Upload
najibullah-safi
View
86
Download
1
Embed Size (px)
Citation preview
FRAMEWORK FOR ASSESSING
GOVERNANCE OF HEALTH SYSTEM IN
DEVELOPING COUNTRIES: GATEWAY
TO GOOD GOVERNANCE
Najibullah Safi, MD, MSc. HPM
Reference: S. Siddiqi et al./Health Policy 90 (2009) 13-25
“… the exercise of political, economic and administrative authority in the management of a country’s affairs at all level” UNDP
… comprises the complex mechanisms, processes and institutions through which citizens and groups articulate their interest, mediate their differences and exercise their legal rights and obligation
Introduction
Introduction
• Governance is a key determinants of:
– Economic growth, social advancement and overall development
– Governance of health system is the least well-understood aspect of health system
• “Governance is perhaps the single most important factor in eradicating poverty and promoting development” Kofi Annan
• Health system governance concerns theactions and means adopted by a society toorganize itself in the promotion andprotection of the health of its population
• Governance influences all other healthsystem functions, thereby leading toimproved performance and ultimately tobetter health outcomes
Introduction
• Role of the state vs. the market in health• Role of the MoPH vs. other ministries• Actors in governance – public sector, civil
society and the private sector • Static vs. dynamic health system
Issues in the governance of health system
• Health system governance principles Strategic vision
- Long term vision; comprehensive developmentstrategy including health
Participation and consensus orientation- Participation in decision making process; stakeholderidentification and voice
Rule of law- Legislative process; interpretation of legislation toregulation and policy; enforcement of law, andregulation
Framework for assessing governance
• Health system governance principles Transparency
- Transparency in decision making and allocation of
resources
Responsiveness- Response to population health needs at all level
Equity and inclusiveness- Equity in access to care; fair financing of health care;
disparities in health
Framework for assessing governance
• Health system governance principles Effectiveness and efficiency
- Quality of HR; communication processes; capacity forimplementation
Accountability- Internal and external accountability
Intelligence- Information: generation, collection, analysis,dissemination
Ethics- Health care and research ethics
Framework for assessing governance
• Assessment levels National level (broader context) Policy formulation Policy implementation
• Source of information Published report Unpublished report Interviews
Framework for assessing governance
• Raising awareness• Policy implication of assessing each
governance principle• Point out issues at all levels• Financial cost for improving health system
governance
Policy implication of assessing health system governance
QUESTIONS?