governance roundtable brown bag presentation
DESCRIPTION
In August 2013, USAID supported the Second Annual Round Table on Governance for Health in Low- and Middle-Income Countries (LMICs). The purpose of the round table was to bring thought leaders together to discuss how good governance enables and facilitates better health system performance and outcomes Join us for a summary of key conclusions from the round table followed by a discussion about new insights into principles and practices of smart governance in the health systems of LMICs.TRANSCRIPT
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Governance as an Enabler for Health Systems Strengthening and Country Ownership
Date: December 11, 2013Time: 2:30-4:00pm
Location: GHFP - 1201 Pennsylvania Ave, NW Room 2031
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Agenda2:30 Welcome and Participant Introductions: Ann Hirschey, PRH (5 minutes)
2:35 Background on Governance Roundtable: Temi Ifafore, PRH (5 minutes)
2:40 USAID on growing importance of Governance: Bob Emrey, OHS (5 minutes)
2:45 Review of Roundtable Themes and Observations (45 minutes)Moderator: Temi Ifafore, PRH1) Roundtable Summary, Practices for Good Governance: Jim Rice, LMG2) The Need for Evidence on Impact of Good Governance for HSS: Reshma
Trasi, LMG3) Governing Decentralized Health Systems: Mahesh Shukla, LMG4) Diverse stakeholder engagement: Belkis Giorgis, LMG5) Key Next Steps: Jim Rice, LMG and Jodi Charles, OHS
3:30 Group Discussion on Implications of Round Table and Ideas Exchange
4:00 Adjourn
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Desired Outcomes:• Foster global dialogue on governance practices and
capacity building interventions• Create a network of governance practitioners, educators
and researchers• Identify opportunities to build evidence that better
governance leads to health system performance improvements
Goals of 2013 G4H
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Participants in G4H RoundtableDr. Peter Eriki, ACHEST, UgandaDr. Göran Tomson, Karolinska Institutet, SwedenMr. Thomas Rottler, BoardEffect, USADr. Rifat Atun, Imperial College London, UKMr. Mahugnon Achille Togbeto, IPPF , UK Mr. Bob Emrey, USAID, USAMs. Laura Lartigue, MSH, USAMr. Lawrence S. Michel, MSH, USAMr. Maurice Middleberg, Free the Slaves, USADr. Jonathan D. Quick, MSH, USADr. James A. Rice, MSH, USADr. Mahesh Shukla, MSH, USADr. Tomohiko Sugishita, JICA, JapanMs. Helena Anna Walkowiak MSH, USAMs. Maeghan Orton, Medic Mobile, KenyaMs. Alisha Kramer, CSIS, USA
Dr. Kate Tulenko, IntraHealth International, USADr. Delanyo Dovlo, WHO, RwandaMs. Susan Putter, MSH South AfricaMr. Chris Lovelace, Abt Associates, USAMs. Deirdre Dimancesco, Essential Medicines and Pharmaceutical Polices, SwitzerlandMr. Jacob Hughes, HDI, USAMr. Rebeen Pasha, USAID, USADr. Reshma Trasi, MSH, USAMr. Taylor Williamson, RTI International, USADr. Willy De Geyndt, Georgetown University, USADr. Bernhard Liese, Georgetown University, USAMr. Didier Trinh, Modernizing Foreign Assistance Network, USADr. Taryn Vian, Boston University, USA
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Key Questions Asked During G4H Roundtable:
1) What is good governance? 2) How do we address corruption?3) How do we create change?4) What are essential governance practices?5) How is good governance taught in the field?6) How can we make better use of technology?7) What is the state evidence of evidence?8) How do we involve more women, youth?
Introduction to Health Governance
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G4H Roundtable Themes
• Good Governance/Corruption• Measurement • Decentralization• Diverse Stakeholder Engagement• Recommendations
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Governance is: 1) Setting strategic direction
and objectives; 2) Making policies, laws, rules,
regulations, or decisions, and raising and deploying resources to accomplish strategic goals and objectives; and
3) Oversight monitoring to make sure that strategic goals and objectives are accomplished.
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Four (4) Key Practices for Smart Governance
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Governance is robust when: 1) The decisions are based on information, evidence, and shared
values;2) The process is transparent, inclusive, and responsive to the
needs of the people the ministry or the organization3) Those who make and those who implement decisions are
accountable;4) The strategic objectives are effectively, efficiently, ethically, and
equitably met; 5) The vitality and mission of the ministry or the organization is
maintained.
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Smart Governance Enables Stronger Health SystemsStronger Health Systems. Greater Health Outcomes
Sustainable health
outcomes and impact aligned with national health goals
and MDGs 3, 4, 5, and 6
LeadingScanFocusAlign/MobilizeInspire
ManagingPlanOrganizeImplementMonitor/Evaluate
GoverningCultivate AccountabilityEngage StakeholdersSet Shared DirectionSteward Resources
People and teams empowered to lead, manage and govern
Enhanced work environment &
empowered male and female
health workers Responsive health systems
prudently raising and allocating resourcesStrong
management systems
Improved health system performance Results
Conceptual Model: Leading, Managing and Governing for Results
Increased Service Access
Expanded Service Availability
Increased Utilization
Better Quality
Lower Cost
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G4H Roundtable Themes
• Good Governance/Corruption• Measurement • Decentralization• Diverse Stakeholder Engagement• Recommendations
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Political, economic, legal and social
system
Health Facilities
Communities
Health care worker
Household/family
Levels; Nonlinear Pathways; Complex, Adaptive Systems; Institutional Theory and Power Dynamics
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Measuring governance
• Governance interventions are complex, contextual and diverse
• Frameworks and logic models are nonlinear
• Metrics are specific and comparable
Multiplicity
Frameworks
Metrics
End Points
Disciplines
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What are we measuring?
Outcomes (Intended and Unintended)
Processes
Behaviors and
practices
Values and perceptions
Pre-Existing Conditions
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Measurement: The Way Forward
• Need to demonstrate both what is changing and how • Measurement, evaluation and research will need to be:
– Multi-method– Multi-disciplinary– Multi-level
• Scope for innovation and new methods
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G4H Roundtable Themes• Good Governance/Corruption• Measurement • Decentralization• Diverse Stakeholder Engagement• Recommendations
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Decentralization: Complexity, Opportunity to Find, Refine and Use Evidence
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Governing Decentralized Systems:Five Strategies
1) Screen public health services with clear criteria2) Define degrees of decentralization for decision-
making processes3) Establish effective governance model design4) Define governing body Terms of Reference5) Report results transparently
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G4H Roundtable Themes
• Good Governance/Corruption• Measurement • Decentralization• Diverse Stakeholder Engagement• Recommendations
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Diverse Stakeholder Engagement• Impediments• Gender equity/inclusion =
good governance• Recommendations:
– Mentoring– Consider “whole person”--
work/life balance– Address discrimination,
harassment– Include civil society in
governance process
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G4H Roundtable Themes
• Good Governance/Corruption• Measurement • Decentralization• Diverse Stakeholder Engagement• Recommendations
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Overall Recommendations• Collaborate: Support USAID and CAs (and now WHO) global technical
working groups on good governance• Partner: Expand partnerships with academic institutions to promote
research, KE• Strengthen M&E: Develop theory of change article; case studies; build
theory; construct an evaluation database; define a research agenda; publish preliminary set of “Governance Indicators;” design longer-term research agenda
• Promote Inclusion: Promote value of diversity on governance boards, high-level leadership (women, youth, minorities)
• Next roundtable in an LMIC: Strong suggestion from participants to hold 2014 G4H Roundtable in Africa
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Thank you!Questions?