Accountability, a cyclical process of monitoring, review and action to assess progress, document success, identify problems that need to be rectified and take prompt action as and where needed, according to the Accountability Framework of the UN Secretary General’s Global Strategy for Women’s and Children’s Health. It's an ideal fit for civil society to ensure governments are translating their grand commitments into grand actions. Jess Beagley shares why she thinks the New Year's Resolution we all need to adhere to for 2019 is embracing accountability, and she shares some handy and recent tools to help you along the way to making good of your own commitment to do more for NCDs this post-HLM3 year. 

"Who set that date? 7 years from now? What on earth were they thinking while people are dying? …If you or your child were dying of this, you might think about it differently." - Michael R. Bloomberg.

Bloomberg’s sharp condemnation following the announcement that the next UN High-Level Meeting on NCDs would not be held until 2025 echoed the shock, exasperation and dismay of the international NCD community. This scheduling risks prolonged procrastination, at a time when political leaders must urgently realign the trajectory towards meeting the targets that they have committed to for 2025 and 2030. 

The power of independent accountability

The role of developing, strengthening and leveraging robust accountability mechanisms to sustain and accelerate the NCD response for the coming seven years is therefore crucial, and we must place it at the heart of what we hope to achieve in 2019. 

A discussion paper for the forthcoming Global Action Plan for healthy lives and wellbeing for all notes how ‘CSOs can serve as watchdogs and independent monitors to promote transparency and enhance accountability’and in ‘strengthening civic trust in public institutions and official data, shining a spotlight on corruption and initiating processes of healing in communities mistreated or failed by the health system’. The paper goes as far as to highlight the acute importance of this role in an era dominated by ‘fake news’. If we neglect accountability, our years of advocacy for NCD prevention and control is meaningless – without accountability, the international commitments we have worked so hard to secure are no more than a set of empty promises. 

Accountability goes beyond numbers and data and pretty graphs - there are people behind these figures. It also allows us to identify patterns and trends which reveal ever more information on about the underlying factors which shape enabling or challenging environments for NCD prevention and control. And crucially, it makes governments sit up and listen. Speaking at the launch of the World Bank Human Capital index, Jim Yong Kim shared that ranking countries is 'a tough decision...because governments do not like to be ranked', but that it was evident that 'ranking is really what captivates attention.' The index is important to encourage countries to move up the rankings and invest in people. This same framing can be applied to accountability for the NCD response. 

“There is something in a human being which makes us innately competitive people. When you see yourself lagging in an index, it gives you an impetus to do what you should have been doing anyway.” Asad Umar, Pakistan’s Federal Minister for Finance, Revenue, and Economic Affairs

NCD-relevant accountability tools

In the past 18 months, invaluable tools have been released which reveal progress and gaps in the NCD response. Armed with this information, the NCD community can ensure that a resolution to hold governments accountable in 2019 becomes a reality, and that the momentum created in the lead up to the UN HLM continues. 

The resources below build on a previous NCD Alliance blog post, which goes into more detail on exactly how these tools can be put to work to accelerate the global NCD response.  

1. WHO’s 2018 NCD Country Profiles detail the percentage of deaths due to NCDs, probability of death between ages 30-70, whether national targets have been set in alignment with the Global Action Plan on NCDs, and – for extra political clout -  the number of lives that could be saved by 2025 through implementing WHO’s Best Buys. 
2. The inaugural data for NCD Countdown 2030 closes in on NCD mortality and ranks countries according to their progress towards SDG target 3.4 to reduce NCD mortality 1/3 by 2030 – both for four major diseases between ages 30 and 70, but also all NCDs between 0-80 years for a more inclusive approach.  
3. If you’re interested in seeing how national progress on NCDs compares to other health related SDG indicators, this is fully covered in IHME’s 2017 Global Burden of Disease study, with papers published this month in the Lancet, including a full range of data visualisations for SDG health indicators and more.  There’s an app for IHME’s Health Atlas too!
4. WHO updates its Global Health Estimates regularly – you can quickly see global, regional and national data for both mortality and DALYs for any age range, sex or income region.
5. Those who focus on implementation of policy solutions will already be familiar with the 2017 WHO NCD Progress Monitor, which tracks 19 policy indicators for all WHO Member States, spanning the existence of national NCD targets, multisectoral NCD plans, risk reduction, and NCD management.
6. If you already know that your country has a plan or a policy in place, you can look it up in more detail via WHO’s NCD Document Repository. Or, if it’s time for your country’s NCD policy or plan to be developed or updated and you have a chance to input, check which other countries’ policies have attributes that it would be useful to replicate!
7. The WHO NCD Country Capacity Survey report has just been updated. This latest edition compares 2017 data on national infrastructure, surveillance and health systems capacity for NCDs and compares results to previous data from 2010, 2013 and 2015 to provide an overview of progress over the seven year period. 
8. If the prospect of having any of these publications to hand when you need them is entirely unrealistic, fear not. 21^stCentury WHO has even developed a mobile app – the WHO NCD Data Finder so you can have all the data you could need at your fingertips – offline, anywhere. 
9. The World Bank’s new Human Capital Index quantifies the contribution of investments in health and education to the productivity of the next generation of workers. Use it to assess how much income is foregone in your country because of human capital gaps, and make the case for how much faster these losses can be turned into gains with action now. 

Use it or lose it

“Like physical tools, advocacy and accountability tools are no use left in a box to rust.”

Advocates have a wealth of tools at their fingertips. But, just like physical tools, they are no use left in a box to rust. We must learn how to use them, and to build an NCD response which is rooted in evaluation and accountability. If we need progress to have been made by the time of the next UN HLM in 2025, and for lives to be saved, then we must use those seven years to leverage the sophisticated data available and use it to hold governments accountable year in year out. The NCD community is far from a seven year slumber – we’re just getting started. 

In the coming months, we will be sharing further resources on accountability to fuel the NCD response, and support our resolution to translate of data into action through accountabilty. Stay tuned! Do you have a handy accountability tool relevant to NCDs that you can recommend? Drop us a line or share on social media tagging @ncdalliance. 

About the Author

Jess Beagley (@JessicaBeagley) is Policy Research Manager with NCD Alliance, and coordinates policy research and collates evidence to inform NCD Alliance’s advocacy priorities. She manages commissioned policy research, overseeing NCDA policy briefs and reports, as well as accountability work such as the NCD Countdown initiative. Jess also leads NCDA’s work on environmental health, in particular relating to urbanisation and climate change.