Transparent accountability in international health program effectiveness? Constraints in the Design and Use of Reliable Population and Health Information for Decision-making

Even in the current decade of the MDGs, the Paris Declaration and results-based planning and budgeting, transparent accountability in health program effectiveness research and impact evaluation leaves a lot to be desired, particularly in Sub-saharan Africa. We have found the gap between the increasing demand for and the proper use of information for evaluation and subsequent decision-making for policy and program development is growing. While the health sector has a longer history of program evaluations that many other development sectors, a recent review of evaluations by the Overseas Development Institute has shown that there have been relative few impact evaluations focusing on health. Thematically, health is being left behind by many more evaluations carried out in the social protection area, particularly cash transfer, education and agricultural/natural resources programs. Given these issues, and the increasing availability of population and health data in Sub-saharan Africa, we have carried out a recent exploratory assessment in two East African countries on the demand for, access to and use of demographic and health data for decision-making. At least four glaring gaps between data availability and its policy use have been identified: 1- lack of awareness of, and easy access to, reliable, appropriate and updated information; 2- Public mistrust and lack of local ownership in data generated by certain government institutions and associated international partners; 3- Weak local institutional capacity to analyze, interpret and disseminate (in a user-friendly format) reliable population and health evidence; and 4- Lack of a culture of evidence and inadequate political will to use available information that might not be favorably to vested interests. To better analyze these gaps, an algorithmic flow chart is presented along 8 steps from initial stakeholder demand and data generation to evidence-based communication, decision-making and uptake. Recommendations on bridging the non-use gap and promoting transparency and local ownership include: continuous stakeholder engagement, capacity-strengthening in data quality control, analysis and interpretation, communication (including the media) and continuity in uptake; and more accountable international partner-supported M&E systems.