Accountability for Health

The role of data, ICT and civil society

Kirthi Ramesh
Social Development Specialist, ADB
Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect the
views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent.
ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any
consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.

06 June, 2016

Outline
1
Importance of accountability now

2
Unpacking the concept of Accountability

3
Interventions to strengthen accountability

Outline
1
Importance of accountability now

2
Unpacking the concept of Accountability

3
Interventions to strengthen accountability

Why talk about Accountability

for health results now?
Poor and marginalized have been
left behind
Donors under pressure to show
results /use of resources
Fragmentation of health
information systems
Achieving Universal Health
Coverage, Health-related SDGs
Results-based financing
Digital and data revolution

Outline
1
Importance of accountability now

2
Unpacking the concept of Accountability

3
Interventions to strengthen accountability

The Accountability promise

Information
about rights/
entitlements

Information on
provider
performance
Information
on mandate/
expectations

Accounta
bility
mechanis
ms

Government
/
Provider
Response

IMPROVED
HEALTH
OUTCOMES

Accountability actors

Accountability relationship
Principal

Agent

Mandates/Delegates

Equips with resources

Performs /Informs

Monitors/Investigates
Answers/Justifies
Sanctions/rewards

Prerequisites for Accountability

Principal

Agent
Job descriptions, Service
Mandates/Delegates

standards, licensing and

accreditation, SDGs/UHC

Equips with resources

Human & financial

resources, skills,
knowledge, data

Informs/Answers/Justifies
Information (data)
and transparency,
institutional
Monitors/Investigates
mechanisms

Sanction/reward:
Enforces
elections, market,
public pressure, resultsbased financing

Accountability mechanisms
DEMAND SIDE (citizen led)

Traditional vertical forms of

accountability
Elections, demonstrations,
investigative journalism,
media
Social Accountability
mechanisms (development
cooperation)
Citizen report cards,
community based
monitoring, social audit,
grievance redress
mechanisms, complaint
boxes

SUPPLY SIDE (state centered)

Traditional horizontal forms of

accountability
Checks and balances
Regulatory agencies
Command chains
Mechanisms that enable
voice/facilitate demand side
Information Act
Mechanisms that shape
responsiveness
Incentives, rewards, sanctions
Performance-based pay,
results-based management,
greater autonomy, .

are mutually

reinforcing

Context matters

Accountability ecosystem
Government
question
Defend/
explain

Judiciary

Sanction/
overrule
Anti
corruption
bureau

Legislative
(Parliament,
Local Council)

Politicians

Regulatory
bodies

Auditor
general

Bureaucracy
High ranking
civil servants

Ministry of
Health
Public and
private health
care facilities

Decentralized
Health unit

Lower ranking
civil servants

Frontline
service providers
(nurses,
midwives)

Governance
for Health

Whole-ofgovernment
approach

Outline
1
Importance of accountability now

2
Unpacking the concept of Accountability

3
Interventions to strengthen accountability

Tackle

the Data Challenge

Strengthening Accountability requires

access to information and transparency
Challenges
Data fragmentation
Low data quality and
availability
Data duplication

Results
No timely information on
health needs and provider
performance
Inefficiencies and
reporting burden

Leveraging data for accountability requires:

Robust Health Information
systems (HIS)

Comprehensibility/
Visualization of data

Integration or
interoperability of HIS

Actionability and
relevance of data

Independent
verification of data
Data security,
protection/
responsible use

Examples

Health Data
Collaborative

AeHIN
Interoperability
labs

Data
Integration,
Bangladesh

Data
intermediaries,
Indonesia

ADB
involvement

Maximize
ICT Solutions

A cost effective tool to enable citizen

voice and make information available
Timely data
collection and
processing
(e.g. HIS)

Covering hard-toreach populations

(e.g. Mobile data collection)

Data visualization
and dissemination
(e.g. Dashboards, GIS maps)

Enabling voice
(e.g. complaints via SMS)

ICT Examples

UHC
Dashboards,
Philippines

PorMiBarrio,
Uruguay

SMS
complaints,
Bangladesh

Mobile data
collection,
Bangladesh

ICT Examples

Engage
citizens

3 - Engage citizens

Citizen and
beneficiary
feedback

Citizen-led
monitoring
and
oversight

Get patients views in

decisions that impact their
lives
Receive patients feedback
on whether their needs are
met
Find solutions to challenges
jointly

Data
verification

Consultations

Empowerment and building

citizen capacity

Collaborative
decision
making

Examples

UGIIP-3,
Bangladesh
Community
based
monitoring,
Uganda
Participatory
budgeting,
Brazil
KINJERA,
Indonesia

Strengthen
the supply side

Accountability mechanism
SUPPLY SIDE
(state centered)

Traditional horizontal
forms of accountability

DEMAND SIDE
(citizen led)

Mechanisms that enable

voice/facilitate demand
side
Mechanisms that shape
responsiveness

Examples

Information
Act, India
Strengthening
of regulatory
bodies,
Malawi

Freedom of
Information
Act,
Indonesia

Citizen
Charters,
Bangladesh

Leverage
Results-based
lending

Results-based lending and accountability

Strengthening
accountability supports
results-based lending:
Results-based lending
strengthens
accountability:

Incentivize service
providers/
governments
(enforcement)
Equip them with
resources to fulfill
their mandate

Better data for information

about performance
(information/monitoring)
ICT solutions improve data
collection, processing and
visualization
(information/monitoring)
Community based
monitoring/data
collection/feedback for
verification of
results/performance
Community feedback for
improved health outcomes

For more Information:

Kirthi Ramesh
kramesh@adb.org

Health Sector Website:

http://www.adb.org/secto
rs/health/main

Invest in Health for All