International Health Leadership Programme 2004
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International Health Leadership Programme 2004 Transforming Health :From Policy to Action. International Health Leadership Programme History and Philosophy of the Programme:.

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International Health Leadership Programme 2004 Transforming Health :From Policy to Action

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International health leadership programme 2004 transforming health from policy to action

International Health Leadership Programme 2004

Transforming Health :From Policy to Action


International health leadership programme 2004 transforming health from policy to action

International Health Leadership Programme

History and Philosophy of the Programme:

*Built around the strong conviction that despite all the technical knowledge concerning health reform, no changes will be sustained without a strong developed leadership development.Also the missing link appears to be in making Policy actually happen

*We focus on knowledge of current issues and trends, skill development, and weave through a strong thread of personal reflection about leadership

*We value the ‘developed’/’developing’ mix highly and use it

*Our faculty is terrific but we really do all learn from each other

* We hope to keep you in our web through alumni follow up


International trends and challenges in health systems our collective view

International Trends and Challenges in Health Systems…our collective view

The Judge Institute of Management Studies

Pam Garside


Who health systems performance report 2000

WHO Health Systems Performance Report (2000)

Where did your country come in the rankings ?


Who health systems performance report 20001

WHO Health Systems Performance Report (2000)

Where did your country come in the rankings ?

Were you happy with it ?


Who health systems performance report 20002

WHO Health Systems Performance Report (2000)

Where did your country come in the rankings ?

Were you happy with it ?

How much do you spend per capita ($) on health ?


International health systems performance who world health report 2000

International Health Systems Performance (WHO World Health Report 2000)

1 France($2125)

…yet health economists now say that the WHO’s accolade

was a catastrophe for France.

As one put it: ‘All possibility of change was instantly dead

in the water.What possible merit could there be in

reforming the best system in the world?…

Expensive,inefficient and lacking quality controls, it is

a system driven by doctors in which spending is rocketing

out of control ’

$xxx= total expenditure in Int’l dollars

0=Ranked overall system performance


International health leadership programme 2004 transforming health from policy to action

hhh OF HEALTH SPENDING, GDP AND POPULATION, 1994

Global Distribution of Health Spending ,GDP and Population

GLOBAL DISTRIBUTION OF HEALTH SPENDING, GDP AND POPULATION, 1994

GLOBAL HEALTH SPENDING: US$ 2.3 TRILLION

89%

82%

84%

18%

16%

11%

Source: Schieber and Maedo ,1997,World Bank DataGLOBAL DISTRIBUTION OF HEALTH SPENDING, GDP AND POPULATION, 1994

GLSOBAL DISTRIBUTION OF HEALTH SPENDING, GDP AND POPULATION, 1994

1997); World Bank data

SO(1997); World Bank data.


Ihlp 2004 responses from participants

IHLP 2004 Responses from participants...


2004 ihlp participants who are you

2004 IHLP-Participants-Who are you?

  • 23 Participants

  • 17 Countries

  • 12 Medically trained

  • New countries to this programme:

    • Denmark

    • Macedonia

    • Madagascar/Mali


2004 international health leadership programme main challenges facing health systems

2004 International Health Leadership Programme - Main challenges facing health systems

=1 Financing and resources…Scarcity of resources, escalating costs, poor macroeconomic growth, inefficient allocation /distribution mechanisms, lack of appropriate incentives, lack of health sector spending priority,gap between money and public expectations (11)

=1 Human Resources…Recruitment and retention of quality staff across the spectrum, chronic labour shortages, exodus of staff, lack of qualified and motivated staff, ‘overemployment’, unequal distribution of resource (geography, rural vs urban, models of care), public/private disparities.HR capacity to drive reforms (11)


2004 international health leadership programme main challenges facing health systems1

2004 International Health Leadership Programme - Main challenges facing health systems

Challenges associated with access/responsiveness/inequalities…lack of universal coverage,unresponsive services,widening inequalities gaps,equity between urban and rural (8)

=2 Capacity /Infrastructure…poor infrastructure,inadequate capacity and service coverage,waiting lists (8)

=2 Disease/health status…HIV/AIDS (4),Malaria TB Leprosy,immunisation,the prevention agenda (8)


2004 international health leadership programme main challenges facing health systems 2

2004 International Health Leadership Programme - Main challenges facing health systems…(2)

3 Disease/health status…Increases in communicable and non communicable diseases and reemergence of old diseases. Huge burden of HIV,TB,Malaria. Increase in the burden of preventable disease, and lifestyle related diseases in more developed countries (7)

