Governance for Better Health Webinar Wednesday, 27 June 2012 9 AM to 10 AM EDT
Good Governance from Villages to Parliaments: What Global Health Needs Nowby Jonathan D. Quick, MD, MPH on June 22, 2012
LMG’s Governance Studies Research questions – What is effective governance in the context of health – What enables it and what hinders it – What are practices of effective governance – How to measure it – What are the gender issues involved – How leadership, management and governance interact to produce better health outcomes
LMG’s Governance Studies Targeted literature review Surveys – 2011 Governance Survey – 2012 Governance Survey ►477 health leaders, governors and managers form 80 countries Interviews – 25 key informant interviews from 16 countries Governance roundtable 18 May 2012 – 30 governance thought leaders, experts, practitioners, donors and CAs
What is effective governance in the context of health• The governance that leads to both an improvement in health service and the health of individuals and populations• Predominant themes Impact on health service and health of people Transparency Accountability Participation Inclusion Ethical and moral integrity Focus and vision Efficiency and Equity
What enables it and what hinders it# Deterrent # Enabler1 1 Ethical and moral integrity Ineffective leadership2 Corruption 2 Competent leaders governing3 3 Governing with a definite policy on measurement, Ineffective management data gathering, analysis, and use of information for policy making4 Inadequate transparency 4 Sound management5 5 Adequate financial resources available for Inadequate accountability governing6 Inadequate systems to collect, manage, analyze 6 Openness and transparency and use data7 Inadequate participation of community/ citizens/ 7 Client/community participation in decision making clients/ consumers/ patients8 8 Accountability to citizens/clients Political context9 9 Governing based on scientific evidence Inadequate checks and balances10 Inadequate financial resources for governance 10 Good Governance in sectors other than health
Defining governing in practical terms100% 6% 5% 8%90% 8% 9% is not a part of governing 8% at all 17% 17%80% 21% 26%70% 25% 29% is a slightly significant part of governing60%50% is a moderately40% 75% 75% significant part of 67% 63% governing30% 60% 58%20% is a highly significant part of governing10% 0% To include To steer To regulate To collaborate To oversee To allocate
Practices of Effective Governance Cultivate Accountability Engage Stakeholders Set Shared Direction Steward Resources
Practice PrinciplesCULTIVATE ACCOUNTABILITY Accountability Transparency Legal, ethical and moral behavior/Moral capital Accessibility Social justice Oversight LegitimacyENGAGE STAKEHOLDERS Participation Representation Inclusion Diversity Gender equity Conflict resolutionSET SHARED DIRECTION Stakeholder alignment Leadership Management AdvocacySTEWARD RESOURCES Ethics Efficiency Effectiveness Resourcefulness Financial Accountability Development Social responsibility
Practices Principles Governing actionsG CULTIVATE Accountability 1. Establish, champion, practice and enforce codes of conductO ACCOUNTABILITY Transparency 2. Embed accountability into the governing institutions Legal, ethical and moral 3. Make all reports on finances, activities, and plans available to the publicV Foster a facilitative behavior 4. Establish oversight and review processesE decision-making Accessibility 5. Establish a formal consultation mechanismR environment Social justice 6. Sustain a culture of integrity and openness that serves the public interest Moral capitalN OversightI Legitimacy ENGAGE Participation 1. Empower marginalized voices, including womenN STAKEHOLDERS Representation 2. Ensure appropriate participation of key stakeholdersG Inclusion 3. Create and maintain a safe space for the sharing of ideas Identify, engage and Diversity 4. Provide an independent conflict resolution mechanism collaborate with Gender equity 5. Elicit, and respond to, all forms of feedback diverse stakeholders Conflict resolution 6. Establish alliances for joint action at whole-of-government and whole-of-P society levels SET SHARED DIRECTION Stakeholder alignment 1. Oversee the process for developing and implementing a shared action planR Leadership 2. Advocate on behalf of stakeholders’ needs and concernsA Develop a collective Management 3. Document and disseminate the shared vision of the ‘ideal state.’ vision of the ‘ideal Advocacy 4. Set up accountability mechanisms for achieving goalsC state’ 5. Oversee the process of setting goals to reach the ‘ideal state.’T 6. Oversee the process of realization of the shared goals and the desiredI outcomes. STEWARD RESOURCES Financial Accountability 1. Champion the acquisition and deployment of resourcesC Development 2. Protect and invest the resources to serve stakeholders and beneficiariesE Steward resources Social responsibility 3. Collect, analyze and use information and evidence for making decisions responsibly, building Capacity building 4. Build capacity to absorb resources and deliver quality servicesS capacity Country ownership 5. Use resources in a way that maximizes the health and well-being of the Ethics public Resourcefulness 6. Inform and allow the public opportunities to monitor raising, allocation, Efficiency and use of resources, and realization of the outcomes
LMG for ResultsHSS for Results
Measuring governanceProcessOutcomes Health service attributes Health outcomes Both process and outcomes Impact Health impact Impact beyond health• An overwhelming majority asserted that governance must be measured by the result in terms of improvement in health service and the health.• A typical comment was — ―I think it is fundamental to be able to show results.‖
Gender in governance + ++ +++ Gender — 0 perspective Exploitative Blind Aware Responsive Transform of our key 8% 8% -ative 12% informants maintain gender 56% gender do not inequalities does not seek to clearly 16% and influence responsive stereotypes how challenge seek to the status to different decisions needs transform are made quo based on gender gender relationsRoles women play in a health system and promote Women in boardrooms or governing positions equity Women in health workforce Women as users of health care— ―In a situation like that where governance basically is a male thing, then women’s issues are likely to be forgotten…..‖
How L+M+G interact to produce better health outcomes► Leadership, management and governance are interdependent, intricately linked, and reinforce each other.► There is a clear overlap between the roles of leading, managing, and governing.► Leaders are critical to the governing process. — Effective leadership is a prerequisite for effective governance and effective management.
