Validation of Indicators for Implementation of the Plan of Action on Health in All Policies: Proposal for Application at National Level

Abstract

[Executive Summary]; In September 2014, the Directing Council of the Pan American Health Organization (PAHO) approved the first Regional Plan of Action on Health in All Policies (Regional HiAP Plan), with a view to defining concrete measures for implementation of this ambitious and innovative approach to public policies in the countries of the Americas. With this initiative, the Region of the Americas is leading the way in implementation of the Global Framework for Action at the Country Level on Health in All Policies (Global HiAP Framework) of the World Health Organization (WHO), defined in January 2014. Following the six strategic lines of action of the Global HiAP Framework, the Regional HiAP Plan proposes nine objectives and 12 indicators for the 2014–2019 period. The indicators were formulated in 2014 through an open and collective process of consultation in the countries of the Region, and at various meetings with experts, in order to integrate a diversity of perspectives on and experiences with the intersectoral approach. The objective of the Regional HiAP Plan indicators is to support the countries of the Region of the Americas in assessing their state of preparation at the beginning of the Plan of Action (baseline) and determining what level of progress toward HiAP they want to have achieved at the end of the five years (2019). This document presents an analysis of the 12 indicators of the Regional Plan of Action with a view to facilitating their application. Using an analytical framework for evaluating the intersectoral approach and HiAP based on a review of experiences carried out in the Region (1, 2), we propose a typology for classifying the set of indicators in terms of their contribution to advancing the HiAP approach at the country level, in order to determine the specific characteristics of each indicator and the differences among them, as well as the coherence of the plan’s set of indicators. This typology distinguishes four major groups of indicators with regard to key aspects of plan implementation: generating an enabling environment for HiAP; characterizing current HiAP initiatives; establishing monitoring and evaluation; and developing knowledge and capacities for work on HiAP. This classification is intended to help each country define “its own path towards Health in All Policies,” selecting the indicators that it wishes to use, “taking into account the social, economic, political, legal, historical, and cultural challenges as well as current and future health challenges and priorities” (3). The analysis of the indicators presented in this document is intended to strengthen the validity and reliability in recording and monitoring at the local, national, and regional levels. The Regional HiAP Plan indicators for the most part are process indicators formulated in terms of the number of countries in the Region with relevant experiences on each strategic line of action of HiAP. In general, determination of these indicators requires making judgments on the degree of progress on key requirements or elements, based on each country’s documentation and reporting of the indicators it has chosen to implement as part of the monitoring process...