2n

dC

on

fere

nce o

f th

e A

fric

an

H

ealt

h E

co

no

mic

s a

nd

Po

licy

As

so

cia

tio

n (

AfH

EA

)

Th

e B

ala

nc

ed

Sc

ore

ca

rd:

A T

ool fo

r D

evelo

pin

g the H

ea

lth S

ecto

r D

evelo

pm

ent

Pla

n I

V in E

thio

pia

20 M

arc

h 2

011

Rahel G

izaw

, M

LI-

Eth

iopia

Countr

y L

ead

2

Wh

at

is a

Ba

lan

ced

Sco

reca

rd (

BS

C)?

�A

Str

ate

gic

Pla

nnin

g a

nd M

anagem

ent

tool

for

alig

nin

g

emplo

yee

s’day

to d

ay w

ork

wit

h a

n o

rgan

izat

ion’s

mis

sion a

nd

vis

ion

�A

change i

nit

iati

ve f

or

com

munic

atin

g l

eader

ship

and

org

aniz

atio

nal

goal

s

�T

he

BS

C b

reak

s st

rate

gy i

nto

act

ionab

le S

trate

gic

Obje

ctiv

es

linked

in a

val

ue

crea

tion s

tory

(a

“str

ateg

y m

ap”)

thro

ugh f

our

dis

tinct

Per

spect

ives

�T

he

BS

C u

ses

Str

ate

gic

Perf

orm

ance

Measu

res

and S

trate

gic

Init

iati

ves

to a

ttai

n or

mai

nta

in t

arget

ed l

evel

s of

org

aniz

atio

nal

per

form

ance

Strategic Initiatives

Strategic Initiatives

Strategic Initiatives

Strategic Initiatives

Th

e L

ogic

of

BS

C S

trate

gic

Pla

nn

ing

30,000 ft.

30,000 ft.

30,000 ft.

30,000 ft.

30,000 ft.

30,000 ft.

30,000 ft.

30,000 ft.

15,000 ft

15,000 ft

15,000 ft

15,000 ft

15,000 ft

15,000 ft

15,000 ft

15,000 ft ..

Ground

Ground

Ground

Ground

Ground

Ground

Ground

Ground

25,000 ft.

25,000 ft.

25,000 ft.

25,000 ft.

25,000 ft.

25,000 ft.

25,000 ft.

25,000 ft.

Strategy M

apStrategy M

apStrategy M

apStrategy M

ap

Mission

Mission

Mission

Mission

Vision

Vision

Vision

Vision

Strategic

Strategic

Strategic

Strategic

Perspectives

Perspectives

Perspectives

Perspectives

Strategic Themes &

Strategic Themes &

Strategic Themes &

Strategic Themes &

Results

Results

Results

Results

Perform

ance M

easures

Perform

ance M

easures

Perform

ance M

easures

Perform

ance M

easures

& Targets

& Targets

& Targets

& Targets

Objectives

Objectives

Objectives

Objectives

Objectives

Objectives

Objectives

Objectives

Customer/

Customer/

Customer/

Customer/

Customer/

Customer/

Customer/

Customer/

Stakeholder

Stakeholder

Stakeholder

Stakeholder

Stakeholder

Stakeholder

Stakeholder

Stakeholder

Needs

Needs

Needs

Needs

Needs

Needs

Needs

Needs

Str

ate

gic

Str

ate

gic

Altitude

Altitude

Altitude

Altitude

Altitude

Altitude

Altitude

Altitude

3

�T

he F

MO

H h

as a

deep s

eate

d c

om

mitm

ent to

im

pro

vin

g

perf

orm

ance a

nd m

an

agem

ent

in the h

ea

lth s

ecto

r.

