Improving Our Capacity to Develop Capacity in Health_Dr. Leonardo Cubillos Turriago_4.23.13

Health Systems Strengthening

Improving our capacity to develop capacity in health

Leonardo Cubillos-TurriagoSenior Health Specialist

World Bank Institute

Core Group Spring Meetings 2013April 23rd, 2013Baltimore, MD

This presentation is based on WBI’s Capacity Development Results Framework, and on the work of WBI & WBG health programs


Cambodia faces a rapid increase in NCD

Sub Saharan Africa has increased health expenditure and access to ART, but still lacks adequate access to the other basic medicines

Need for Governance & Transparency are on top on the agenda in the Egyptian Health Care System

Increased prevalence of AIDS in prisons in the Democratic Republic of Congo


Some facts…

• Financial development assistance for health increased from US$10.5 billion in 2000 to US$27 billion in 2010.

• Each year donors spend more than $20 billion on products and activities designed to enhance the capacity of developing countries. This level of commitment reflects commitment of donors.

• The Paris Declaration on Aid Effectiveness signed by more than

100 multilateral and bilateral donors states that the “capacity to plan, manage, implement, an account for results… is critical for achieving development objectives”


Global Health: Where are we?

What have we achieved• Eradication of smallpox• Reduction in the burden of

communicable diseases• Dramatic reductions in

infant and maternal mortality rates

• Increased life expectancy• Strengthened health

systems

Our challenges• Resurgence of pandemics:

multi resistant tuberculosis• We are suffering from more

NCDs• Rising health care inequalities• 2 billion people without access

to basic medicines• Expenditures are mounting. As

an example, 25% of TGHE go to medicines (15% only 7 years back).


Global Health: Where are we?

Our challenges• MDG 4, 5 & 6 will not be

met• MDG 1 will be met partly

due to China’s economic growth


CHALLENGES IN CAPACITY DEVELOPMENT

1. Definition of capacity and capacity development are very broad– “Capacity” is understood as the ability of people, organizations, and society as a

whole to manage their affairs successfully– “Capacity development, CD” is understood as the process whereby people,

organizations, and society as a whole unleash, strengthen, create, adapt, and maintain capacity over time (OECD 2006b)

2. Lack of consensus about operational definition of CD3. Lack of consensus about the expected results4. Links between CD outcomes and development goals are poorly articulated5. It is hard to identify good practices for replication because there is inattention

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


DEFINITION (1)

• Capacity for development, is the availability of resources (human, financial, technical) and the efficiency and effectiveness (these depend on socio-political, institutional, and organizational factors) with which societies deploy those resources to identify and pursue their development goals on a sustainable (when results and performance are locally owned and can be replicated and scaled up by local actors) basis.


DEFINITION (2)

Capacity development, is a locally driven process oflearning by leaders, coalitions and other agents of change that brings about changes in sociopolitical, policy-related, and organizational factors to enhance local ownership for and the effectiveness and efficiency of efforts

Transformational learning interventions ought to be designed and implemented aiming at acting on change agents. They would, in turn, act on socio political, policy-related, and organizational factors.


Capacity development is a necessary condition for the development process.


THREE INSTITUTIONAL CAPACITY DEVELOPMENT AREAS where change should occur


The conduciveness of the sociopolitical environment to

achievement of the goals

is made up of the political and social forces that determine the priority given to the development goal by the government, the private sector, and the civil society.


The efficiency of the policy instruments and other formal means by which the society guides action to achieve the

goals

They are to be used to guide stakeholder action. They can take the form of administrative rules, regulations, laws, and standards.


The effectiveness of the organizational arrangements that stakeholders inside and outside of government adopt

to achieve the goals.

Systems, rules of action, processes, personnel, and other resources with which actors work together.


Open Knowledge

connect to global knowledge

Collaborative Governance

coalesce stakeholders to make change happen

InnovativeSolutions

scan & incubate innovations

Growth &

CompetitivenessFragile States Governance Climate Change

Health Systems Urban PPP Others

Catalyze change for development results

Structured learning

e-Institute

Knowledge Exchange

SSKE

Open Government & Open Aid

Participation & Oversight by Non-Government Actors

Citizen Feedback using ICTs

Multi-stakeholder Collaborative Action

Competitions & Grand Challenges

Development Marketplace DM 2.0

Innovation Lab

By strengthening the capacity of government and non-governmental actors to collectively tackle development challenges

Results Areas


Learning, joint learning, and joint action as the basis for Capacity Development


Learning outcomes exemplified


CRITICAL QUESTIONS IN THE DESIGN, IMPLEMENTATION, AND MONITORING OF

CAPACITY DEVELOPMENT EFFORTS

• What is the program’s development objective?

• 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 with local leaders / communities? Are we encouraging an open analysis and an open discussion among stakeholders through out the program cycle?


SOME EXAMPLES…

1. Cambodia – Developing the capacity of the community & the health system to monitor & control HTA & DM: The experience of MoPoTsyo

2. DRC – Developing the capacity of the prisoners and the prison system to take sustainable action on HIV-AIDS: The experience of RDCompétence

3. East Africa – Improving the capacity of transparent and accountable procurement & supply management of basic medicines: The experience of e-nepp (WBI)

4. Latin America – Improving the capacity to set fair, accountable, and actionable priorities in health (WBI)


“Pooled funds will never be able to cover 100% of the population for 100% of the costs and 100% of needed services… Each country fills the box in its own way, trading off the proportion of services and the proportion of the costs to be met from pooled funds”, (WHO, 2010).