You may access the reportsof our governance studieson the LMG web pageof the MSH external site athttp://www.msh.org/global-presence/lmg-project.cfm Over to Karen for how LMG can help enhance governance in public, private, not-for-profit and civil society organizations in partner countries
LMG´s Governance Interventions KarenJohnson June 27, 2012Lassner
Who are the potential clients for governance strengthening? • Public sector: parlimentarians, state legislators, senior MOH officials, state and local health departments, hospital boards, state/province/ municipal/ district/village health boards, and elected councilors • Multi-sector bodies: CCMs, specific councils for AIDS, RH, TB, women, children & others • Civil society: CBOs, FBOs,NGOs • Private sector: hospital boards; company CSR programs • Academia: Schools of medicine, nursing, pub. health &
How can LMG help enhance health governance in public, private and not-for-profit institutions in partner countries? • Training • Technical Assistance • Knowledge Exchange
LMG Governance Training
Senior Leadership Program• Who: Teams of 4-6 senior people; from all sectors• How long: 12-month process with workshops at months 3, 6 & 12• Content: effective governance practices; strategic problem solving; leadership development; design, implementation & evaluation of a strategy for a priority health problem.• Certificate: from Yale University
Leadership Development Program Plus (new and improved LDP) • Who: Managers and teams of health workers who focus on a specific health result • How long: 6-8 months • Process: Senior Alignment Meeting chooses priority health area; Technical Team identifies indicators and interventions to address Priority Health Area; Improvement teams meet in 3 workshops to learn L+M+G practices; On-Site Team Meetings to address challenges; 2 Shared Learning Sessions
Effective Board Governance Training Program• Who: Members of CSO Boards of Directors & key Executive Staff• How long: One 2-3 day workshop• Content: L+M+G practices; definition of governance, accountability & transparency; responsibilities of Boards of Directors compared to staff; board operations; risk management; CoI; produces a Governance Enhancement Plan
Effective Board Governance TOT Program• Who: Trainers who will provide governance training to CSO boards of directors & staff• How long: One 2-3 day TOT workshop• Content: L+M+G practices; definition of governance, accountability & transparency; responsibilities of Boards of Directors compared to staff; board operations; risk management; CoI;adult learning techniques
Community Leadership, Management & Governance Training Program • Who: Community leaders in rural communities • Process: Five 2-day workshops every 3-4 weeks • Content: Values-based leadership (personal, family & community); participatory planning; project monitoring; accountability & transparency; reconciliation & forgiveness; conflict resolution; communication; commitment to children; produces a community health project putting leadership & governance skills into practice
Integration of Governance, Leadership, & Management into Pre-Service Curricula• Who: Curriculum integration teams & support staff• Process: Three workshops, including a final TOT workshop; includes Pre- Service Guide; can also be delivered virtually• Content: Local adaptation and integration of action- oriented, practical governance, leadership and Pre-Service Guide provides 3 management content into sample curricula, facilitators’ notes, the pre-service curricula & resources on logistics & roles and responsibilities within the curriculum integration process.
The Virtual CSO Board Governance Program (VCBG) • Who: Teams of CSO board members and staff • Process: Eight-week virtual training program • Content: role of the board of directors, elements of an effective board of directors, transparency and accountability. By the end of the VCBG, participants develop a draft policy on board transparency and a governance improvement plan.