�B

efo

re t

he B

SC

, th

e F

MO

H h

ad a

lrea

dy im

ple

mente

d:

–a R

esults O

riente

d P

rogra

m A

ppra

isal (R

OP

A)

pro

cess a

nd

–B

usin

ess-P

rocess R

eengin

eering (

BP

R)

�A

do

ptin

g t

he B

SC

was the n

ext

ste

p in u

sin

g these t

ools

fo

r a c

ohere

nt

manag

em

ent

and s

uccess s

trate

gy.

4

Wh

y w

as

it r

igh

t fo

r th

e F

MO

H?

5

2008

Marc

h

2009

On-g

oin

g

Cascad

ing

Tim

elin

e o

f F

MO

H-M

LI

BS

C E

ffo

rts

Health

Secto

r

BS

C

Develo

pe

d

Earl

y

2011

6

1.

BS

C i

s th

e only

str

ateg

ic p

lannin

g a

nd m

anag

emen

t to

ol

for

the

GoE

.

2.

BS

C w

as u

sed a

s fr

amew

ork

for

dev

elopin

g t

he

HS

DP

IV

–a

5 y

ear

stra

tegic

pla

n

for

the

sect

or.

3.

>125 s

taff

fro

m t

he

FM

OH

, R

egio

ns

and M

in.

of

Cap

acit

y B

uil

din

g t

rain

ed i

n

BS

C m

ethodolo

gy

.

4.

BS

C U

ser

Man

ual

and E

val

uat

ion T

oolk

it p

repar

ed f

or

its

use

thro

ughout

the

long

term

oper

atio

ns

of

the

hea

lth s

yst

em.

5.

Exper

ience

of

the

MoH

in B

ots

wan

a p

rovid

ed v

aluab

le p

ract

ical

les

sons

for

Eth

iopia

to s

hap

e B

SC

appro

ach.

6.

Str

ong l

eader

ship

com

mit

men

t an

d o

wner

ship

fro

m t

he

FM

OH

7

Ou

tco

mes

8

Nat

ion

al S

trat

egic

Gu

idan

ce (

PA

SD

EP

)P

lan

for

Acc

eler

ate

d a

nd

Su

stain

ed D

evel

op

men

t to

En

d P

over

ty

Hea

lth S

ecto

r S

trat

egy (

BS

C)