LITIGATION IS BEING USED TO ENFORCE ACCESS TO PRIORITIZED AND NON PRIORITIZED

SERVICES

Source: WHO, Global Health Report 2010


DO PEOPLE ACCESS THEM WITHOUT

GOING TO COURTS?

BASIC SERVICES

No

No

YESi

YES

IV I

IIIII

TYPES OF LITIGATION

Fuente: Cubillos et al (2012),"Universal health coverage and litigation in Latin America", JHOM


COSTA RICA: TREND ON INDIVIDUAL RIGHTS LITIGATIONS RULED BY THE CONSTITUTIONAL CHAMBER (SALA IV) OF THE

SUPREME COURT OF JUSTICE

Source: Bruce M. Wilson. Enforcing Rights and Employing an Accountability Function. University Central Florida – CHR Michelsen Institute, March 2009

Health Systems Strengthening22

COLOMBIA: GROWING RESOURCE ALLOCATION AS A RESULT OF LITIGATIONS FOR NON PRIORITIZED

MEDICATIONS (45% ANNUAL INCREASE)

0

20.000.000

40.000.000

60.000.000

80.000.000

100.000.000

120.000.000

140.000.000

160.000.000

1998

-07

2000

-05

2000

-08

2000

-10

2000

-12

2001

-03

2001

-05

2001

-07

2001

-09

2001

-11

2002

-01

2002

-03

2002

-05

2002

-07

2002

-09

2002

-11

2003

-01

2003

-03

2003

-05

2003

-07

2003

-09

2003

-11

2004

-01

2004

-03

2004

-05

2004

-07

2004

-09

2004

-11

2005

-01

2005

-03

2005

-05

2005

-07

2005

-09

2005

-11

2006

-01

2006

-03

2006

-05

2006

-07

2006

-09

2006

-11

2007

-01

2007

-03

2007

-05

2007

-07

2007

-09

2007

-11

2008

-01

2008

-03

2008

-05

2008

-07

2008

-09

2008

-11

2009

-01

2009

-03

2009

-05

2009

-07

2009

-09

2009

-11

2010

-01

Valor Mensual Recobros (USD/08)

Valor Presentado Valor Aprobado

Source : Eduardo Alfonso, Estudio de Caso de Colombia, en Proceso de Elaboración por WBIHS, Agosto2010


LITIGATION HAS AN IMPORTANT IMPACT ON EQUITY

Fuente: Cubillos, Escobar, et al (2012),"Universal health coverage and litigation in Latin America", JHOM

Fuente: Capítulo 4 Ferraz. Yamin, Gloppen Litigating health rights: Can courts bring more justice Health?. 2011


DEVELOPMENT OBJECTIVE

To contribute to improve the level and distribution of key health outcomes, as well as the governance, accountability, transparency and financial sustainability of the health sector of participating countries. As such, it is expected that the Initiative, would ultimately, contribute to the realization of health as a human right.


INSTRUMENTS OF CHANGESupport participating countries create and/or strengthen regional and national multi-stakeholder coalitions that contribute to the following set of objectives:

• Strengthen the capacity of countries to exchange knowledge and share experiences;

• Enhance the effectiveness of policy instruments;• Implement fair, transparent, and technically sound priority setting

processes 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 health

systems;• Ensure that access to health services is non-discriminatory; and• Improve the quality and access to health services by citizens (right

holders)


Knowledge Exchange

Analytical Work

Online community

Country Multi Stakeholder activities

Latin American Multi Stakeholder activities

Global Multi Stakeholder activities

06/11

06/10

06/13

06/12

http://www.worldbank.org/lac


The conduciveness of the sociopolitical environment to

achievement of the goals

Political & social leaders have expressed commitment to embark in a multi stakeholder process of change.


The efficiency of the policy instruments and other formal means by which the society guides action to achieve the

goals

Rulings are changing

New laws & regulations are being discussed & approved


The effectiveness of the organizational arrangements that stakeholders inside and outside of government adopt

to achieve the goals.

Actor regularly meet together. New & different channels of communication are appearing.Actors work together.


Open Knowledge

connect to global knowledge

InnovativeSolutions

scan & incubate innovations

Collaborative Governance

coalesce stakeholders to make change happen

Knowledge Exchange

Multi-levelMulti-stakeholder coalition building

ICT Platform

An Example of WBI’s Approach in Constitutional Mandates and Priority Settings in Health


“A post-2015 world should have more engagement of people, inclusivity, transparency, and accountability. Emerging governance models also provide opportunities for far greater citizen participation, influence and intersectoral action.

Civil society and community dimensions of “country ownership” are vital for both strong policy development and for holding all stakeholders accountable for progress.”

High Level Dialogue on Health in the Post-2015 Development Agenda,Gaborone, 4-5 March 2013



Thank you!

[email protected]

For more information• The World Bank Institute• [email protected]• www.worldbank.org• www.saluderecho.net

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Improving Our Capacity to Develop Capacity in Health_Dr. Leonardo Cubillos Turriago_4.23.13