Governance Roundtable Brown Bag Presentation

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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.

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  • Today I will cover 2 key topics:1. An overview of the key themes and discussions from the August 2013 Round Table2. Key recommendations made by the participants
  • Bold names and alphabetize by last names
  • Please refer to attached eManager on Governance
  • Let me start with a basic premise: it is challenging to measure and evaluate governance interventions. Here’s why. Let’s think of a fundamental governance-related intervention. [need to develop this.]
  • So, why is it that measurement is challenging when there are multiple frameworks and metrics that have been developed?Diversity - missing a genealogy of governance interventions
  • What outcomes are we measuring? Health outcomes, governance outcomes, development outcomes?
  • OpportunitiesEpidemiology, economics, political science, anthropology, management theory, organizational behavior, developmental psychology and behavior change, etc. Centrality of the people we serve and the importance of placing people and communities at the center and at the table.
  • Establish a mentoring program to help women become effective leadersTake into consideration the work life balances of womenAddress discrimination in the workplace and sexual harassment issues in the health workforceInclude civil society groups particularly women’s organizations to become stakeholders in the governance process
  • Governance Roundtable Brown Bag Presentation

    1. 1. Governance as an Enabler for Health Systems Strengthening and Country Ownership Date: December 11, 2013 Time: 2:30-4:00pm Location: GHFP - 1201 Pennsylvania Ave, NW Room 2031
    2. 2. Agenda 2:30 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, PRH 1) Roundtable Summary, Practices for Good Governance: Jim Rice, LMG 2) The Need for Evidence on Impact of Good Governance for HSS: Reshma Trasi, LMG 3) Governing Decentralized Health Systems: Mahesh Shukla, LMG 4) Diverse stakeholder engagement: Belkis Giorgis, LMG 5) 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
    3. 3. Goals of 2013 G4H 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
    4. 4. Participants in G4H Roundtable Dr. Peter Eriki, ACHEST, Uganda Dr. Göran Tomson, Karolinska Institutet, Sweden Mr. Thomas Rottler, BoardEffect, USA Dr. Rifat Atun, Imperial College London, UK Mr. Mahugnon Achille Togbeto, IPPF , UK Mr. Bob Emrey, USAID, USA Ms. Laura Lartigue, MSH, USA Mr. Lawrence S. Michel, MSH, USA Mr. Maurice Middleberg, Free the Slaves, USA Dr. Jonathan D. Quick, MSH, USA Dr. James A. Rice, MSH, USA Dr. Mahesh Shukla, MSH, USA Dr. Tomohiko Sugishita, JICA, Japan Ms. Helena Anna Walkowiak MSH, USA Ms. Maeghan Orton, Medic Mobile, Kenya Ms. Alisha Kramer, CSIS, USA Dr. Kate Tulenko, IntraHealth International, USA Dr. Delanyo Dovlo, WHO, Rwanda Ms. Susan Putter, MSH South Africa Mr. Chris Lovelace, Abt Associates, USA Ms. Deirdre Dimancesco, Essential Medicines and Pharmaceutical Polices, Switzerland Mr. Jacob Hughes, HDI, USA Mr. Rebeen Pasha, USAID, USA Dr. Reshma Trasi, MSH, USA Mr. Taylor Williamson, RTI International, USA Dr. Willy De Geyndt, Georgetown University, USA Dr. Bernhard Liese, Georgetown University, USA Mr. Didier Trinh, Modernizing Foreign Assistance Network, USA Dr. Taryn Vian, Boston University, USA
    5. 5. Introduction to Health Governance Key Questions Asked During G4H Roundtable: 1) 2) 3) 4) 5) 6) 7) 8) What is good governance? How do we address corruption? How do we create change? What are essential governance practices? How is good governance taught in the field? How can we make better use of technology? What is the state evidence of evidence? How do we involve more women, youth?
    6. 6. G4H Roundtable Themes • • • • • Good Governance/Corruption Measurement Decentralization Diverse Stakeholder Engagement Recommendations
    7. 7. Governance is: 1) Setting strategic direction and objectives; 2) Making policies, laws, rules, regulatio ns, 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.
    8. 8. Four (4) Key Practices for Smart Governance
    9. 9. 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 organization 3) 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.
    10. 10. Smart Governance Enables Stronger Health Systems Stronger Health Systems. Greater Health Outcomes Conceptual Model: Leading, Managing and Governing for Results People and teams empowered to lead, manage and govern Improved health system performance Results Leading Scan Focus Align/Mobilize Inspire Managing Enhanced work environment & empowered male and female health workers Plan Organize Implement Monitor/Evaluate Governing Cultivate Accountability Engage Stakeholders Set Shared Direction Steward Resources Strong management systems  Increased Service Access Responsive health systems prudently raising and allocating resources  Expanded Service Availability  Increased Utilization  Better Quality  Lower Cost Sustainable health outcomes and impact aligned with national health goals and MDGs 3, 4, 5, and 6
    11. 11. G4H Roundtable Themes • • • • • Good Governance/Corruption Measurement Decentralization Diverse Stakeholder Engagement Recommendations
    12. 12. Levels; Nonlinear Pathways; Complex, Adaptive Systems; Institutional Theory and Power Dynamics Political, economic, le gal and social system Health Facilities Communities Health care worker Household/ family
    13. 13. Measuring governance Frameworks Disciplines Multiplicity End Points Metrics • Governance interventions are complex, contextual and diverse • Frameworks and logic models are nonlinear • Metrics are specific and comparable
    14. 14. What are we measuring? Pre-Existing Conditions Behaviors and practices Values and perceptions Processes Outcomes (Intended and Unintended)
    15. 15. 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
    16. 16. G4H Roundtable Themes • • • • • Good Governance/Corruption Measurement Decentralization Diverse Stakeholder Engagement Recommendations
    17. 17. Decentralization: Complexity, Opportunity to Find, Refine and Use Evidence
    18. 18. Governing Decentralized Systems: Five Strategies 1) Screen public health services with clear criteria 2) Define degrees of decentralization for decisionmaking processes 3) Establish effective governance model design 4) Define governing body Terms of Reference 5) Report results transparently
    19. 19. G4H Roundtable Themes • • • • • Good Governance/Corruption Measurement Decentralization Diverse Stakeholder Engagement Recommendations
    20. 20. Diverse Stakeholder Engagement • Impediments • Gender equity/inclusion = good governance • Recommendations: – Mentoring – Consider “whole person”-work/life balance – Address discrimination, harassmen t – Include civil society in governance process
    21. 21. G4H Roundtable Themes • • • • • Good Governance/Corruption Measurement Decentralization Diverse Stakeholder Engagement Recommendations
    22. 22. 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
    23. 23. Thank you! Questions?

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