FM

OH

Directorate

Directorate

Team

Reg

ional

Hea

lth B

ure

auR

egio

nal

Hea

lth B

ure

au

Zone

HO

Zone

HO

Woreda

HO

Woreda

HO

Kebele

HO

Kebele

HO

Four

Fed

eral

Hea

lth A

gen

cies

Four

Fed

eral

Hea

lth A

gen

cies

Individual

Individual

Federal

Hospital

Directorate

Directorate

Team

Team Individual

Individual

Team

Individual

Directorate

Directorate

Team

Team

Individual

Individual

Regional

Hospital

Regional

Hospital

Team

Team

Individual

Individual

Team

Team

Individual

Individual

Team

Team

Individual

Individual

Team

Team

Individual

Individual

BS

C C

asc

ad

ing

Mo

del

9

10

Ch

all

enges

Fa

ced

�T

her

e ar

e m

any c

om

pet

ing

pri

ori

ties

wit

hin

th

e F

MO

H

�T

her

e is

a s

ignif

ican

t ti

me

and

res

ou

rce

inv

estm

ent

in i

mp

lem

enti

ng t

he

too

l

�D

on

ors

hav

e li

mit

ed i

nte

rest

in

fund

ing t

he

BS

C a

s th

ey a

re u

nfa

mil

iar

wit

h

its

ben

efit

s an

d h

ow

it

can

im

pac

t h

ealt

h o

utc

om

es

�S

om

e h

ealt

h s

ecto

r st

aff

per

ceiv

e th

e B

SC

as

mai

nly

a m

easu

rem

ent

too

l –

the

BS

C w

as i

nit

iall

y d

eplo

yed

as

a m

onit

ori

ng

an

d e

val

uat

ion

to

ol

for

stra

teg

y e

xec

uti

on

of

acti

vit

ies

at t

he

ind

ivid

ual

lev

el

�A

ten

den

cy a

mo

ng

st p

oli

cym

aker

s to

try

to r

esh

ape

pre

-ex

isti

ng

pla

nn

ing

and m

anag

emen

t sy

stem

s in

to t

he

BS

C f

orm

at

�S

ho

rtag

e of

HR

an

d h

igh

turn

ov

er i

n t

he

hea

lth

sec

tor

11

�T

her

e is

str

ong p

oli

tica

l co

mm

itm

ent

fro

m t

he

Go

E a

nd

hea

lth

sec

tor

lead

ers

to i

mp

lem

ent

BS

C.

�T

he

imp

lem

enta

tion

of

BP

R p

rio

r to

th

e B

SC

hel

ped

to

im

pro

ve

stra

teg

ic

cust

om

er f

ocu

s, a

key

ele

men

t of

BS

C.

�T

he

BS

C

iden

tifi

es s

tren

gth

s an

d w

eak

nes

ses

in t

he

cap

acit

y o

f hea

lth

staf

f an

d p

rov

ides

info

rmat

ion

to

hel

p a

ddre

ss t

he

gap

s. B

SC

id

enti

fies

hig

h p

erfo

rmin

g s

taff

and

hel

ps

man

ager

s to

rew

ard

and

ret

ain

top

per

form

ers.

�T

he

FM

OH

has

a s

trong

cu

lture

of

incl

usi

ve,

top-d

ow

n a

nd

bott

om

-up

stra

teg

ic p

lann

ing p

roce

sses

in p

lace

. T

he

capac

ity t

o t

hin

k s

trat

egic

ally

is

a k

ey e

nab

ler

for

succ

essf

ul

BS

C s

yst

ems.

Op

po

rtu

nit

ies

12

Nex

t S

tep

s /W

ay

Fo

rward

AR2

Slide 12

AR2

This picture is a bit odd--is there a pic from Ethiopia that we can use? A woreda level facility perhaps?

Aarthi Rao, 3/10/2011

13

Glo

bal L

esso

ns

�T

he

com

mit

ted e

ng

agem

ent

of

hig

h l

evel

lea

der

s is

ess

enti

al t

o e

ffec

tiv

e

stra

teg

ic p

lann

ing a

nd

per

form

ance

man

agem

ent

�C

om

mu

nic

atio

n b

etw

een

lea

der

s, m

anag

ers,

an

d s

taff

acr

oss

th

e h

ealt

h

sect

or

nee

ds

to b

e in

tera

ctiv

e; t

he

BS

C p

rov

ides

a f

ram

ework

for

this

typ

e o

f co

mm

un

icat

ion

�C

on

tinu

ou

s in

ves

tmen

t in

bu

ild

ing t

he

capac

ity o

f le

ader

s w

ith

inan

org

aniz

atio

n i

s es

sen

tial

; th

e B

SC

is

a g

ood

too

l fo

r ca

pac

ity a

sses

smen

t

�In

tegra

ting

or

lev

erag

ing

ex

isti

ng

pla

nn

ing

an

d m

anag

emen

t to

ols

and

syst

ems

hel

ps

fost

er b

uy-i

n a

nd

sust

ain

abil

ity f

or

the

BS

C

14

Ackn

ow

led

gem

en

ts

Imp

lem

enta

tion

of

the

BS

C a

t E

thio

pia

’s f

eder

al l

evel

is

suppo

rted

by

the

Min

iste

rial

Lea

der

ship

In

itia

tiv

e fo

r G

lob

al H

ealt

h (

ML

I)

wit

h t

echn

ical

ass

ista

nce

fro

m

the

Bal

ance

d S

core

card

In

stit

ute

(B

SC

I).

Th

is w

ork

was

fund

ed b

y T

he

Bil

l an

d M

elin

da

Gat

es F

ound

atio

n.