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

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

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

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

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

G4H Roundtable Themes

• Good Governance/Corruption• Measurement • Decentralization• Diverse Stakeholder Engagement• Recommendations

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.

Four (4) Key Practices for Smart Governance

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.

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

G4H Roundtable Themes

• Good Governance/Corruption• Measurement • Decentralization• Diverse Stakeholder Engagement• Recommendations

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

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

What are we measuring?

Outcomes (Intended and Unintended)

Processes

Behaviors and

practices

Values and perceptions

Pre-Existing Conditions

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

G4H Roundtable Themes• Good Governance/Corruption• Measurement • Decentralization• Diverse Stakeholder Engagement• Recommendations

Decentralization: Complexity, Opportunity to Find, Refine and Use Evidence

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

G4H Roundtable Themes

• Good Governance/Corruption• Measurement • Decentralization• Diverse Stakeholder Engagement• Recommendations

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

G4H Roundtable Themes

• Good Governance/Corruption• Measurement • Decentralization• Diverse Stakeholder Engagement• Recommendations

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

Thank you!Questions?