L e a d e r s h i p , r e s o u r c i n g a n d g o v e r n a n c e • Communication and co-operation between the technical experts and political leaders responsible for UHC not being sufficient • Policy-makers not always being aware of the challenges faced by those who have to implement their policies at the frontline (for example, at the hospital or clinic level) • The flexibility and the ability to make adjustments in the policy reform process sometimes lacking. This requires reliable information, openness to acknowledge problems and willingness to work towards solutions We’ve learned the importance of political leadership for UHC and the need to invest in the development of leadership of the senior teams that support the minister, the minister’s trusted advisors and the next generation of leaders. We’ve also learned the importance of building cross-departmental and cross-ministerial mechanisms to share evidence, have regular policy dialogue and work towards efficient, evidence-based policy reforms and processes. While leadership for UHC is largely a domestic issue, development partners have a role to play. In 2011 leaders from five ministries of health signed a joint Call to Action recognising the essential role of leadership in improving the health of populations. Leaders of health ministries called for three practical steps for country-led development: 1. Government leaders, including ministers of health and their senior teams, must be clear about their priorities 2. Development partners must be flexible and willing to listen and follow the priorities set by country leaders 3. Countries must be given greater opportunities to learn from one another and develop ongoing relationships among leaders Technical expertise and implementation ‘know how’ In the JLN, the practitioners in ministries of health and other key agencies are the experts. They are the ones developing plans to align multiple fragmented health financing schemes; designing and costing benefits packages; defining criteria for identifying and enrolling vulnerable populations (such as the poor); reforming provider payment systems to encourage delivery of primary health care; developing systems for quality improvement; and designing information technology systems and core business processes to enable data analytics and more robust performance monitoring. Practitioners must have resources and connections to be effective in their roles, and the JLN is working to ensure this need is met. They need to be able to find the relevant evidence and experience from other countries quickly. Often the type of knowledge they need is tacit and implementation focused, and not documented in the literature. Learning from peers through networks and communities of practice, such as the JLN, can help fill knowledge gaps and empower these leaders with the know-how they need to move forward. We have also seen that facilitating dialogue between policymakers and practitioners can have real policy- and programmelevel impact. For example, when a group of practitioners and a parliamentarian from Ghana worked together to identify key bottlenecks and determine solutions for expanding coverage of the more than seven million poor people in the country, this swiftly led to a legislative amendment requiring annual reporting on equity in coverage in Ghana. In India, we’ve seen the power of a sub-national joint-learning forum of state-level practitioners facilitated by the World Bank in close collaboration with the government. This learning forum has facilitated collaborative work across states to address common challenges and codevelop practical new solutions, such as a collaboration on how to cost health services to help set new provider payment rates. As the global movement towards adopting UHC as a post-2015 goal gains traction, practitioners will need more opportunities to exchange first-hand, experiential knowledge of how to implement policies and programmes that will advance their countries towards UHC. Peer learning platforms like the JLN can help connect practitioners with their peers, streamline their expertise, build practical knowledge as a global public good and help countries around the globe achieve UHC. Ethiopia’s Balanced Scorecard initiative ‘Building strong health systems is heavily dependent on the ability of ministries of health to lead and take ownership of the reform process.’ – Tedros Adhanom Ghebreyesusm, former Health Minister at the Federal Ministry of Health, Ethiopia In 2008 Ethiopia’s Federal Ministry of Health (FMOH) joined the Ministerial Leadership Initiative for Global Health (MLI) to enhance leadership and management of the health system. The Minister of Health and his senior team elected to design and implement a strategic planning and management system (called the Balanced Scorecard) that would align objectives and priorities for health services at the national, regional and local levels. To create Ethiopia’s health sector Balanced Scorecard and ‘cascade’ it through all levels of the health sector, the FMOH organised workshops and training with senior FMOH leaders, regional and hospital health personnel, and CEOs and managers across all government sectors. Participants were able to visualise how the Balanced Scorecard system could help them effectively monitor and measure the performance of the health sector and of individual units. As a result of implementing the Balanced Scorecard, Ethiopia’s health system has been able to track and respond to incidences of preventable communicable diseases and malnutrition much more easily. Today, the FMOH and other units of the health sector have a common vision, mission and set of core values that are the foundation for Ethiopia’s UHC strategy and ongoing health system strengthening. According to one senior FMOH leader, such alignment and sense of ownership within the health sector has allowed for a consistent flow of creative and innovative ideas between talented leaders, and has increased participation from all levels of the health sector. For more information on the MLI Ethiopia Program, see: www.ministerial-leadership.org/country/ethiopia/program-focus. 116 Commonwealth Health Partnerships 2015
Commonwealth Health Partnerships 2015
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