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

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

UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia 2 |2 | UHC in Cambodia “…entire health sector and to ensure supportive environment for increased demand and 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:

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

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

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

UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia 6 |6 | Monitoring and Measuring UHC Key Messages 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

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

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

UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia 9 |9 | Outstanding Issues What is the right mix of tracer indicators? – Criteria for country-specific intervention coverage indicator selection What measures of equity and financial risk protection? – 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? How do we minimize data collection and reporting burden? How do we build on the national M&E framework and core indicators that already exist?

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

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

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

WHO Regional Office for the Western Pacific Core Indicators (2012 – 2016) Inputs and ProcessesOutputsOutcomesImpact Health financing Total health expenditure per capita, as % of GDP General government expenditure on health 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 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 population Health posts and clinics per population Health centres per population District hospitals per population Provincial hospitals per population Regional/specialized/teaching and research hospital per population Hospital beds per population Others (information, governance) Civil registration coverage of deaths (%) 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 per 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) 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) DPT3 immunization coverage Measles immunization coverage HepB3 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 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 Prevalence of raised blood pressure Prevalence of raised blood glucose 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 (15-49) 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 Information & Intelligence Platform

14 Health Information and Intelligence Platform (HIIP) for the Western Pacific

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

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

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

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

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

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

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

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

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

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

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

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

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

28 Health Information and Intelligence Platform (HIIP) for the Western Pacific  HIIP ongoing enhancements/development Dashboard development Health systems strengthening review (draft)

29 Health Information and Intelligence Platform (HIIP) for the Western Pacific  HIIP ongoing enhancements/development Dashboard development Assessing national capacity for prevention and control of NCDs (draft)

30 Health Information and Intelligence Platform (HIIP) for the Western Pacific  HIIP ongoing enhancements/development Dashboard development Malaria (draft) MDG 4 enhancement (draft)

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

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

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

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

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

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

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

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

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

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

Include in initial WPRO core set Available in HIIP WPRO core set of UHC M&E indicators WHO HQ indicators into framework dimensions Identify related / proxy HIIP indicators with data Identify dimensions with insufficient / no indicators Identify remaining dimensions with insufficient / no indicators Indicator rationalization 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 Not available in HIIP 41

World Health Organization 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 42

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

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

UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia 45 | 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 (DHIS2 Tableau, others)

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

UHC Dashboard Consultation, 17 September 2014, Phnom Penh, Cambodia 47 | 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

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