GOVERNANCE.pptx. .

Governance in CBR

1. Dr. akshay GOVERNANCE

2. INTRODUCTION Governance of health systems comprises the actions adopted by society to organize itself to promote the health of its population. Good governance results in the effective delivery of health services and improves health outcomes. As health services and service providers are often disorganized in various poor setting resources, it hampers their access. This results in the provision of poor quality services, inefficient use of resources, duplication of services, and decreased service-user satisfaction .

3. In recent years, governance has transitioned to the fore of the international development agenda, shifting from micro-level, project-specific objectives to macro-level issues of policy-making. There is a need for the policymakers in less-resourced settings to know how to most adequately strengthen the performance of health systems . The complexities of leadership and governance can be addressed through a participative, transparent, well-defined, and structured framework. To promote good governance and leadership of health systems, coherent and flexible policies incorporating health-related human rights and opportunities together are essential.

4. Leadership and Governance The leadership and governance of health systems, also called stewardship, are the most complex and critical building block of any health system. It is about the role of the government in health and its relation to other actors whose activities impact health. It involves overseeing and guiding the whole health system, private as well as public, to protect the public interest. This needs both political and technical action with increased attention to corruption and calls for a more human rights-based approach to health.

5. All governments are faced with the challenge of defining their role in health concerning other actors. Any approach to leadership and governance must be contingent on national circumstances. WHO helps governments as follows: Develop health sector policies and frameworks Regulatory framework: design, implement and monitor health-related laws, regulations, and standards; regulation of medical products, vaccines, and technologies; regulation concerning occupational health and workplace safety

6. Accountability on monitoring health system performance as discussed earlier in the building blocks. Generate and interpret intelligence and research on policy options Build coalitions across government ministries, with the private sector and with communities: to act on key determinants of health; to protect workers’ health; to ensure the health needs of the most vulnerable are properly addressed; to anticipate and address the health impact of public and commercial investments. Work with external partners to promote greater harmonization and alignment with national health policies . Package of Rehabilitation Interventions (PRI) is developed to support ministries of health in planning, budgeting and integrating rehabilitation interventions into health systems.

7. Governance Framework According to the WHO (2007) model of the Health system, the governance framework is based on major independent building blocks that overlap each other . Service delivery acts as the output or is perceived as the quality of the Health System, Human Resources, Medical Technologies, Information/Data collection, and Financing form the health system inputs, And People, as the governance includes overseeing the entire health system, it permeates with all other building blocks and is driven by People and Actors in the system.

8. Health Systems Building B locks

9. Strategic vision & policy design and participation & consensus orientation can be viewed more conventionally as governance inputs; these are all interlinked within the governance building block and are dynamic and interchangeable.

10. Assessing G overnance across the Health System

11. Strategic vision using transparent information by the stewards are important factors for good health system governance. A well-designed system should increase integration, reduce fragmentation & duplication, and encourage the participation of all relevant stakeholders, both state and non-state (such as citizen groups, pharmaceutical companies, insurance firms) in designing policies. Literature suggests a need for meaningful participation of the person with disabilities in the policymaking process. The participation can be strengthened by supporting access to research, statistical information, training for people with disabilities.

12. Governance in health can be assessed by estimating the Determinants of Governance which measures whether the procedure or regulation or policy or law exists. Governance Performance Indicator assesses implementation of rules or policies and it is done by surveys such as Public Expenditure Tracking Surveys, Exit Interviews. Consensus should be sought when the voices of numerous stakeholders differ and are not homogeneous . Addressing corruption, being transparent, and being accountable are governance processes.

13. To ensure that the systems’ rules are followed, a good health system governance should involve accountability. It includes holding public officials/service providers answerable for processes and outcomes, and imposing sanctions if the specified outcome is not delivered. Clear goals should be based on the participation of relevant stakeholders especially from disadvantaged groups or those with less power in order to influence policies, design transparent policies, and promote accountability, thereby reducing the risk of corruption .