In August 2013, USAID supported the Second Annual Round Table on Governance for Health in Low- and Middle-Income Countries (LMICs). The purpose of the round table was to bring thought leaders together to discuss how good governance enables and facilitates better health system performance and outcomes Join us for a summary of key conclusions from the round table followed by a discussion about new insights into principles and practices of smart governance in the health systems of LMICs.

1. Governance as an Enabler for
Health Systems Strengthening and Country Ownership
Date: December 11, 2013
Time: 2:30-4:00pm
Location: GHFP - 1201 Pennsylvania Ave, NW Room 2031

2. Agenda
2:30
Welcome and Participant Introductions: Ann Hirschey, PRH (5 minutes)
2:35
Background on Governance Roundtable: Temi Ifafore, PRH (5 minutes)
2:40
USAID on growing importance of Governance: Bob Emrey, OHS (5 minutes)
2:45
Review of Roundtable Themes and Observations (45 minutes)
Moderator: Temi Ifafore, PRH
1) Roundtable Summary, Practices for Good Governance: Jim Rice, LMG
2) The Need for Evidence on Impact of Good Governance for HSS: Reshma Trasi, LMG
3) Governing Decentralized Health Systems: Mahesh Shukla, LMG
4) Diverse stakeholder engagement: Belkis Giorgis, LMG
5) Key Next Steps: Jim Rice, LMG and Jodi Charles, OHS
3:30
Group Discussion on Implications of Round Table and Ideas Exchange
4:00
Adjourn

3. Goals of 2013 G4H
Desired Outcomes:
• Foster global dialogue on governance practices and
capacity building interventions
• Create a network of governance practitioners, educators
and researchers
• Identify opportunities to build evidence that better
governance leads to health system performance
improvements

4. Participants in G4H Roundtable
Dr. Peter Eriki, ACHEST, Uganda
Dr. Göran Tomson, Karolinska Institutet, Sweden
Mr. Thomas Rottler, BoardEffect, USA
Dr. Rifat Atun, Imperial College London, UK
Mr. Mahugnon Achille Togbeto, IPPF , UK
Mr. Bob Emrey, USAID, USA
Ms. Laura Lartigue, MSH, USA
Mr. Lawrence S. Michel, MSH, USA
Mr. Maurice Middleberg, Free the Slaves, USA
Dr. Jonathan D. Quick, MSH, USA
Dr. James A. Rice, MSH, USA
Dr. Mahesh Shukla, MSH, USA
Dr. Tomohiko Sugishita, JICA, Japan
Ms. Helena Anna Walkowiak MSH, USA
Ms. Maeghan Orton, Medic Mobile, Kenya
Ms. Alisha Kramer, CSIS, USA
Dr. Kate Tulenko, IntraHealth International, USA
Dr. Delanyo Dovlo, WHO, Rwanda
Ms. Susan Putter, MSH South Africa
Mr. Chris Lovelace, Abt Associates, USA
Ms. Deirdre Dimancesco, Essential Medicines and
Pharmaceutical Polices, Switzerland
Mr. Jacob Hughes, HDI, USA
Mr. Rebeen Pasha, USAID, USA
Dr. Reshma Trasi, MSH, USA
Mr. Taylor Williamson, RTI International, USA
Dr. Willy De Geyndt, Georgetown University, USA
Dr. Bernhard Liese, Georgetown University, USA
Mr. Didier Trinh, Modernizing Foreign Assistance
Network, USA
Dr. Taryn Vian, Boston University, USA

5. Introduction to Health Governance
Key Questions Asked During G4H Roundtable:
1)
2)
3)
4)
5)
6)
7)
8)
What is good governance?
How do we address corruption?
How do we create change?
What are essential governance practices?
How is good governance taught in the field?
How can we make better use of technology?
What is the state evidence of evidence?
How do we involve more women, youth?

6. G4H Roundtable Themes
•
•
•
•
•
Good Governance/Corruption
Measurement
Decentralization
Diverse Stakeholder Engagement
Recommendations

7. Governance is:
1) Setting strategic direction
and objectives;
2) Making
policies, laws, rules, regulatio
ns, or decisions, and raising
and deploying resources to
accomplish strategic goals
and objectives; and
3) Oversight monitoring to make
sure that strategic goals and
objectives are accomplished.

