A Model of Effective Governance for Health

WHO Workshop on transparency and good governance in the pharmaceutical sector

July 11, 2012

Background• Global Health Initiative established in May 2009

under Yale’s Jackson Institute of Global Affairs• Global Health Leadership Institute was created

under GHI umbrella to focus on global health systems strengthening through:– Targeted training – Innovative leadership development– Research

Literature Review

Purpose: to inform the creation of a model of effective governance practices to incorporate into leadership development curriculum

Literature review focus: to determine what governance activities in low- and middle-income countries have been empirically linked to health outcomes

Literature ReviewGovernance search terms –governing boards, decision making, democracy, health policy, stewardship, accountability, planning , councils, participation, social capital, stewardship, capacity building

Health outcomes –health status, quality of care, mortality, life expectancy, immunization rate, essential medicines

1,232 abstracts 21 articles for data extraction

Findings1. There is not a strong research base linking

governance practices to health outcomes

2. The structures of governance (institutions, type of decision making bodies) matter less than the mechanisms of governance

3. The processes that happen at the local level, or closest to the point of service, have the greatest impact

Foster a facilitative decision-making

environment

Engage stakeholders

Steward Resources

Good Governance in Practice

Foster a facilitative decision-making environment

Engage stakeholders

Steward resources

Develop shared vision and oversee the process of achieving it

Foster the environment1. Document and enforce codes of conduct.2. Make all reports on finances, activities, and plans

available to the public, and share them formally with stakeholders.

3. Demand that other stakeholders share similarly.4. Establish a formal review process (judicial board,

external evaluation, etc.) to assess the impact of decisions made.

5. Establish a formal consultation mechanism (open forum, special status at meetings, etc.) through which constituencies may voice concerns or provide other feedback.

Engage stakeholders1. Empower marginalized voices, including women,

by giving them a place in formal decision-making structures.

2. Ensure appropriate participation by key stakeholders through fair voting and decision-making procedures.

3. Provide an independent conflict resolution mechanism accessible by all stakeholders and interested parties.

4. Elicit, and respond to, all forms of feedback in a timely manner.

5. Build coalitions and encourage consensus on working toward the shared vision.

Steward resources1. Make evidence-based decisions on the use of

resources, both financial and technical.2. Determine, and execute, a strategy for

building the health sector’s capacity.3. Invest in advocacy, so that the needs of the

health sector are addressed in every appropriate decision-making venue.

Develop shared vision1. Determine and promote a process for developing

and implementing a shared action plan.2. Advocate on behalf of stakeholders’ needs and

concerns, as identified through the formal mechanisms above; making sure to include these in defining the shared direction.

3. Document the shared vision of the ‘ideal state.’4. Oversee the setting of goals to reach the ideal

state and set up accountability mechanisms for their achievement.

5. Advocate for the ‘ideal state’ in all other arenas with a role to play in its realization (higher levels of governance, other sectors, other convening venues).

Next StepsLeadership, Management, Governance Initiative

Test model through senior leadership development

Evaluation of model through application to health delivery agencies and other entities that impact health

Improve research methods and evidence base