4 Capacity/Infrastructure Capacity problems in public sector, poor management and fragmentation, poor health facilities, poor performance measurement and planning, lack of leadership…thus lack of sustainability (6)


2004 international health leadership programme main challenges facing health systems 3

2004 International Health Leadership Programme - Main challenges facing health systems…(3)

=5 Health Care Reform itself…decentralisation, repeated reform and reform fatigue, implementation problems, roles and rsponsibilities of organisations, weak governance and institutional structures, people,skills and information required to implement the reforms (6)

=5 Inequalities Lack of access to universal cover,health inequalities in terms of economic disadvantage, access to care, health status according to economic group. Uneven distribution of resources and facilties. (6)

7 Public/Private mix… Growth of the dual system and how to make PPPs work for the system (3)


Barriers to implementing policy

Barriers to implementing policy

(Lots of agreement here…)


Barriers to implementing policy1

Barriers to implementing policy

  • 1 ‘The system’-inadequate capacity and structural weaknesses of the delivery system,poor planning and implementation of programmes,particularly change management and misaligned incentives. Centre-state relationships,institutional inertia and weak governance systems.Inadequate leadership for transformation

  • 2 Stakeholder resistance-health professionals, local governments, doctors-conservatism of the medical profession, even within the Ministry of Health

  • 3 Policy process/information –health policy not translated well into implementation.Lack of policy skills in government, and policy stasis.Lack of information,data,demographic and epidemiological research and information management systems in general


Barriers to implementing policy 2

Barriers to implementing policy (2)

  • 4 Politics and Politicians-insufficient political commitment/political will at all levels and unwillingness to make difficult decisions.Poor budget allocation decisions

  • 5 Population and Behaviour- expectations/unwillingness to engage public in policy and behaviour change.Insufficient attention to health promotion and health seeking behaviour.Poor community participation

  • 6 Limited resources for health,tax levels,cost escalation in private sector

  • 7 Human Resources-workforce shortages,working conditions,skills to support reform,getting people to work in new ways

  • 8 Public/Private Sector collaboration not strong-need to improve policy and practice


Barrier to change

Barrier to Change….?

“Ninety per cent of politicians give the other ten per cent a bad reputation”

Henry Kissinger,

former US Secretary of State


Issues which have assumed greater importance 1997 2004

Issues which have assumed greater importance 1997-2004

  • Values as a key piece of context

  • Implementation of reform strategies-that this is a process to be managed and that processes need attention as much as resources

  • Human Resources Management and the Workforce as critical issues

  • How to deal with cumbersome government bureaucracies –can the public sector actually deliver reform?

  • Reduced emphasis on market solutions but concern about the role of the private sector-how to maximise?


Issues which have assumed greater importance 1997 2004 cont d

Issues which have assumed greater importance 1997-2004 (cont’d)

  • Importance of the rise in public expectations and engaging the public through improved communication of health policy

  • Addressing the political power of stakeholders

  • Importance of organisational change and personal leadership skills

  • Globalisation

  • Burden of new/old diseases

  • The quality of health care and services we deliver, including access

  • Intersectoral working


Health sector reform terminology confusion

Health Sector Reform:Terminology Confusion….

  • Decentralisation… privatisation;

  • “Quality” of care… outcome;

  • “Managed Care”, “Managed Competition”;

  • even “Reform”

    WHO definition: “ a purposive, dynamic and sustained process that results in systemic structural change”


International health leadership programme 2004 transforming health from policy to action

International Health Leadership Programme 2003

Transforming Health :From Policy to Action

Public Private Partnerships

Modules

1 Current Issues in Health Sector Reform

2&3 Financing Health Systems

4 Globalisation

5 Managing Change

6 The Future : new biology and disruptive technologies

7 Quality

Implementing Policy (2)

Policy Context for Reform

One to One

Advisory

Strategy and Skills

Lunchtime

Workshop Discussions

Chile Case Study

Insights into Leadership

Group Work

Country Experiences


Tensions in health sector reform

Tensions in Health Sector Reform

  • Demands and Costs……..Capacity to Deliver

  • Additional investment in health….Capacity to deliver improvements

  • Curative health services….preventive care

  • Hospital…..community and primary care

  • Health for the population…individual health

  • Urban….rural

  • Public….private


Common aspects of health sector reform

Common aspects of health sector reform…

Funding

systems

Resource

Allocation

Changing role

of the state

Transforming delivery-

structure,performance,

accountability,quality and

outcomes

Promoting citizens’ rights

and participation

Political Will,Leadership,and Capacity to Implement

Reform strategies


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