8. Four (4) Key Practices for
Smart Governance

9. Governance is robust when:
1) The decisions are based on information, evidence, and shared
values;
2) The process is transparent, inclusive, and responsive to the
needs of the people the ministry or the organization
3) Those who make and those who implement decisions are
accountable;
4) The strategic objectives are effectively, efficiently, ethically, and
equitably met;
5) The vitality and mission of the ministry or the organization is
maintained.

10. Smart Governance Enables Stronger Health Systems
Stronger Health Systems. Greater Health Outcomes
Conceptual Model: Leading, Managing and Governing for Results
People and teams
empowered to
lead, manage and govern
Improved health system
performance
Results
Leading
Scan
Focus
Align/Mobilize
Inspire
Managing
Enhanced work
environment &
empowered male
and female
health workers
Plan
Organize
Implement
Monitor/Evaluate
Governing
Cultivate Accountability
Engage Stakeholders
Set Shared Direction
Steward Resources
Strong
management
systems
 Increased
Service
Access
Responsive
health systems
prudently
raising and
allocating
resources
 Expanded
Service
Availability
 Increased
Utilization
 Better
Quality
 Lower Cost
Sustainable
health
outcomes and
impact aligned
with national
health goals
and MDGs
3, 4, 5, and 6

11. G4H Roundtable Themes
•
•
•
•
•
Good Governance/Corruption
Measurement
Decentralization
Diverse Stakeholder Engagement
Recommendations

12. Levels; Nonlinear Pathways; Complex, Adaptive Systems;
Institutional Theory and Power Dynamics
Political, economic, le
gal and social system
Health Facilities
Communities
Health care
worker
Household/
family

13. Measuring governance
Frameworks
Disciplines
Multiplicity
End Points
Metrics
• Governance
interventions are
complex, contextual
and diverse
• Frameworks and
logic models are
nonlinear
• Metrics are specific
and comparable

14. What are we measuring?
Pre-Existing Conditions
Behaviors
and
practices
Values and
perceptions
Processes
Outcomes (Intended
and Unintended)

15. Measurement: The Way Forward
• Need to demonstrate both what is changing and how
• Measurement, evaluation and research will need to be:
– Multi-method
– Multi-disciplinary
– Multi-level
• Scope for innovation and new methods

16. G4H Roundtable Themes
•
•
•
•
•
Good Governance/Corruption
Measurement
Decentralization
Diverse Stakeholder Engagement
Recommendations

17. Decentralization:
Complexity, Opportunity to Find, Refine and Use Evidence

18. Governing Decentralized Systems:
Five Strategies
1) Screen public health services with clear criteria
2) Define degrees of decentralization for decisionmaking processes
3) Establish effective governance model design
4) Define governing body Terms of Reference
5) Report results transparently

19. G4H Roundtable Themes
•
•
•
•
•
Good Governance/Corruption
Measurement
Decentralization
Diverse Stakeholder Engagement
Recommendations

20. Diverse Stakeholder Engagement
• Impediments
• Gender equity/inclusion =
good governance
• Recommendations:
– Mentoring
– Consider “whole person”-work/life balance
– Address
discrimination, harassmen
t
– Include civil society in
governance process

21. G4H Roundtable Themes
•
•
•
•
•
Good Governance/Corruption
Measurement
Decentralization
Diverse Stakeholder Engagement
Recommendations

22. Overall Recommendations
• Collaborate: Support USAID and CAs (and now WHO) global technical
working groups on good governance
• Partner: Expand partnerships with academic institutions to promote
research, KE
• Strengthen M&E: Develop theory of change article; case studies; build
theory; construct an evaluation database; define a research agenda;
publish preliminary set of “Governance Indicators;” design longer-term
research agenda
• Promote Inclusion: Promote value of diversity on governance
boards, high-level leadership (women, youth, minorities)
• Next roundtable in an LMIC: Strong suggestion from participants to hold
2014 G4H Roundtable in Africa

23. Thank you!
Questions?