Ghli governance 07.11.12
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Presented at the Workshop on Governance and Transparency in the Pharmaceutical Sector, WHO, Geneva, July 11, 2012
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Ghli governance 07.11.12
- 1. A Model of Effective Governance for Health WHO Workshop on transparency and good governance in the pharmaceutical sector July 11, 2012
- 2. Background • Global Health Initiative established in May 2009 under Yale’s Jackson Institute of Global Affairs • Global Health Leadership Institute was created under GHI umbrella to focus on global health systems strengthening through: – Targeted training – Innovative leadership development – Research
- 3. Literature Review Purpose: to inform the creation of a model of effective governance practices to incorporate into leadership development curriculum Literature review focus: to determine what governance activities in low- and middle-income countries have been empirically linked to health outcomes
- 4. Literature Review Governance search terms – governing boards, decision making, democracy, health policy, stewardship, accountability, planning , councils, participation, social capital, stewardship, capacity building Health outcomes – health status, quality of care, mortality, life expectancy, immunization rate, essential medicines 1,232 abstracts 21 articles for data extraction
- 5. Findings 1. There is not a strong research base linking governance practices to health outcomes 2. The structures of governance (institutions, type of decision making bodies) matter less than the mechanisms of governance 3. The processes that happen at the local level, or closest to the point of service, have the greatest impact
- 6. Foster a facilitative decision-making environment Engage stakeholders Steward Resources
- 7. Good Governance in Practice Foster a facilitative decision-making environment Engage stakeholders Steward resources Develop shared vision and oversee the process of achieving it
- 8. Foster the environment 1. Document and enforce codes of conduct. 2. Make all reports on finances, activities, and plans available to the public, and share them formally with stakeholders. 3. Demand that other stakeholders share similarly. 4. Establish a formal review process (judicial board, external evaluation, etc.) to assess the impact of decisions made. 5. Establish a formal consultation mechanism (open forum, special status at meetings, etc.) through which constituencies may voice concerns or provide other feedback.
- 9. Engage stakeholders 1. Empower marginalized voices, including women, by giving them a place in formal decision-making structures. 2. Ensure appropriate participation by key stakeholders through fair voting and decision-making procedures. 3. Provide an independent conflict resolution mechanism accessible by all stakeholders and interested parties. 4. Elicit, and respond to, all forms of feedback in a timely manner. 5. Build coalitions and encourage consensus on working toward the shared vision.
- 10. Steward resources 1. Make evidence-based decisions on the use of resources, both financial and technical. 2. Determine, and execute, a strategy for building the health sector’s capacity. 3. Invest in advocacy, so that the needs of the health sector are addressed in every appropriate decision- making venue.
- 11. Develop shared vision 1. Determine and promote a process for developing and implementing a shared action plan. 2. Advocate on behalf of stakeholders’ needs and concerns, as identified through the formal mechanisms above; making sure to include these in defining the shared direction. 3. Document the shared vision of the ‘ideal state.’ 4. Oversee the setting of goals to reach the ideal state and set up accountability mechanisms for their achievement. 5. Advocate for the ‘ideal state’ in all other arenas with a role to play in its realization (higher levels of governance, other sectors, other convening venues).
- 12. Next Steps Leadership, Management, Governance Initiative Test model through senior leadership development Evaluation of model through application to health delivery agencies and other entities that impact health Improve research methods and evidence base
Editor's Notes
- First of all, there is not a strong evidence base linking governance to health outcomes in low- and middle-income countries. Furthermore, the research that exists is not particularly rigorous. We have our work cut out for us in terms of building the capacity of academic, in-country partners to build the evidence base in governance. The research we did find supported two main overarching themes:2. The processes of governance are more important than structures. For instance, one article following the health policy reforms of Bangladesh found that while there was a high level political commitment to “Health for All,” weak enforcement at the local level allowed a system of informal payments to persist, perpetuating a lack of access for impoverished populations at the point of delivery 2.Of these, the processes of engagement at the local level make the difference. For instance, research conducted in Kenya demonstrated the effectiveness of a system of evidence-based dialogue between communities and service providers in increasing both immunization coverage and utlllization of insecticide-treated bednets by women and children under 5. The intervention was designed around committees led by CHWs who were trained as facilitators. One way in which accountability was formalized was through the use of anonymous patient comment boxes in the facilities (Kaseje et al, 2010).