Use of Results-Oriented Monitoring tools to enhance global health accountability: lessons from the European Commission/WHO 'Health Systems Strengthening for Universal Health Coverage' programme.

Governments and organisations must demonstrate accountability and delivery of results. Results-Oriented Monitoring (ROM) is a European Commission mechanism aiming at enhancing internal control and management. The Health System Strengthening (HSS) for Universal Health Coverage (UHC) programme provides support towards achieving UHC through policy dialogue in 115 countries.Drawing from the ROM review of the HSS for UHC programme, we examine the value of the Commission's ROM system as a tool to enhance accountability of large Global Health (GH) programmes. We present the lessons learnt and provide specific recommendations about how ROM tools can be employed to strengthen GH accountability.ROM reviews can provide critical data to inform the design, implementation and evaluation of large-scale GH programmes through a well-integrated mixed-methods approach in which quantitative and qualitative components reinforce each other. Recognising the tremendous power of measures of performance, they track available quantitative indicators from baseline to target along the results chain. Firmly grounded on qualitative tools, they also capture the complex nature of health systems, and the critical influence of contextual factors and stakeholder dynamics.Poor data quality and insufficient multistakeholder engagement are persisting but not unsurmountable challenges. As increasing support is provided to strengthen health information and management systems, the process of codeveloping Monitoring and Evaluation frameworks at country level could serve as a tool to enhance mutistakeholder engagement in policy dialogue. The political nature of both results-oriented systems and GH programmes suggests that mechanisms to assess power dynamics should be incorporated into policy dialogues and ROM review processes.