Governance for health

Governance For Health
Dr. Ahmed-Refat AG Refat ( ) www.SlideShare.net/AhmedRefat

Governance
For Health

‫الصحة‬ ‫الحوكمة من أجل‬
Dr. Ahmed-Refat A.G Refat
Dr. Ahmed-Refat AG Refat
Dec. 2012

1


“good governance is perhaps
the single most important factor in
eradicating poverty
and promoting development”

Kofi Annan
The former Secretary General of the United Nations,

2


Contents
 Why GOVERNANCE for health?
 GOVERNANCE background
 Basic Concepts:
 GOVERNANCE – Stewardship- Intersectoral action
 GOVERNANCE in health sector
 History of GOVERNANCE
 Health GOVERNANCE actors
 Principles of GOVERNANCE
 Current Framework of GOVERNANCE
 WHO –PAHO -World Bank UNDP
 Assessment approach

3


Why Governance for Health ?
The complex epidemiological, economic and social
issues confronting health systems around the world
make it necessary for governments to adjust their
approaches in order to manage these challenges and
ensure the health of their populations and the
prosperity of their countries.

4


Why Governance for Health ?- cont's

In recent decades, knowledge development about
what creates health and ill- health has made it clear
that the only way to make real gains in population
health is to broaden strategies beyond the health care
system, to include conditions in which people live,
work and play.

5


Why Governance for Health ?- cont's

Health systems must therefore subscribe to this
broader vision, and the governments that produce
them must consider population health as an issue
that concerns every sector and calls upon all actors
of society.

Governance influences all other health system
functions, thereby leading to improved performance
of the health system and ultimately to better health
outcomes.

6


Determinants of Health

7


Relationship between Governance indices
and health outcomes

KKM Index: Kaufmann, Kraay, Matruzzi Index (2005)

8


Governance: Background

Recent international WHO consensuses expressed in
the Bangkok Charter for Health Promotion (WHO, 2005)
and the Commission on Social Determinants of Health
(WHO, 2008), recommend that governments establish
processes favouring a “whole of government approach”,
which ensure more coherence among a government’s
missions insofar as they touch on population health and
wellbeing.

9


Governance: Background -cont's

Other policy documents and declarations at Regional
levels have also strongly promoted this view, including, for
example, the WHO Health for all Update 2005 the recent
Community strategy “Together for Health: a strategy
approach for EU 2008-2013”.

11


Governance: Background -cont's

The term “whole of government approach” refers to what
is called a pan-governmental approach, that is, an
approach that calls for both horizontal (cross government)
and vertical (across levels of government) management.

Such an approach requires the establishment of various
mechanisms allowing for coordination and
collaboration between various government actors and
stakeholders from civil society or the private sector.

11


Basic Concepts

Stewardship
Governance
Intersectoral Action
12


1. Stewardship
The concept of stewardship was put forward by the World Health
Report 2000 as a central function for health ministers (WHO, 2000). It is
“the careful and responsible management of the well-being of the
population” (WHO 2000). and it refers to three broad tasks:
1._ Providing vision and direction for health systems;
2._ Exerting influence;
3._ Collecting and using intelligence on health system performance
in order to ensure accountability and transparency.

13


The function of stewardship is essentially to develop intersectoral
work processes in all sectors of the government and with its partners
to promote the implantation of health programs.

The World health report 2000 proposed stewardship as one of the four
main functions of the health system, along with financing, creating and
managing resources, and service delivery . It recognized stewardship
as the function of the government responsible for the welfare of the
population and concerned about the trust and authority with which its
activities are viewed by the public
http://www.euro.who.int/healthsystems/stewardship/20061004_1

14


2. Governance
Governance refers to
 the challenge to take on the direction and coordination of a
complex collection of organizations through a control system
built upon many links.
 The exercise of political, economic and
administrative authority in the management of a
country’s affairs at all levels.
15


 2. Governance-cont's
 “the set of values, policies and institutions by
which a society manages economic, political and
social processes”.

 “the manner in which power is exercised in the
management of a country’s economic and social
resources for development”.

