Transcript Trends, Challenges, Comparisons - Pam Ga[...]

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
Pam Garside
The Judge Institute of Management Studies
WHO Health Systems
Performance Report (2000)
Where did your country come in the rankings ?
WHO Health Systems
Performance Report (2000)
Where did your country come in the rankings ?
Were you happy with it ?
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)
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 ’
$xxx= total expenditure in Int’l dollars
0=Ranked overall system performance
hhh OF HEALTH SPENDING, GDP AND POPULATION, 1994
Global
Distribution
of Health SpendingOF
,GDPHEALTH
and Population
GLOBAL
DISTRIBUTION
SPENDING, GDP
AND POPULATION, 1994
HEALTH
GDP
POPULATION
89%
82%
GLOBAL HEALTH
SPENDING: US$ 2.3
TRILLION
16%
84%
18%
11%
Source: Schieber and Maedo ,1997,World Bank DataGLOBAL DISTRIBUTION OF HEALT
GLSOBAL
DISTRIBUTION
OF HEALTH SPENDING, GDP AND
1997); World Bank data
SO(1997); World Bank data.
IHLP 2004
Responses from
participants...
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
=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 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)
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)
=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
(Lots of agreement here…)
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)
 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….?
“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
 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)
 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….




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 2003
Transforming Health :From Policy to Action
1 Current Issues in Health Sector Reform
Public Private Partnerships
2&3 Financing Health Systems
4 Globalisation
Policy Context
for Reform
Strategy and
Skills
Implementing Policy (2)
5 Managing Change
6 The Future : new biology and disruptive technologies
7 Quality
Chile Case Study
Insights into Leadership
Group Work
Country Experiences
One to One
Advisory
Lunchtime
Workshop Discussions
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…
Funding
systems
Transforming deliverystructure,performance,
accountability,quality and
outcomes
Resource
Allocation
Changing role
of the state
Promoting citizens’ rights
and participation
Political Will,Leadership,and Capacity to Implement
Reform strategies