rti international is a trade name of research triangle institute health systems and the governance...
TRANSCRIPT
RTI International is a trade name of Research Triangle Institutewww.rti.org
Health Systems and the Governance Building Block
Derick W. Brinkerhoff
Global Health Council, 37th Annual International ConferencePanel on Health Systems Building Blocks: How to Build Strong Health
Systems that Deliver Quality ServicesWashington, DC
June 15, 2010
2
www.rti.org
Where does governance fit in health systems performance?
3
www.rti.org
Defining governance
• Governance is about rules that distribute roles and responsibilities among societal actors and shape interactions among them. These rules can be:
– formal, embodied in institutions (e.g., democratic elections, parliaments, courts, sectoral ministries);
– and informal, reflected in behavioral patterns (e.g., trust, reciprocity, civic-mindedness).
• Governance encompasses authority, power, and decision-making in the institutional arenas of:
– civil society– politics– policy– public administration.
4
www.rti.org
Health governance model
5
www.rti.org
Health governance and power inequalities
6
Governance levels
7
www.rti.org
Responsible health governance
• Responsiveness to public health needs and clients’/citizens’ preferences
• Leadership to address public health priorities• Inclusion of clients’/citizens’ voice• Clear and enforceable accountability• Transparency in policymaking, resource allocation, and
performance• Evidence-based policy and decision-making• Efficient, effective, and equitable service provision,
regulation, and management
8
www.rti.org
Entry points—voice & accountability: citizens facility
PAQs (Partenariats pour l’Amélioration de la Qualité) in Rwanda
Quality Assurance Partnership Committees (QAPCs) in the Philippines
9
www.rti.org
Entry points—responsiveness, accountability, transparency: central local, public private
• Transfer of resources, authority, decision-making, accountability
• Examples: – Devolution of health functions to
local governments, e.g., Philippines, Rwanda, Uganda
– Intergovernmental transfers, e.g., District Incentive Fund grants in Rwanda
– Hospital autonomy in sub-Saharan Africa
– Privatization, e.g, Family Group Practices in Kazakhstan
10
www.rti.org
Entry points—responsiveness, efficiency & effectiveness: MOH facility
• HRH planning, e.g., workforce planning in Egyptian governorates
• Financial incentives, e.g, pay-for-performance
• Non-monetary incentives, e.g., operations research in Swaziland on incentives for HCT performance
11
www.rti.org
Entry points—accountability, regulation, transparency: rule of law
• Medicines Transparency Alliance (MeTA), UN Convention against Corruption (UNCAC)
• Improved management control systems, e.g., electronic cash registers in Mombasa, Kenya hospital
• Performance-based monitoring, e.g., Global Fund accountability system and LFA oversight
• Citizen report cards on health services, e.g., India and Uganda
12
www.rti.org
A governance perspective on HSS helps to…
– Identify institutional factors influencing HSS at various levels (facility global)
– Recognize the role of power and politics– Clarify connections among HS actors– Connect the HS building blocks– Focus attention on incentives for
responsiveness and sustainable performance