chas biennial conference kampala – speke resort, munyonyo governance and management capacity...
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CHAs Biennial ConferenceKampala – Speke Resort, Munyonyo
Governance and management capacity building of UCMB health facilities
Dr. Sam Orochi OrachAg. Executive Secretary - UCMB
Purpose of presentation
To highlight importance of good governance and management for sustainability of health care
Share UCMB’s experience in strengthening governance and management in the network
Outline of presentation
Brief background of UCMB network Core function of UCMB Why the focus on governance and
management What UCMB has done to strengthen
governance and management
270 Facilities registered with UCMB by level
HC IV, (5) 2%
HC III, (151) 56%
Hospitals, 29, 11%
HC II, (85) 31%
Regional distribution of UCMB Health Facilities (269 Registered)
Western79(29.26%)Western79(29.26%)
Central92(34.07%)Central92(34.07%)
Northern 58 (21.48%)Northern
58 (21.48%)
Eastern41(15.19%)Eastern41(15.19%)
Core functions of UCMB
UCMB not owner Facilities owned by dioceses or religious
congregations Final responsibility lies with the owners Hence the focus on strengthening local
governance and Based on principle of subsidiarity
UCMB acts as coordinator, advocate and provides technical assistant / advice
Core function of UCMB Systems strengthening
Improving managerial, administrative, fiscal, legal capacities of RCC Health Services
Advocacy, representation and Liaison on behalf of network
Facilitating the work of the Health Commission and AGM
Report to the Catholic Bishops’ Conference
Why systems strengthening as core function?
Central to any success Often least funded or paid attention to Identified as major cause of weakness of
health sector in Uganda But UCMB saw this many years ago
Hence concentration on systems strengthening Avoid concentrating on what is already
done by many others
The Context
Ageing institutions With a good reputation still Becoming more and more costly Becoming less efficient Often with uncertain organizational set-up
Increasing opportunities for partnership Increasing demand for accountability But also increasing stress on systems
Especially the GHI (mainly for HIV/AIDS) All these demand strengthening of
systems and capacities (governance and management)
What has UCMB done?
Improving management capacity and processes Initially received greater attention
While improving governance Initially received less attention Now receives greater attention in our
strategic and operational plan. Key to embedment of systems built at
diocesan and facility levels
What has UCMB done?1. Developed governance and management
tools Governing charters / constitutions HR manuals / Employment manuals Finance management manuals Various guidelines Formats – e.g. Annual analytical report format
To encourage analytical thinking Reports assessed and scored
Etc. Encouragement of utilisation of these tools
Developed tools to assess implementation
What has UCMB done? Advisory services on governance and
development to individual hospitals and dioceses
Technical Assistance in long-term (strategic) planning
Feedback on annual performances with focus on TRENDS Focused on 4 composite indicators / indices
“Access”, “Equity”, “Productivity” and “Quality” Analyses help identify need for management
and governance strengthening and informs further planning and
What has UCMB done? Data must be presented to and discussed
by boards of governors to take delicate and pragmatic decisions
E.g. What is the give and take between Rising unit cost of service (driven by cost of HR)
Amidst reducing budget support from govt Temptation to raise fee / unit output (↓ equity) This begins to affect utilisation (↓ access) Eventually counter affects income from user fees So far quality is maintained at cost of access
Examples will be seen in the presentation on using ICT to strengthen management and health systems
What has UCMB done?
2. Institution of an annual accreditation system (About 10 yrs ago – 1st in Uganda)
Not for punitive purpose But as a learning process
Has: Statutory criteria – approved by the Health
Commission of UEC Undertakings or commitments agreed on
annually with hospital managers or diocesan - incremental
What has UCMB done?3. Strengthened HMIS and ICT Hospitals and diocesan health offices able to produce
and analyse data Improve planning – short term and strategic Building capacity of governors to use analysed
information for strategic decisions Ability to use data / information at source
Many targeted trainings Sharing of data and information at workshops
All UCMB hospitals and Diocesan Health Offices, HC IVs and Training schools connected to internet / e-mail
Improved reporting
What has UCMB done?
4. Provide financial management advisory services
Encouraged shift to “cost- / Accrual-based” “cost-centre” accounting
Developed accounting software (modular) to enable electronic accounting
Based on cost-based, cost-centre accounting
Provided training and back-up support for the use of the software
What has UCMB done?
