Assessing Partner Alignment in Support of Health Information System in Zambia – Zambia
Background and problem statement
The Sustainable Development Goals (SDGs) framework (2016-2030), which includes 17 development goals, guides global action and policy for global peace and prosperity (UN DESA, 2022). The health goal of SDG 3 aims to enable healthy lives and promote well-being at all ages and includes a sub-goal (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 galvanizes action at international and national levels to strengthen health systems and improve the equitable delivery of health services (WHO, 2021).
The goal of UHC reflects general lessons; health initiatives; calls to action, strategies and policy statements that have taken place 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 and Nabyonga-Orem, 2016). At the same time, there was also a growing awareness of the importance of strengthening countries’ health systems, including health information systems (HIS), to improve the health of the population (Witter et al ., 2019).
These developments occurred in the context of key declarations such as the 2005 Paris Declaration on Aid Effectiveness, the 2008 Accra Agenda for Action and the 2012 Busan Partnership for Development Cooperation. These declarations called for better alignment and harmonization of development assistance for health, in order to get the most out of strategic investments in the health sector. Evaluations of the implementation of the Paris Declaration – which had as key principles (i) ownership, (ii) alignment, (iii) harmonization, (iv) results-based management and ( v) mutual accountability – concluded that it was, above all, a program of political action, rather than a technical set of solutions (Wood et al., 2008). These statements were made as part of a broader implementation of the sector-wide approach (SWAp) in health, which aimed to create governance structures for joint planning, financing and implementation of health priorities. health sector by governments and their development partners (Martinez-Alvarez, 2018).
To achieve UHC, strong data systems are needed. However, the 2020 Global Report on Health Data Systems and Capacity found that almost 50% of countries have limited capacity to routinely monitor quality of care and that only 8% of reported deaths in countries with low income are leading causes of death (WHO, 2020). Fragmented health data systems hinder the availability and effective use of data, especially during epidemics, which in turn weaken policy and resource allocation decisions in countries.
The Health Data Collective
In this general context, the Health Data Collaborative (HDC) undertook an analysis of the level of alignment of partners’ technical and financial investments in HIS in selected African countries. The HDC is a joint effort of several global health partners to work alongside countries to improve the availability, quality and use of data for local decision-making and monitoring progress towards the SDGs related to health (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 the SIS are aligned or linked to the country’s national priorities.
- Investigate whether the partners synergize, link and coordinate their technical and financial activities for the strengthening of the SIS.
The overall objective is to support national governments and their partners in the coordination structures, strategies and procedures necessary for better alignment of partners’ investments in the SIS. Zambia is one of the three countries studied, as the Zambian government, through its Ministry of Health (MoH), has adhered to the principles and working procedures of the HDC and has shown interest in this work, given its relevance to its purposes.
This report presents the methodology adopted to assess the above objectives, including the development of the conceptual and analytical framework. It provides background information on the health system and the social, political and economic contexts of Zambia. The results are then presented in three areas: policy and regulatory alignment, systems alignment and operational alignment. The report ends with a summary of findings and a proposed alignment performance matrix. The matrix could be used to periodically review progress in aligning development partners’ technical and financial investments with the country’s SIS.