For countries to build back better from COVID-19 and better manage future public health emergencies, it is imperative to focus on creating more resilient national public health systems.
The INTOSAI Development Initiative (IDI), in cooperation with KSC and ASOSAI CDA, is currently supporting 14 SAIs in the ASOSAI region to undertake an SDG implementation audit (performance audit) on the SDG 3.d implementation efforts. The Health Services Resilience team in World Health Organisation (WHO) is providing technical input to IDI on health systems resilience.
"Health system resilience" can be defined as ability of all actors and functions related to health, to collectively mitigate, prepare, respond and recover from disruptive events with public health implications, while maintaining the provision of essential health services, and using experiences to adapt and transform the system for improvement. This requires a multifaceted, multisectoral, whole-of-society approach for public health emergencies, at policy, operational and service delivery level, including investment and strengthening of essential public health functions.
One of the ways in which SAIs can provide a relevant audit response to the current situation is to examine government efforts to strengthen capacities for early warning, risk reduction and management of national and global health risks (SDG target 3.d). The performance audits (3.d audits) will focus on how government has acted on lessons learned from COVID-19 and possibly other public health emergencies, to enhance capacities.
- to forecast, prevent and prepare for public health emergencies (PHEs)
- to adapt, absorb and respond to PHEs
- to maintain essential health services during emergency/crisis 14
WHO, Health Systems Resilience Toolkit (NOT YET PUBLISHED)
Pending on the relevant context and risks in a given country, SAIs may choose to focus on all these capacities, while others may concentrate on some capacities only. It is, however, necessary to include the capacities related to preparedness as a minimum focus for the audits.
The SAIs are receiving education and support to undertake this audit through IDI’s Integrated Education and Audit Support Framework. The framework includes audit education, social learning, working area for the audit teams and other resources.
Moreover, the 3.d audits follow IDI’s SDG Audit Model (ISAM). This implies that these audits are expected to follow the specific requirements of any performance audit of SDG implementation – focusing on a whole-of-government approach, policy coherence and integration, assessing government efforts at leaving no one behind and multi-stakeholder engagement in implementing the SDG target under audit.
IDI encourages SAIs to engage with key stakeholders throughout the audit process and focus on the impact of their audit work, mainstreaming the audit impact considerations throughout the audit as outlined in the ISAM guidance.
You can read more about the 3.d audits on the IDI website.