Roundtable Seeks Way Forward on Governance for Health

Berhanu Feyisa Tilla, Director General of the Federal Ministry of Health, Ethiopia, said encouraging the “health-seeking behavior” of the population is “only possible through the openness, accountability, and results-seeking behavior of leaders.” {Photo credit: MSH.}Photo credit: MSH.

Governance has become a hot topic among development experts, but what do we mean by governance, particularly in the context of health? Is there a relationship between effective governance and stronger health systems? What are the “governing practices” that help leaders enhance their own governing abilities?

The USAID Leadership, Management, and Governance (LMG) project, led by Management Sciences for Health, brought together 30 well-known governance and international health experts on May 18, 2012, at The Brookings Institution in Washington, D.C. for a day of presentations, and discussion around these issues related to governance in the health sector in low-and middle-income countries (LMICs). The LMG project, which began operations in late 2011, is working to create tools, resources, and learning opportunities for those who lead, manage, and govern in the health sector. The governance roundtable gave the LMG project an opportunity to present recent research carried out by its staff on health governance, and start a dialogue with experts on how to enhance the competencies and confidence of those who govern in low- and middle-income countries.

The keynote speaker was Martinus Desmet, MD, PhD, a public health and development expert and currently the Organisation for Economic Cooperation and Development’s Development Assistance Committee delegate from Belgium, who spoke of emerging lessons of the value and importance of governance for strengthening health systems performance. He cited Bjorkman and Svensson’s randomized field experiment in fifty rural communities of Uganda where community monitoring of providers improved health outcomes. Desmet also suggested moving forward four essential governing practices to be used in modeling of governance for health: engage/collaborate; set direction; steward/steer; and oversee. 

Topics discussed during the roundtable included what has been learned about the value of governance for health systems strengthening and improved health outcomes; how to enhance country engagement and ownership; factors that frustrate good governance; factors, interventions and tools that enhance governance effectiveness; and opportunities for shared research and collaboration to enhance governance practices in the health sector and in health institutions of low- and middle-income countries.

Berhanu Feyisa Tilla, Director General of the Federal Ministry of Health for Ethiopia, spoke of numerous health governance reform efforts that the Ethiopian government is making, including what is being called the Ethiopian “Health Development Army” -- health workers who “want to work to encourage the health-seeking behavior of the population.” Tilla continued, “This is only possible through the openness, accountability, and results-seeking behavior of leaders.”

[Carol Peasley, President and CEO of CEDPA, said her bottom line is: “Policy to promote inclusiveness, including the role of women but also other marginalized groups.” (Photo credit: MSH)]Carol Peasley, President and CEO of CEDPA, said her bottom line is: “Policy to promote inclusiveness, including the role of women but also other marginalized groups.” (Photo credit: MSH)Carol Peasley, President and CEO of the Center for Development and Population Activities (CEDPA), spoke about policies that promote more women into governance roles, including the use of quotas. “You really have to take simultaneous steps to empower those who are filling those quotas,” said Peasley. “That’s my bottom line: policy to promote inclusiveness, including the role of women but also other marginalized groups.”

This sentiment was echoed by Brenda Doe, Deputy Division Chief within the Global Bureau of USAID and the Agreement Officer’s Representative (AOR) for the LMG project: “Failing to involve and include women and minorities and other disadvantaged groups is going to be the biggest barrier to a real, full, honest realization of good governance, and we just can’t forget them.”

Bill Savedoff, senior fellow at the Center for Global Development, said, “We started the day with lots of different definitions of governance, but in the course of the day, we’ve shown how thirty people can come to a common understanding of the concept through this kind of discussion.” In addition, said Savedoff, “We cannot design and implement governance reforms. We can only help countries to improve their own governance.” Savedoff suggested three ways forward: greater use of performance measures; making sure that the “driver of change is domestic—that there’s country ownership;” and always keeping in mind that when we provide ideas, techniques and suggestions, we should convey them with humility for adaptation and use by local citizens.

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The Leadership, Management, and Governance (LMG) Project, funded by USAID, is building innovative strategies for smarter leadership, management, and governance to enhance health system performance and promote better health outcomes for all, including vulnerable populations worldwide. Members of the LMG Consortium include: Management Sciences for Health (MSH); African Medical and Research Foundation (AMREF); International Planned Parenthood Foundation (IPPF); Johns Hopkins University Bloomberg School of Public Health (JHSPH); Medic Mobile; and the Yale Global Health Leadership Institute (GHLI). For more information about the LMG project, please contact Project Director Jim Rice: [jrice@msh.org].

 

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