Health Systems Research Shapes Governance Impact

This post also appears on the LMG for Health blog.

There is a growing pool of studies that good governance matters as “The Big Enabler” for health systems strengthening.

Health systems researchers in the Capetown, South Africa, Third Global Symposium on Health Systems Research explore the theory of change that guides governance interventions: a solid governance infrastructure enables sound management of health systems, which increases the probability that health services will be better used and health outcomes will improve.

Both policy makers and health service providers have become interested in how good governance increases the probability that health services will be better used for better health outcomes.

But why do they believe that?
How is it possible that better governance can yield better health?
I think the short answer is… it cannot UNLESS certain conditions are available. Conditions like:
  • structures for governance decision-making (governing bodies of various types and sizes) that have clear terms of references and effective leadership;
  • participants in the governing processes that understand their roles and responsibilities;
  • decision-making processes that understand and effectively accomplish the 4+1 practices of:
    • create a culture of accountability;
    • engage diverse stakeholders;
    • set strategic directions;
    • steward scarce resources; and then
    • continuously improve the above practices.
  • leadership staffing that supports and enhances the work of the governing bodies;
  • enough resources that allow governing decisions to actually get implemented; and
  • a context and culture that has rule of law and ethics that demand results and transparent decision-making.
Where is the evidence that smart governance matters?
These substantial studies show the power and value of good governance to enable the work of those who deliver, manage and lead health services organizations:

Celebrating African Health Leaders at the Global Symposium on Health Systems Research

Wednesday evening was spent celebrating the work and vision of African Leaders driving for stronger health systems and greater health outcomes in Sub-Saharan Africa. After a day of thought provoking sessions at the Global Symposium on Health Systems Research, Lord Nigel Crisp, Former Chief Executive of the UK’s National Health Service (NHS)  and Dr. Francis Omaswa, Executive Director of the African Centre for Global Health and Social Transformation (ACHEST), launched their new book, African Health Leaders: Making Change and Claiming the Future.

The book, with support from The Rockefeller Foundation, KPMG, and Oxford Press, is a collection of this of important stories and lives from 23 Sub-Saharan African health leaders and provides an inspiring vision for the future: African health leaders claiming their own future for their people and health systems; forging new relationships with international donors and partners to invest in growing deep roots into the soils, society and economies of traditionally low resourced countries.

In the past, as Omaswa asserts in Chapter 2, to improve their health systems, Africans went to institutions and countries for advice and money and got both.  But often this was in exchange for certain core values that in too many instances did not reinforce or acknowledge the traditional insights needed for the ownership and pride to sustain the solutions.

Her Excellency Dr. Nkosazana Dlamini-Zuma, Chairperson of the African Union Commission based in Ethiopia says it well in her dedication to the book: “As Africans we must celebrate improvements in health and the people who have made them happen, but we must also claim our own future for ourselves. Written by Africans, this book is essential reading for African health leaders who want to build on our own traditions and experience. It is also a vital orientation for partners who want to know how they can best support our efforts in a spirit of global solidarity.”

Three of the authors were present at the book launch to share their stories: Dr. Hannah Faal; Dr. Peter Eriki; and Dr. Ndwapi R. Ndwapi.

Dr. Hannah Faal was born in Nigeria and received a Fellowship to the Royal College of Surgeons in Edinburgh in 1975. She is respected for her pioneering work in The Gambia where she established the national eye care program that lead to The Right to Sight, a global initiative of WHO and the International Agency for the Prevention of Blindness, of which she became the President.

Dr. Peter Eriki attended the LMG Global Roundtable on Governance for Health in 2013 and is Director of Health Systems for ACHEST, a partner of ours supported by USAID to develop a “Ministerial Orientation Programme” that supports the capacity transfer for stronger health systems in Africa. Eriki has served as the WHO country representative for over 15 years in several priority African countries. He played a significant role in the revitalization of immunization programmes in Nigeria which had threatened to derail the global polio eradication effort. For this he received the Paul Harris Fellowship by Rotary International. He has his medical degree from Makarere University in Uganda and an MPH from Harvard.

Dr. Ndwapi R. Ndwapi is currently Manager of the Ministerial Strategy Office of the Ministry of Health in Botswana. Heralded as one of the “young leaders for health in Africa,” he has had responsibility as Director of Clinical Services with overseeing Botswana’s 26 public hospitals and more than 500 free-standing public outpatient clinics.

We can all learn from this collection of innovators and leaders about the knowledge, skills and attitudes it takes to address and master the many health challenges in Sub Saharan Africa. The launch was an inspiring evening with real change-makers from health systems in Africa.

Photo Credit: ACHEST. From Left: Lord Nigel Crisp, Prof. Francis Omaswa, Hon. Ruhakana Rugunda, Susan Edjang, Prof. Miriam Were, and Hon. Okello Oryem