5. Human Resource management Advisory services
6. UCMB Scholarship scheme- encourage management courses
UCMB Scholarship Fund - Awards per type of training
22
81
139
102
29 28 29
83
404832
26 2531
16162013
0
20
40
60
80
100
120
140
160
2000 2001 2002 2003 2004 2005 2006 2007 2008
Clinical / technicalManagerial
What has UCMB done?
7. Training of managers Institutional training
Target to have at least 3 people in hospital management position having recognized training in health management
Masters, Diplomas, Certificate High priority choice for UCMB scholarship to
the network Is becoming part of accreditation criteria
Twice-yearly technical workshops Supervision
What has UCMB Achieved? 25/27 accredited (2
more are new) have boards inducted
15/19 Diocesan health boards inducted
25/27 hospitals have at least 2 of people in management position having had formal HSM training
UCMB Hospitals and No. of managers having formal HSM training
23
15
7
0
2
4
6
8
10
12
14
16
1 manager 2 managers 3 managers 4 managers
What has UCMB Achieved? Governors and managers beginning to make
informed decisions E.g. What is the give and take between
Rising unit cost of service (driven by cost of HR) Amidst reducing budget support from govt
Temptation to raise fee / unit output (↓ equity)
Beginning to affect utilisation (↓ access) Eventually counter affects income from user
fees So far quality is maintained at cost of access
What has UCMB achieved? Management greatly improved
Both diocesan health coordination and hospital Various tools / guidelines are being used
but to varying levels Still a lot depends on sustained over-sight
by UCMB Not healthy for sustainability
Hence emphasis to shift oversight capacity and responsibility to owners and governors Closer to the point of service
Emphasising good corporate governance
Why the emphasis on good corporate governance? In the nineties the world started registering very
important scandals and critical accidents in corporate life E.g. BCCI, Barings Bank, .....Enron.... Due to gross managerial malpractices that
boards should have been able to detect and correct
The questions arose How comes that this could happen? How comes that those who were supposed to be
in the know (the boards) did not know? How comes managers had so much leeway in
doing what they were doing?
In Uganda, A number of organisations continue to
collapse or under perform due to poor corporate governance
We have had bank closures We continue to have high cases of
corruption/fraud by managers that go undetected by boards or condoned by the boards
Why are public hospitals not performing well?
Why emphasis on governance?
Hence a new interest for the specific function of oversight A lot was known about what managers should do
and not do But little if anything was clear about the function
of oversight and control This global situation was also true for UCMB
network Emphasis was put on strengthening
management and little on governance The current UCMB strategic plan puts
emphasis on building and enhancing good governance by targeting the stewards (boards)
Governance and management
“………. If management is about running business, governance is about seeing that it is run properly.”
Prof Bob Tricker, 1984
Importance of Good corporate governance
Central to good health system
Increased efficiency Strengthened transparency and accountability Reduced risks of conflict Teamwork enhanced Improved communication Key to sustainability Credibility and increased capacity to attract
attention and support
What is UCMB doing now? Emphasis on good corporate
governance The three levels / tiers in our case
Ownership Governance Management
Each with its own clear roles Complement each other Management strengthening not
abandoned
What is UCMB doing now?
Ensure governance structures in place and trained Regional training workshops on
corporate governance Jointly for managers and governors
Induction of boards continues Hospital boards - Diocesan health boards As undertakings considered for
accreditation
What is UCMB doing now?
Developed set of “must-ask” and “must-be-answered” questions
Require evidence of reporting to the Board
Require confirmation that external audit has been carried out (part of accreditation criteria)
Challenges The major challenge is to embed / root
what has been created with help of UCMB into the systems at the lower levels
Also greatly affected by HR attrition Unwillingness of many partners to support
these aspects of systems strengthening External developments that limit funding of
health services Frustrates people who see “no benefits” of the
changes they have made UCMB itself needs sustained support in
order to sustain implementation of its mandate
Conclusion We have gone a long way
But also still remain a long way to go Strengthening of local governance and
management is key to sustainability It is important to support / strengthen
national coordination bodies (CHAs) to sustain that support to the local governance and management efforts
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