21.G. Round table: Strengthening national level health systems governance

Very often, important health system reforms are delayed, rendered ineffective or they simply go badly wrong. All too often this happens not because of a lack of money, health workers or health care facilities but because we adopt unfit ideas and decision and/or implement them insufficiently. The incapacity to develop, adopt and implement good decision is quintessentially the definition of bad governance. If we are to develop our health systems towards Universal Health Coverage and health systems performance improvement, we will need to strengthen our health system governance. Governance is vitally important to health systems reform and refers to how decisions are made and implemented - everything from the ability of policy-makers to take evidence-based and relevant decisions to their ability to implement policies and create alignment between different actors. In this workshop we will share experiences from a governance spring course for policy makers from Eastern Europe and Central Asia. Connected to this we will also share preliminary results of a study on National Level Health Systems Governance. The panelists will address five key issues The contribution of governance to Universal Health Coverage. This contribution will focus on a) the concept of governance defined as the way societies make and implement collective decisions and b) its 5 main domains including transparency, accountability, participation, integrity and capacity. (S Greer)Governance improvement needs in Eastern Europe and Central Asia: experiences from working with policy makers including countries like Azerbaijan, Georgia, Kyrgyzstan, Moldova Tajikistan, Ukraine and Uzbekistan. For purpose of peer-learning and contrasting experiences we have paired these countries with policy makers from Austria, Finland and Ireland (G Pastorino)Stakeholder participation in decision making and implementation: Very often, powerful stakeholders, like the medical profession, is over-represented and exerts immense veto power, while the voice of other professions, patients, and citizens remained unheard. What are the governance strategies and instruments to harness those underrepresented stakeholders for Universal Health Coverage? (G Fattore)Governing centralized and decentralized budgets in primary, social and hospital care: population-based health care in larger countries requires decentralization of part of the health care budget. What are the accountability lines and instruments that ensure that regional and local budget holders aligning with national policies for Universal Health Coverage? (L Hawkins)Governance contribution addressing corruption: According to surveys health systems are perceived prone to corruption. What is the contribution of governance to heal corruption and make the system work according to rules? (D Clarke) Key messages If we are to make progress towards Universal Health Coverage, we will need to strengthen health systems governance. Without strengthening health systems governance we will fail to manage stakeholders, budgets and corruption.

Early Warnings: The Lessons of COVID-19 for Public Health Climate Preparedness

The early 2020 response to COVID-19 revealed major gaps in public health systems around the world as many were overwhelmed by a quickly-spreading new coronavirus. While the critical task at hand is turning the tide on COVID-19, this pandemic serves as a clarion call to governments and citizens alike to ensure public health systems are better prepared to meet the emergencies of the future, many of which will be climate-related. Learning from the successes as well as the failures of the pandemic response provides some guidance. We apply several recommendations of a recent World Health Organization Policy Brief on COVID-19 response to 5 key areas of public health systems – governance, information, services, determinants, and capacity – to suggest early lessons from the coronavirus pandemic for climate change preparedness. COVID-19 has demonstrated how essential public health is to well-functioning human societies and how high the economic cost of an unprepared health system can be. This pandemic provides valuable early warnings, with lessons for building public health resilience.

The Literature Review of the Governance Frameworks in Health System

Introduction: Governance in the health system refers to a range of decision making, and implementation undertakings conducted by decision-makers as they find ways to achieve national health policy objectives that are favourable to each country's health system. Currently, there are different types of frameworks that have been developed and these frameworks try to operationalize and assess how principles of governance at different levels of a health system are administered. While a number of frameworks for assessing governance in the health sector have been proposed, their application is often constrained by impractical indicators that are often not well-grounded, resulting in limited pragmatic work on governance in the health systems itself.Methods: Adopting a scoping review method, articles were identified using these databases namely BMC, Emerald, Elsevier, PubMed, Science Direct, Sage, Springer, Taylors & Francis, WHO and Wiley. Only articles written and published in English from 2009 to 2019 were included.Results: 5 of the frameworks have actually been tested and operationalized in practice from the 13 identified and reviewed frameworks that are largely theoretically based.Conclusion: A multitude of frameworks to assess health systems governance exist, however, there are not many examples of their application in the literature and healthcare systems with well-grounded proven results. Consequently, to facilitate a more comprehensive assessment and peruse of governance frameworks in health systems, the health system should have clear goals with continuous and committed support by accountable decision-makers pivoted by principles of good governance.