16


2. Governance-cont's

 "the exercise of political, economic and
administrative authority in the management of a
country’s affairs at all levels".

 Governance comprises the complex
mechanisms, processes and institutions through
which citizens and groups articulate their interests,
mediate their differences and exercise their legal
rights and obligations.
17


2. Governance-cont's
The key elements for good governance are:
1. _ The inclusion of several actors from both inside and
outside the government;
2. _ The use of horizontal and vertical management;
3. _ Accountability and control mechanisms;
4. _ High-level political commitment;
5. _ Financial and human resources support;
6. _ Skills development;
7. _ The existence of knowledge production systems.
18


3. Intersectoral action
The intersectoral action is the foundation for the practice of
stewardship and governance.
Key elements of intersectoral actions :
1. _ Create an inspiring framework for health;
2. _ Ensure political support;
3. _ Engage key partners at the very beginning;
4. _ Ensure leadership and rewards;
5. _ Develop practical models, tools and mechanisms to
support the implementation of intersectoral action;
6. _ Accountability frameworks;
19


Governance in the health sector
The concept of stewardship, or governance, in the health
sector is relatively new, and there is little guidance for
collection or standardization of information on this aspect of
the health system.
Evidence shows a positive relationship between governance
indices and measures of health performance and outcomes .

21


History
of Governance
21


First wave: intersectoral action and primary health care
In the Declaration of Alma-Ata (WHO, 1978), the participants
in the International Conference on Primary Health Care stated
that the role of governments in health, in all countries, both
developing and developed, in the late 20th century should be
redefined and strengthened and that intersectoral action is a
key to better health.
The Declaration called for a comprehensive health strategy
that not only provided health services but also addressed the
underlying social economic and political causes of poor health.

22


Second wave: health promotion and healthy public policy
The health promotion movement reinforced call to engage
other sectors for health in the 1980s.
The Ottawa Charter for Health Promotion (WHO Regional
Office for Europe, 1986) introduced “build healthy public
policy” as one of the five action areas for health promotion,
the others being “create supportive environments”, “strengthen
community action”, “develop personal skills” and “reorient
health services”.
23


Third wave: health in all policies

The health in all policies approach considers the impacts of
other policies on health through health determinants when
policies of all sectors are being planned, decisions between
various policy options are being made, and when
implementation strategies are being designed.

24


Health Governance Actors
 The first set of actors include politicians,
policymakers, and other governmental officials

 The second set of actors is health service
providers

The third set of actors contains beneficiaries,
health services users and general public

25


26


Elements of Good Governance

1. Public Participation:

2. Accountability and transparency.

3. Respect for the rule of law and Human Rights

4. Efficient and effective public sector management :

27


Governance in Health System Building Blocks

28


Governance of the Health System: Principles
 Strategic vision
 Participation and consensus orientation
 Rule of law
 Transparency
 Responsiveness
 Equity and inclusiveness
 Effectiveness and efficiency
 Accountability
 Information and intelligence
 Ethics

29


Current
Frameworks for
Assessing governance

31


The current frameworks for assessing
governance are as follows:
1- WHO- domains of stewardship;
2- Pan American Health Organization’s
(PAHO) essential public health functions (EPHF);
3- World Bank’s six basic aspects of governance;
4- UNDP’s principles of good governance.
Siddiqi S et al., Framework for assessing governance of the health system in developing countries: Gateway to good governance Health
Policy 90 (2009) 13–25

31


1- WHO- domains of stewardship

The World health report 2000 recognizes stewardship
as a function of the health system similar to governance. It
identifies several basic tasks of stewardship:
 Generation of intelligence
 Formulating strategic policy direction

32


 Ensuring tools for implementation: powers,
incentives and sanctions
 Building coalition/building partnership EPHF 4
Social participation in health
 Ensuring a fit between policy objectives and
organizational structure and culture
 Ensuring accountability
http://www3.who.int/whosis/discussion papers/pdf/paper48.pdf.

