suited to answer questions on bottlenecks and barriers to achieving programme goals and to validate/triangulate routine information & monitoring systems Intended to trigger action to remove bottlenecks at decentralised levels Approach draws on quantitative research and the power of statistical analysis with the insight that qualitative assessment can offer into programme processes and complex situations. Builds on and strengthens existing data collection systems and fills gaps on bottlenecks and/or causes of bottlenecks where appropriate Assessments through a mutually reinforcing data collection and analysis process strengthens programming, as well as enables involvement of key stakeholders. Validity of qualitative data can be enhanced through triangulation with other sources of information.
Step 4- 6: Identify bottlenecks, analyse causes and correct actions Supply Bottlenecks 40% difference in food security Demand bottlenecks Utilisation limited by food availability & additional continuity and quality bottlenecks Similar accessibility to CHW & education Community participation / dialogue; Strengthened partnerships btw community & services; Refresher training of CHW; performance incentives for quality IPC / counseling on feeding practices to most deprived mothers and monitoring General Food Distribution to targeted deprived districts Source Bangladesh, Nepal, Pakistan 80% 72% 54% 43% 63% 59%
Step 7: Reporting of changes in bottlenecks at country and inter-country levels Of 30 countries which selected to monitor reduction in stunting Reporting start date: 20 countries identified “availability of complementary foods” as their critical bottleneck By Period 1: Of these 20 countries,12 countries reported that they removed this bottleneck by mobilizing/leveraging other partners; In 7 of these 12 countries, socio-cultural barriers to complementary feeding were then reported as the major bottlenecks By Period 2: Socio-cultural barriers were reported to be lifted by mobilizing key influencers
INITIAL IMPLEMENTATION IN 26 COUNTRIES RegionCountries WCAROBenin, Ghana, DRC, Niger, Senegal, Nigeria ESAROUganda, Rwanda, South Africa, Zimbabwe, Mozambique MENAMorocco, Egypt, Lebanon EAPROPhilippines, Laos, Indonesia CEE/CISGeorgia, Moldova TACROPeru, Guatemala, Nicaragua ROSANepal, Bangladesh, Bhutan, Pakistan Key Phases in Implementation A. Clarification/Scoping; B. Planning; C. Capacity building; D. Leveraging/Advocacy; E. Technical Support (indicators, MOV and processes); F. Field Test / initial implementation; G. Monitoring of bottleneck reductions and Synthesis; H. Documentation and Dissemination
Lessons Learned in first wave countries The bottleneck analysis is a very useful tool for identifying – important programme and knowledge/data gaps; – priority actions – cross-sectoral issues/bottlenecks Useful for assessing existing M&E systems and considering adaptations to strengthen them Reinforces the link between Levels 1 and 3 and the importance of having an evidence based SitAn in place. Various entry points depending on country context Value added when partners included in bottleneck analysis but varied approaches on when to engage partners Engagement and discussion across sectors and participation of whole office extremely valuable Different starting points for the analysis – by determinants as “neutral” conditions or by bottlenecks
MORES IN HUMANITARIAN CONTEXTS Monitoring of Results for Equity System (MoRES) adapted in Emergencies ( = Humanitarian PM) Level 1 Needs assessment Draws on prior Situation Analysis Re-assesses enabling environment, services and support, and access and use of services Level 2 SitReps at agreed frequency (e.g. weekly, monthly, quarterly according to context) including: narrative report and VISION management reports on resources for selected IRs Level 3 In major emergencies (e.g. Appeals > $15 million ORE), CO to prioritize/redirect resources to scale up monitoring Monitoring aligns to new priority results in line with CCCs Key steps of MoRES Level 3 monitoring compressed Defining indicators and data collection systematically include: Key output indicators for coverage estimates (supply) thru partners Quality issues (access, use) thru field monitoring Cluster milestones thru self-reporting Higher frequency management review