Innovative approaches to researching governance
-
Upload
resyst -
Category
Health & Medicine
-
view
169 -
download
3
description
Transcript of Innovative approaches to researching governance
![Page 1: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/1.jpg)
Innovative approaches to researching governance
issues for UHC“International Experience on Provider Payment Reforms for Universal Health
Coverage”, Hanoi 16th Sept 2013
![Page 2: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/2.jpg)
Outline
1.Governance and UHC
1.Researching governance within RESYST
![Page 3: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/3.jpg)
‘It is more useful to think of UHC as a direction, rather than as a destination’
Kutzin, 2013 p.604
…pursuing UHC requires coordinated policy action & implementation, across system
functions and over time
![Page 4: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/4.jpg)
Kutzin, 2013
![Page 5: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/5.jpg)
De Savigny & Adams, 2009
Decision-making by people is at the heart of health system governance
![Page 6: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/6.jpg)
Governance issues for UHC
Governance
…of UHC and the health system
… and of change/reform itself
![Page 7: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/7.jpg)
1) The hardware: establish frameworks of accountability & spread power
![Page 8: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/8.jpg)
Governance structures• Develop a coherent network of ‘structures’
across the health system that spread power for decision-making across actors
• Develop legislative frameworks that underpin the structures and their power to act, and hold them accountable upwards and outwards
![Page 9: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/9.jpg)
2) The software: enable the responsible exercise of power by system actors
![Page 10: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/10.jpg)
‘Governance is about the (formal & informal) rules that distribute roles and responsibilities among societal actors and that shape the interactions among them (decision-making)’
Brinkerhoff & Bossert (2008)
![Page 11: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/11.jpg)
Influencing decision-making?
• Through a combination of:– values & principles• Professional ethics• Transparency
– leadership & role modeling– relationships of accountability– information– financial incentives
![Page 12: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/12.jpg)
3) The governance of change: maintain a consistent path and learn through doing
![Page 13: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/13.jpg)
Thai experience
![Page 14: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/14.jpg)
Always important
• Sustained political leadership & commitment to change
• Forming partnerships• Engaging and managing stakeholders• Sustained technical intensity & support
![Page 15: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/15.jpg)
Plan - Do - Study - Act
But also:
Expect the unexpected
Encourage learning processes & cultures
![Page 16: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/16.jpg)
Understanding governance: the Resyst approach
![Page 17: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/17.jpg)
The tangible software:• Sets of human resources • Management knowledge &
skills • Formal management
processes
The intangible software:• The informal rules,
communication patterns, values, norms that shape relationships and interactions among actors (relative power, trust, civic-mindedness)
Leadership
Lead
ersh
ip
The hardware: e.g. a coherent network of ‘structures’ across the health system that spread power; legislative frameworks that underpin accountability; resource levels & distribution patterns signaling value
Governance as collective organisational capacity
![Page 18: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/18.jpg)
RESYST governance focus
• The micro-practices of governance, and what influences them
the decision-making practices of public sector leaders working within the routines of the health system
• And how these practices influence accountability, policy implementation & health system change
![Page 19: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/19.jpg)
Research challenges
• Micro-practices of governance are dynamic & complex, hard to observe
• Difficult to disentangle governance effects from other health system elements/changes
• Seek to inform and support continuing processes of decision-making, rather than to identify a single policy intervention
![Page 20: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/20.jpg)
The job of the health system researcher
‘...is to illuminate the processes of change and experience that they observe...
to make a contribution ... to the social process of understanding or promoting change.’
Barnes et al., 2005
![Page 21: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/21.jpg)
Critical reflection
Learning through
doing
Research to support learning
![Page 22: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/22.jpg)
RESYST governance research
• Learning sites within the ‘District Health System’
• Continuous engagement over time within a context
• Focus on planning & priority setting
• Understanding implementing actors’ 'theories of change’ for system reforms
• Focus on specific UHC-related reforms (South Africa, Tanzania, Nigeria)
Encouraging reflection about decision-making practices through research
![Page 23: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/23.jpg)
Why focus on peripheral facilities?
RESYST learning sites
![Page 24: Innovative approaches to researching governance](https://reader033.fdocuments.in/reader033/viewer/2022052623/5598944a1a28ab0c718b4887/html5/thumbnails/24.jpg)
Supporting distributed leadership for UHC
‘Probably the most complex challenge in health systems is to nurture persons who can develop
the strategic vision, technical knowledge, political skills, and ethical orientation to lead the complex processes of policy formulation and implementation. Without leaders, even the best designed systems will fail’ (Frenk
2010: 2)