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Improving Our Capacity to Develop Capacity in Health_Dr. Leonardo Cubillos Turriago_4.23.13
Health Systems StrengtheningImproving our capacity todevelop capacity in healthLeonardo Cubillos-TurriagoSenior Health SpecialistWorld Bank InstituteCore Group Spring Meetings 2013April 23rd, 2013Baltimore, MDThis presentation is based on WBI’s Capacity Development Results Framework, and on the work of WBI &WBG health programs
Health Systems StrengtheningCambodia faces a rapid increase in NCDSub Saharan Africa has increased healthexpenditure and access to ART, but still lacksadequate access to the other basic medicinesNeed for Governance & Transparency are ontop on the agenda in the Egyptian HealthCare SystemIncreased prevalence of AIDS in prisons in theDemocratic Republic of Congo
Health Systems StrengtheningSome facts…• Financial development assistance for health increased fromUS$10.5 billion in 2000 to US$27 billion in 2010.• Each year donors spend more than $20 billion on productsand activities designed to enhance the capacity ofdeveloping countries. This level of commitment reflectscommitment of donors.• The Paris Declaration on Aid Effectiveness signed by morethan 100 multilateral and bilateral donors states that the“capacity to plan, manage, implement, an account forresults… is critical for achieving development objectives”
Health Systems StrengtheningGlobal Health: Where are we?What have we achieved• Eradication of smallpox• Reduction in the burden ofcommunicable diseases• Dramatic reductions ininfant and maternalmortality rates• Increased life expectancy• Strengthened healthsystemsOur challenges• Resurgence of pandemics:multi resistant tuberculosis• We are suffering from moreNCDs• Rising health care inequalities• 2 billion people without accessto basic medicines• Expenditures are mounting. Asan example, 25% of TGHE goto medicines (15% only 7 yearsback).
Health Systems StrengtheningGlobal Health: Where are we?Our challenges• MDG 4, 5 & 6 will not bemet• MDG 1 will be met partlydue to China’s economicgrowth
Health Systems StrengtheningCHALLENGES IN CAPACITYDEVELOPMENT1. Definition of capacity and capacity development are very broad– “Capacity” is understood as the ability of people, organizations, and societyas a whole to manage their affairs successfully– “Capacity development, CD” is understood as the process wherebypeople, organizations, and society as a wholeunleash, strengthen, create, adapt, and maintain capacity over time (OECD2006b)2. Lack of consensus about operational definition of CD3. Lack of consensus about the expected results4. Links between CD outcomes and development goals are poorlyarticulated5. It is hard to identify good practices for replication because there isinattention to measure results attained6. Many programs are poorly grounded on theory7. Many programs lack consistent conceptual frameworks8. Process by which change occurs is poorly understood9. Importance of strategy is overlooked
Health Systems StrengtheningDEFINITION (1)• Capacity for development, is the availability ofresources (human, financial, technical) andthe efficiency and effectiveness (these dependon socio-political, institutional, andorganizational factors) with which societiesdeploy those resources to identify and pursuetheir development goals on a sustainable(when results and performance are locallyowned and can be replicated and scaled up bylocal actors) basis.
Health Systems StrengtheningDEFINITION (2)Capacity development, is a locally driven processoflearning by leaders, coalitions and other agents ofchange that brings about changes insociopolitical, policy-related, and organizationalfactors to enhance local ownership for and theeffectiveness and efficiency of effortsTransformational learning interventions ought to bedesigned and implemented aiming at acting onchange agents. They would, in turn, act on sociopolitical, policy-related, and organizational factors.
Health Systems StrengtheningCapacity development is a necessarycondition for the development process.
Health Systems StrengtheningTHREE INSTITUTIONAL CAPACITY DEVELOPMENTAREAS where change should occur
Health Systems StrengtheningThe conduciveness of thesociopolitical environment toachievement of the goalsis made up of the politicaland social forces thatdetermine the prioritygiven to the developmentgoal by thegovernment, the privatesector, and the civilsociety.
Health Systems StrengtheningThe efficiency of the policyinstruments and other formalmeans by which the societyguides action to achieve thegoalsThey are to be used toguide stakeholderaction. They can takethe form ofadministrativerules, regulations, laws,and standards.
Health Systems StrengtheningThe effectiveness of theorganizational arrangementsthat stakeholders inside andoutside of government adoptto achieve the goals.Systems, rules ofaction, processes, personnel, and otherresources with whichactors work together.
Health Systems StrengtheningOpenKnowledgeconnect toglobal knowledgeCollaborativeGovernancecoalesce stakeholders tomake change happenInnovativeSolutionsscan & incubateinnovationsGrowth &CompetitivenessFragile States Governance Climate ChangeHealth Systems Urban PPP OthersCatalyze change for development resultsStructuredlearninge-InstituteKnowledgeExchangeSSKEOpen Government &Open AidParticipation &Oversight by Non-Government ActorsCitizen Feedbackusing ICTsMulti-stakeholderCollaborative ActionCompetitions & GrandChallengesDevelopmentMarketplace DM 2.0Innovation LabBy strengthening the capacity of government and non-governmental actorsto collectively tackle development challengesResults Areas
Health Systems StrengtheningLearning, joint learning, and joint action as thebasis for Capacity Development
Health Systems StrengtheningLearning outcomes exemplified
Health Systems StrengtheningCRITICAL QUESTIONS IN THEDESIGN, IMPLEMENTATION, AND MONITORINGOF CAPACITY DEVELOPMENT EFFORTS• What is the program’s developmentobjective?• What are the prevailing capacity factors?• Who are the appropriate agents of change?• What is the change process?• What are the learning outcomes?• What are the activities and instruments?• What is our implementation strategy?• How are we measuring progress & results?Are we co-creating this withlocal leaders /communities? Arewe encouragingan open analysisand an opendiscussion amongstakeholdersthrough out theprogram cycle?
