The Sustainable Development Goal (SDG) Framework (2016–2030), which incorporates 17 development goals, is guiding global action and policy for world peace and prosperity (UN DESA, 2022). The SDG 3 health goal aims to ensure healthy lives and promote well-being for all ages and includes a sub-target (3.8.1) on universal health coverage (UHC). UHC means that all individuals and communities receive the health services they need without suffering financial hardship. UHC is galvanizing action at the international and national levels to strengthen health systems and improve the equitable delivery of health-care services (WHO, 2021).
The UHC goal reflects the broad lessons; health initiatives; calls for action, strategies, and policy declarations that have occurred over the past two decades. These include the primary health-care goal of ‘health for all by the year 2000’ (Hanson et al., 2022), and the rise of global health initiatives such as the World Bank’s Multi-country HIV/ AIDS Program; the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) and the United States President’s Emergency Plan for AIDS Relief (Mwisongo & Nabyonga-Orem, 2016). At the same time, there was also growing awareness of the importance of strengthening country health systems, including health information systems (HIS), for improving population health (Witter et al., 2019).
These developments occurred within the context of key declarations such as the 2005 Paris Declaration for Aid Effectiveness, the 2008 Accra Agenda for Action, and the 2012 Busan Partnership for Development Cooperation. These declarations called for greater alignment and harmonization of development assistance for health, to make the most of strategic investments within the health sector. Evaluations of the implementation of the Paris Declaration – which had as key principles (i) ownership, (ii) alignment, (iii) harmonization, (iv) managing for results, and (v) mutual accountability – concluded that it was, first and foremost, a political agenda for action, rather than a technical set of fixes (Wood et al., 2008). These declarations were made within a broader implementation history of the sector-wide approach (SWAp) in health, which aimed at creating governance structures for joint planning, financing and implementation of health sector priorities by governments and their developing partners (Martinez-Alvarez, 2018).
To achieve UHC, strong data systems are needed. However, the 2020 global report on health data systems and capacity, revealed that almost 50 per cent of countries have limited capacity for systematic monitoring of the quality of care and only 8 per cent of reported deaths in low-income countries show causes of death (WHO, 2020). Fragmented health data systems hamper the availability and effective use of data, especially during disease outbreaks, which in turn weakens policy and resource allocation decisions in countries.
The Health Data Collaborative
Within this broad context, the Health Data Collaborative (HDC) has undertaken an analysis of the level of alignment of partners’ technical and financial investments in HIS in selected countries in Africa. The HDC is a joint effort by multiple global health partners to work alongside countries to improve the availability, quality and use of data for local decision-making and tracking progress towards the health-related SDGs (Health Data Collaborative, 2022). This analysis was conducted in three case study countries – Zambia, Cameroon and Kenya – with two specific objectives:
Assess the extent to which partners’ activities in HIS are aligned or linked to the country’s national priorities.
Investigate whether partners synergize, link and coordinate their technical and financial activities for HIS strengthening.
The overall goal is to support national governments and their partners in the coordinating structures, strategies and procedures needed for better alignment of partners’ investments in the HIS. Zambia is one of three case study countries, as the Zambian Government, through its Ministry of Health (MoH), has adhered to the principles and working procedures of the HDC and has manifested interest in this work, given its relevance for its purposes.
This report presents the methodology adopted to assess the above objectives, including the development of the conceptual and analytical framework. It provides some background information on Zambia’s health system and social, political and economic contexts. The findings are then presented in three domains: Policy and Regulatory Alignment, Systems Alignment and Operational Alignment. The report concludes with a summary of the findings and a proposal for an alignment performance matrix. The matrix could be used to periodically review progress in the alignment of development partners’ technical and financial investments to country HIS.
Source: UN Children’s Fund