Post on 22-May-2015
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 Now
by 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 TransparencyAccountabilityParticipationInclusionEthical and moral integrityFocus and visionEfficiency and Equity
What enables it and what hinders it
# Deterrent # Enabler1
Ineffective leadership1 Ethical and moral integrity
2 Corruption 2 Competent leaders governing3
Ineffective management
3 Governing with a definite policy on measurement, data gathering, analysis, and use of information for policy making
4 Inadequate transparency 4 Sound management5
Inadequate accountability5 Adequate financial resources available for
governing
6 Inadequate systems to collect, manage, analyze and use data
6 Openness and transparency
7 Inadequate participation of community/ citizens/ clients/ consumers/ patients
7 Client/community participation in decision making
8Political context
8 Accountability to citizens/clients
9Inadequate checks and balances
9 Governing based on scientific evidence
10 Inadequate financial resources for governance 10 Good Governance in sectors other than health
Defining governing in practical terms
To include To steer To regulate To collaborate To oversee To allocate0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
75% 75%67% 63% 60% 58%
17% 17%21% 26%
25% 29%
6% 5% 8% 8%8%
9%is not a part of governing at all
is a slightly significant part of governing
is a moderately signif-icant part of governing
is a highly significant part of governing
Practices of Effective Governance
Cultivate Accountability
Engage Stakeholders
Set Shared Direction
Steward Resources
Practice Principles
CULTIVATE ACCOUNTABILITY
AccountabilityTransparencyLegal, ethical and moral behavior/Moral capitalAccessibilitySocial justiceOversightLegitimacy
ENGAGE STAKEHOLDERS
ParticipationRepresentationInclusionDiversityGender equityConflict resolution
SET SHARED DIRECTION
Stakeholder alignmentLeadershipManagementAdvocacy
STEWARD RESOURCES
EthicsEfficiencyEffectivenessResourcefulnessFinancial AccountabilityDevelopmentSocial responsibility
Practices Principles Governing actionsCULTIVATE ACCOUNTABILITY Foster a facilitative decision-making environment
AccountabilityTransparencyLegal, ethical and moral behaviorAccessibilitySocial justiceMoral capitalOversightLegitimacy
1. Establish, champion, practice and enforce codes of conduct 2. Embed accountability into the governing institutions 3. Make all reports on finances, activities, and plans available to the public4. Establish oversight and review processes 5. Establish a formal consultation mechanism 6. Sustain a culture of integrity and openness that serves the public interest
ENGAGE STAKEHOLDERS Identify, engage and collaborate with diverse stakeholders
ParticipationRepresentationInclusionDiversityGender equityConflict resolution
1. Empower marginalized voices, including women2. Ensure appropriate participation of key stakeholders 3. Create and maintain a safe space for the sharing of ideas4. Provide an independent conflict resolution mechanism 5. Elicit, and respond to, all forms of feedback 6. Establish alliances for joint action at whole-of-government and whole-of-
society levels
SET SHARED DIRECTION Develop a collective vision of the ‘ideal state’
Stakeholder alignmentLeadershipManagementAdvocacy
1. Oversee the process for developing and implementing a shared action plan 2. Advocate on behalf of stakeholders’ needs and concerns3. Document and disseminate the shared vision of the ‘ideal state.’4. Set up accountability mechanisms for achieving goals 5. Oversee the process of setting goals to reach the ‘ideal state.’6. Oversee the process of realization of the shared goals and the desired
outcomes.STEWARD RESOURCES Steward resources responsibly, building capacity
Financial AccountabilityDevelopmentSocial responsibilityCapacity buildingCountry ownershipEthicsResourcefulnessEfficiencyEffectiveness
1. Champion the acquisition and deployment of resources 2. Protect and invest the resources to serve stakeholders and beneficiaries3. Collect, analyze and use information and evidence for making decisions 4. Build capacity to absorb resources and deliver quality services 5. Use resources in a way that maximizes the health and well-being of the
public
6. Inform and allow the public opportunities to monitor raising, allocation, and use of resources, and realization of the outcomes
GOVERNING PRACTICES
LMG for Results
HSS for Results
Measuring governance
• 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.”
Process Outcomes Health service attributes
Health outcomesBoth process and outcomesImpact Health impact
Impact beyond health
Transform-ative
16%seek to
transform gender
relations and
promote equity
+++
Responsive
56%clearly
responsive to different
needs based on
gender
++
Aware12%
do not seek to
challenge the status
quo
+
Blind8%
gender does not influence
how decisions are made
0
Exploitative8%
maintain gender
inequalities and
stereotypes
—
Gender in governance
Roles women play in a health system Women in boardrooms or governing positions 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…..”
Genderperspective of our key informants
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 studies on the LMG web page of the MSH external site at http://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
June 27, 2012
Karen Johnson Lassner
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 & management
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 management content into the pre-service curricula
Pre-Service Guide provides 3 sample curricula, facilitators’ notes, & 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 & Information
• Governance and Gender
Adaptations are made in the TA based on the context, i.e. public vs. private sector,
governing 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 governance institutions themselves—making them gender-responsive
• Change mindsets
Purpose: Work with governing boards, institutions and individuals to make them more gender-aware, gender -responsive and gender -transformative, internally and externally for clients
Governance Knowledge Exchange
Knowledge Exchange is getting the right information to the right people at the right time so they can make good decisions.
Sharing, exchanging and using governance information
Inputs Processes Outputs
Knowledge Management Logic Model
Health Systems Performance
Improved
• Access
• Coverage
• Quality
• Efficiency
Individual and Organizational Performance
Improved
• Policy and advocacy informed
• Programs and practice enhanced
• Training and education improved
• Research strengthened
*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.
Developed by the KM M&E Working Group (draft: April 27, 2012).
Knowledge Used
• Access • Awareness• Assessment• Adoption• Adaptation
Problem StatementMillions of people die each year due to lack of
information and ill-informed health care services.
Long-Term OutcomeImproved health behaviors and health outcomes
through effective knowledge management
Monitor, Evaluate, and Learn
Initial Outcomes*
Intermediate Outcomes
Procedures
• Best practice guides
•After-Action Reviews
•Mentoring programs
•Communities/ Networks
Services
• Help desk• KM training• Workshops
Products
• Publications• Websites• eLearning
courses • CD-ROMs
KM Culture and CapacityStrengthening
Human andfinancial resources
Data and information
Infra-structure
Equipment
Share
knowledge
Generation
Assessment
Capture Organization
Synthesis
CONNECT, COLLABORATE, BE GENEROUS
Conversation / Activities
Conversation / Activities
Conversation / Activities
Information repository
VersioningInformation
Document process
Facilitation
Adapted from IRC KM Framework
Governance Knowledge Exchange
Sharingknowledge thrupublications
Exchangingknowledgevirtually
Governance Publications
eManager: “Good Governance in Civil Society Organizations”
Governance Publications
eHandbook: HealthSystems in Action
Chapter 3 devoted to Governance
Governance Publications
Guide to Effective CSO Governance
What is it?The Guide is a 34-page compilation of FAQs about CSO governance.
How is the Guide Used?The Guide is used as supplementary training material for face-to-face or virtual training programs on CSO governance. Also serves as a useful Internet resources for 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 Team
Jim Rice
Project Director
jrice@msh.org
Mahesh Shukla
Senior Technical Advisor for Governance
mshukla@msh.org
Karen Johnson Lassner
Governance Officer
klassner@msh.org