Health Systems StrengtheningSOME EXAMPLES…1. Cambodia – Developing the capacity of thecommunity & the health system to monitor &control HTA & DM: The experience of MoPoTsyo2. DRC – Developing the capacity of the prisonersand the prison system to take sustainable actionon HIV-AIDS: The experience of RDCompétence3. East Africa – Improving the capacity oftransparent and accountable procurement &supply management of basic medicines: Theexperience of e-nepp (WBI)4. Latin America – Improving the capacity to setfair, accountable, and actionable priorities inhealth (WBI)
Health Systems Strengthening“Pooled funds willnever be able tocover 100% of thepopulation for100% of the costsand 100% ofneeded services…Each country fillsthe box in its ownway, trading off theproportion ofservices and theproportion of thecosts to be metfrom pooledfunds”, (WHO, 2010).LITIGATION IS BEING USED TO ENFORCE ACCESSTO PRIORITIZED AND NON PRIORITIZEDSERVICESSource: WHO, Global Health Report 2010
Health Systems StrengtheningDO PEOPLE ACCESSTHEM WITHOUTGOING TO COURTS?BASICSERVICESNoNoYESiYESIV IIIIIITYPES OF LITIGATIONFuente: Cubillos et al (2012),"Universal health coverageand litigation in Latin America", JHOM
Health Systems StrengtheningCOSTA RICA: TREND ON INDIVIDUAL RIGHTS LITIGATIONSRULED BY THE CONSTITUTIONAL CHAMBER (SALA IV) OF THESUPREME COURT OF JUSTICESource: Bruce M. Wilson. Enforcing Rights and Employing an Accountability Function.University Central Florida – CHR Michelsen Institute, March 2009
Health Systems Strengthening22COLOMBIA: GROWING RESOURCE ALLOCATION AS A RESULTOF LITIGATIONS FOR NON PRIORITIZED MEDICATIONS (45%ANNUAL INCREASE)020.000.00040.000.00060.000.00080.000.000100.000.000120.000.000140.000.000160.000.0001998-072000-052000-082000-102000-122001-032001-052001-072001-092001-112002-012002-032002-052002-072002-092002-112003-012003-032003-052003-072003-092003-112004-012004-032004-052004-072004-092004-112005-012005-032005-052005-072005-092005-112006-012006-032006-052006-072006-092006-112007-012007-032007-052007-072007-092007-112008-012008-032008-052008-072008-092008-112009-012009-032009-052009-072009-092009-112010-01ValorMensual Recobros(USD/08)Valor Presentado Valor AprobadoSource : Eduardo Alfonso, Estudio de Caso de Colombia, en Proceso de Elaboración por WBIHS, Agosto2010
Health Systems StrengtheningLITIGATION HAS AN IMPORTANTIMPACT ON EQUITYFuente: Cubillos, Escobar, et al (2012),"Universal health coverageand litigation in Latin America", JHOMFuente: Capítulo 4 Ferraz. Yamin, Gloppen Litigating health rights:Can courts bring more justice Health?. 2011
Health Systems StrengtheningDEVELOPMENT OBJECTIVETo contribute to improve the level anddistribution of key health outcomes, as well asthe governance, accountability, transparencyand financial sustainability of the healthsector of participating countries. As such, it isexpected that the Initiative, wouldultimately, contribute to the realization ofhealth as a human right.
Health Systems StrengtheningINSTRUMENTS OF CHANGESupport participating countries create and/or strengthen regional andnational multi-stakeholder coalitions that contribute to the following set ofobjectives:• Strengthen the capacity of countries to exchange knowledge and shareexperiences;• Enhance the effectiveness of policy instruments;• Implement fair, transparent, and technically sound priority settingprocesses that progressively realize the right to health;• Improve key stakeholder ownership of the health and judiciary systems;• Empower citizens to contribute to the ultimate improvement of healthsystems;• Ensure that access to health services is non-discriminatory; and• Improve the quality and access to health services by citizens (rightholders)
Health Systems StrengtheningKnowledgeExchangeAnalytical WorkOnlinecommunityCountry MultiStakeholder activitiesLatin American MultiStakeholder activitiesGlobal MultiStakeholder activities06/1106/1006/1306/12
Health Systems StrengtheningThe conduciveness of thesociopolitical environment toachievement of the goalsPolitical & social leadershave expressedcommitment to embarkin a multi stakeholderprocess of change.
Health Systems StrengtheningThe efficiency of the policyinstruments and other formalmeans by which the societyguides action to achieve thegoalsRulings are changingNew laws & regulations arebeing discussed & approved
Health Systems StrengtheningThe effectiveness of theorganizational arrangementsthat stakeholders inside andoutside of government adoptto achieve the goals.Actor regularly meettogether. New & differentchannels of communicationare appearing.Actors work together.
Health Systems StrengtheningOpenKnowledgeconnect toglobal knowledgeInnovativeSolutionsscan & incubateinnovationsCollaborativeGovernancecoalesce stakeholders tomake change happenKnowledge ExchangeMulti-levelMulti-stakeholdercoalition buildingICT PlatformAn Example of WBI’s Approach inConstitutional Mandates and Priority Settings in Health
Health Systems Strengthening“A post-2015 world should have more engagement ofpeople, inclusivity, transparency, and accountability.Emerging governance models also provide opportunities forfar greater citizen participation, influence and intersectoralaction.Civil society and community dimensions of “countryownership” are vital for both strong policy developmentand for holding all stakeholders accountable for progress.”High Level Dialogue on Health in the Post-2015 Development Agenda,Gaborone, 4-5 March 2013