33


2. Pan American Health Organization’s (PAHO)
essential public health functions

34


35


3- World Bank’s (WB) six basic aspects of governance

The World Bank has been among the leading agencies in raising
awareness of the importance of governance in economic development, in
developing methodological approaches to its measurement and in ranking
countries on the basis of governance performance .
TheWorld Bank’s governance indicators are organized into three clusters
corresponding to the six basic aspects of governance
Kaufmann D, Kraay A, Zoido-Lobaton P. Governance matters. Washington:World Bank policy research working paper no. 2196; 1999.

36


37


4- UNDP’s principles of good governance

The UNDP enunciates a set of principles of good governance
forwhich there is evidence that these have a claim to universal
recognition . These five principles have been further elaborated into
nine thematic areas

United Nations Development Programme. Governance for sustainable human development: a UNDP policy
document. New York: UNDP; 1997. http://magnet.undp.org/policy/chapter1.htm.

38


39


Governance
Assessment
Approaches
41


I- USAIDS- 2002
http://www.healthsystems2020.org/content/resource/detail/528/

41


42


II-Framework
For Assessing Health Governance.

43


44


45


46


II-Framework
For Assessing Health Governance

Based Mainly on:
Kirigia and Kirigia (2011). The essence of governance in health development .International
Archives of Medicine p. 4:11

47


1. Public health leadership and management
1.1 Leadership responsibilities:

1.2 National health policy (NHP):

1.3 National health strategic plan (NHSP):.

1.4 Dissemination of NHP and NHSP:

1.5 Implementation:

48


2. Rule of health-related laws

2.1 Existence of health-related legislations:

2.2 Enforcement of health-related legislations:

49


3. Community participation & responsiveness

3.1 Participation in NHP and NHSP development:

3.2 Participation in NHSP implementation:

3.3 Participation in tracking of progress:

3.4 Responsiveness to communities non-medical
expectations:

51


4. Effective internal and external
partnerships for health
4.1 Intersectoral action:
4.2 Public-private partnerships:
4.3 Alignment of aid flows to national health
development priorities:
4.4 Strengthen capacity by coordinated support:
4.5 Use of country procurement and public financial
management systems:

51


4.6 Strengthen national capacity by avoiding parallel
implementation structures:
4.7 Aid is more predictable:.
4.8 Aid is untied:
.4.9 Shared analysis:
4.10 Sufficient integration of global programmes and
initiatives into NHSP:

52


5. Horizontal and vertical equity in health systems

5.1 Horizontal equity:
5.2 Vertical equity:
5.3 Health fairness in financial contribution (HFC):

53


6. Efficiency in resource allocation and use

6.1 Allocative efficiency:
6.2 Technical efficiency:
6.3 Productivity growth:
6.4 Institutionalization of efficiency monitoring:

54


7. Accountability and transparency in health
development
7.1 Existence of transparent results-oriented
reporting and assessment frameworks
7.2 Diagnostic reviews:
7.3 Use of information from diagnostic reviews:
7.4 Publishing of audit reports for public
consumption:

55


8. Evidence-based decision-making
8.1 National health research systems:
8.2 Health knowledge management systems (HKMS):
8.3 Health management information systems:
8.4 Information, Communication and Technology
Connectivity:

56


9. Ethical practises in health research and service
provision

9.1 International ethical guidelines for medical
practice and health research:
9.2 Bioethics review system
9.4 Institutionalization of ethics training:

57


10. Macroeconomic and political stability

10.1 Link between national economic development
plan, Poverty Reduction Strategy Paper and
NHP/NHSP:
10.2 Existence of a medium-term expenditure
framework (MTEF):
10.3 Political stability:

Kirigia and Kirigia (2011). The essence of governance in health development .International Archives of Medicine
p. 4:11 http://www.intarchmed.com/content/4/1/11
http://www.healthsystems2020.org/content/resource/detail/528/

58

Governance for health

Recommandé

Recommandé

Contenu connexe

Tendances

Tendances (20)

En vedette

En vedette (20)

Similaire à Governance for health

Similaire à Governance for health (20)

Plus de Ahmed-Refat Refat

Plus de Ahmed-Refat Refat (20)

Dernier

Dernier (20)

Governance for health