LMG Governance Technical Assistance
LMG Governance Technical Assistance Areas • Governance Responsibilities • Board Member Development • Governance Performance Assessment • Governance Monitoring &Adaptations are made in the TA Information based on the context, i.e. public vs. private sector, • Governance and Gendergoverning individuals (ministers) vs. a governing body, etc.
LMG TA Area 1: Governance Responsibilities• Role of Governing Body with regard to: Strategic Visioning and Planning, Quality Assurance, Fiscal Vitality, Management, Stakeholder Relations, Interface with Government, Governance Effectiveness• Board Member Position Description and Performance Expectations• Role and Array of Committees and Advisory Bodies• Committee Charges and Annual Work Plans• Board Meeting Calendar for 18-month Period
LMG TA Area 1 : Governance Responsibilities (cont.)• Board Meeting Agendas• Board Chairperson Position Description and Performance Expectations• Committee Chairperson Descriptions and Performance Expectations• Board Policy Manual (including Conflict of Interest and Code of Ethics)• Governance Enhancement Plan for continuous governance improvement
LMG TA Area 2: Board Member Development• Board Member Competencies• Competency Mapping Process to Guide Recruitment and Board Development• Board Member Orientation Program• Board Member Customized Individual Education Plans• Board Education Plan and Budget• Board Portal for 24/7 access to board materials
LMG TA Area 3: Board Member Development (cont.)• Board Experience Exchange Process• Digital Reference Library on Governance Concepts & Practices• eLearning resources• Board Member Mentoring Program
LMG TA Area 3: Governance Performance Assessment • Governance Overall Risk Assessment • Board Overall Performance Self-Assessment • Governance Overall Performance Self-Assessment Tool • Board Member 360 Assessment • CEO Performance Planning and Assessment • Physician (or other specific HR category) Satisfaction Survey • Work Force Satisfaction Survey • Middle Managers Performance Assessment • Patient/Client Satisfaction Assessment • Community Perception Survey
LMG TA Area 4: Governance Monitoring & Information • Design of Board Information System (BIS) • Governance Dashboard Design and Development • Development of Governance Performance Indicators & Metrics
LMG TA Area 5: Governance and Gender What can be done? • Enable more women to participate in governance and empower them • Change the governancePurpose: Work with institutionsgoverning boards, institutionsand individuals to make them themselves—makingmore gender-aware, gender - them gender-responsive and gender - responsivetransformative, internally andexternally for clients • Change mindsets
Governance Knowledge ExchangeKnowledgeExchange is gettingthe rightinformation to theright people at theright time so theycan make gooddecisions. Sharing, exchanging
Problem Statement Long-Term OutcomeMillions of people die each year due to lack of Knowledge Improved health behaviors and health information and ill-informed health care outcomes through effective knowledge services. Management management Logic Model Initial Intermediate Inputs Processes Outputs Outcomes* Outcomes Procedures Knowledge Health • Best practice Used Systems guides • Access Performance • After-Action • Awareness Improved Reviews • AssessmentHuman and Capture Organization • Mentoring • Adoption financial programs • Access • Adaptation knowledgeresources • Communities / Networks • Coverage Share KM Culture • Quality Data and and Capacity Servicesinformation • Efficiency Strengthening • Help desk Individual and Generation Synthesis Organizational • KM training • Workshops Performance Infra- Improved structure Products • Policy and advocacyEquipment Assessment informed • Publications • Websites • Programs and • eLearning practice courses enhanced • CD-ROMs • Training and education improved • Research strengthened Monitor, Evaluate, and Learn *Project achievements are measured at the initial outcomes level. Intermediate and long-term outcome levels are shown to illustrate how initial outcomes can contribute to these other expected outcomes.
CONNECT, COLLABORATE, BE GENEROUS Facilitation Adapted from IRC KM Framework
Governance PublicationseManager: ―Good Governance in Civil Society Organizations‖
Governance PublicationseHandbook: HealthSystems in Action Chapter 3 devoted to Governance
Governance Publications Guide to Effective CSO GovernanceWhat is it?The Guide is a 34-page compilation of FAQs aboutCSO governance.How is the Guide Used?The Guide is used as supplementary training materialfor face-to-face or virtual training programs on CSOgovernance. Also serves as a useful Internet resourcesfor persons seeking information on CSO governance.
Virtual Governance Seminars• LMG can organize virtual seminars of any length on any topic related to governance• Seminar participants: cross-national, from a single country, from single state or province
LMG Governance TeamJim RiceProject Directorjrice@msh.orgMahesh ShuklaSenior Technical Advisor for Governancemshukla@msh.orgKaren Johnson LassnerGovernance Officerklassner@msh.org