International and National Health Care System and Polices in Public Health - PowerPoint Presentation

Slide1

International and National Health Care System and Polices in Public Health

Osama A

Samarkandi

, PhD, RN

EMS

313; Public Health for EMS ProfessionalsSlide2

Governance Defined

The exercise of political, economic and administrative authority in the management of a country’s affairs at all levels.

Comprises complex mechanisms, processes and institutions through which citizens and groups articulate their interests, mediate their differences and exercise their legal rights and obligations Slide3

Frameworks for the Analysis of Governance

WHO’s domains of stewardship;

PAHO’s Essential Public Health Functions;

World Bank’s six Basic Aspects of Governance;

UNDP’s Principles of Good Governance Slide4

WHO’s Domains of Stewardship

Generation of intelligence

Formulating strategic policy direction

Ensuring tools for implementation: powers, incentives and sanctions

Building coalition / building partnership

Ensuring a fit between policy objectives and organizational structure and culture

Ensuring accountability Slide5

PAHO’s Essential Public Health Functions

Monitoring evaluation and analysis of the health situation

Public health surveillance, research and control of risks

Health promotion

Social participation in health

Policies and institutional capacity for planning and management

Strengthening institutional capacity for regulation and enforcement

Evaluation and promotion of equitable access to health services

Human resource development and training

Quality assurance in personal and population-based health services

Research in public health

Reducing impact of emergencies and disasters on health Slide6

World Bank’s Governance Indicators

Process by which those in authority are selected and replaced

Voice and Accountability

Political Instability and Violence

Ability of the government to formulate and implement sound policies

Government Effectiveness

Regulatory Burden

Respect of citizens and the state for institutions which govern their interaction

Rule of Law

Graft (control of corruption)Slide7

UNDP’s Five Principles of Good Governance

Principles

Thematic areas

Legitimacy and voice

Participation

Consensus

orientation

Direction

Strategic

vision

Performance

Responsiveness

Effectiveness

and efficiency

Accountability

Accountability

Transparency

Fairness

Equity

and inclusiveness

Rule

of lawSlide8

Contemporary Issues in the Governance of Health Systems

Role of the state vs. the market in health

Role of the ministries of health vs. other state ministries

Actors in Governance – public sector, civil society and the private sector

Static vs. dynamic health systems

Health Reform vs. Human Rights-based approach to health

Slide9

Why the term –”Governance”?

Governance is better understood by those within the health system and those outside;

International development agencies have delineated the principles of governance that are well understood

Performance of the health system is dependent on overall governance of a country Slide10

Health Governance Principles

Strategic vision

Participation and consensus orientation

Rule of law

Transparency

Responsiveness

Equity and inclusiveness

Effectiveness and efficiency

Accountability

Information and intelligence

EthicsSlide11

Health Governance Analytical Framework

Governance principle

Domain

Broad question

Specific questions / item

Level of Assessment

National

MOH Policy

MOH ImplementationSlide12

Analytical Framework for Assessing Strategic Vision

Governance principle -

Strategic Vision

Domain - Long term vision

Broad Question

Specific Question

National

level

What are the broad outlines of economic policy of the government;

Where does health rank in the overall development framework by resource allocation, and as percentage of total government expenditure

MOH policy level

Whether there is a long term vision (policy) for health;

Is there a national health policy/strategic plan available stating objectives, strategies with a time frame and resources allocated

MOH implementation level

Whether the implementation mechanisms are in line with the stated objectives of health policy

What priority programs are being implemented and how do they correspond to the policy objectivesSlide13

Data Collection and Sources of Information

Documents

National budget document, report of the treasury, state bank,

Reports of ministry of economics, national statistical organizations

Policy documents from

MoH

, analysis by international and NGOs

MoH

policy/ implementation reports, media reports, external reviews

Health budget reports, budget speeches

Reviews of the health legislative process

National information policy

MoH

policy/ implementation reports,

Media reports, external reviews of health policy

PRSP documents

MoH

contracting manual, rules and procedures for civil servants

National statistical reports, national health reports

Interviews

National and MOH policymakers,

Mid- and senior managerial staff of the MOH or its component departments,

Civil society organizations

International development agencies,

Academic institutions,

Media personnel and

Direct community representativesSlide14

Applying the Health Governance Framework in a Country Setting

Health governance map of Pakistan – Strengths

Central level

Social safety nets for the poor and vulnerable;

Increasing role of the media and NGO’s in protecting people’s health.

MOH policy level

Preparation of draft bills to update health legislation;

Emerging role of the Pakistan health policy forum as a civil society organization;

Stable turnover of health policymakers during the last six years are positive elements

MOH implementation level

Increasing public-private interaction

Preventive programs, especially the LHW Program which has a strong community as well as an equity dimensionSlide15

Health governance map of Pakistan – Weaknesses

Central level

Lack of participatory decision making and culture of accountability;

Parallel streams of bureaucracy and technocracy do not work in unison

Adherence to rules and procedures is considered as an end;

Lack of consumer protection act delays or deny justice

MOH policy level

Short-term objectives override the need for focus on health outcomes;

Health equity is not high on the policy agenda;

Mechanisms to monitor transparency of decisions do not exist;

Decisions often tinged with personal preferences, not evidence-based;

Legislation on minimum standards of care is absent with lax regulation and enforcement capacity;

Policy, planning, health information and surveillance units are weak;

Delays in release and utilization of funds;

Accountability systems focus on procedure instead of performance;

Bioethics is not on the policy radar of MOH.Slide16

Appraisal of the Framework

Can health governance be improved without addressing overall governance of a country?

Health system reforms versus broader civil service reforms

Health governance assessment framework relies on qualitative approach and does not follow a scoring or ranking system

retains the richness of information collected

development of a scoring system is not precluded

Does the assessment framework allow for cross-country comparison of the governance function?

A health governance map can be developed for each country

Contemporary issues in relation to health governance included

Flexibility in the framework to integrate newer ones as they emerge

Health governance framework does not cover

global health governance

clinical governanceSlide17

Policy Implications of Assessing Health Governance

Raises awareness among policymakers about governance as a function of the health system

Provides an avenue for debate on a subject that is often ‘pushed under the carpet’

Assesses each governance principle and allows developing interventions to address them

Governance issues identified at three levels, allowing for measures at each

Improving health governance requires political commitment as well as financial resources Slide18

Questions

?