The HFG at Work interview series showcases our staff’s passion for their work as well as their deep technical knowledge. These interviews also share their thoughts and perspectives on the importance of health systems strengthening, especially in light of supporting sustainable development around the world. To learn more about HFG’s experts and staff, please visit the About HFG section of the website.
Dr. Elaine M. Baruwa
Dr. Elaine M. Baruwa is a Senior Health Economist and Country Manager for HFG’s Nigeria country program. She has over 15 years of experience conducting program and economic evaluations, and working on pricing and costing policies/tools for the financing of health services and health systems in Nigeria, Haiti, Ethiopia, Lesotho, Swaziland and other low-income countries. Dr. Baruwa is a senior technical advisor on insurance modeling and other health financing research. She holds a PhD in International Health from Johns Hopkins University, an MSc in Health Management from Imperial College University, and a BSc in Financial Economics from Birkbeck College, University of London.
In your opinion, why should countries be investing resources in strengthening health systems? When asked that question I always respond with some variation of the following question of my own – “If you had a pill in your hand today to prevent malaria for life in the person who took it – how many children do you think you could save in Nigeria next year?” My guesstimate is probably not more than some tiny percentage of the 250,000-300,000 Nigerian children that die from malaria every year, despite the fact that malaria is preventable and treatable. Because the “system” that determines who is buying/procuring/transporting/prescribing/receiving and paying for that pill is broken. That pill is just a pill until a health system turns it into a life saved.
What do you find most satisfying about working in the area of health financing and governance? Well this is an easy one: the variety of people (and their problems!) that I get to work with on health financing and governance activities. In the HFG home office we have so many experts and activities in so many areas that you can learn something new all the time if you put your mind to it—from cost-effectiveness to engaging non-state health actors, from political economy analysis to discrete choice experiments. It is even more varied in the field because you’re working with program implementers, policymakers, politicians, implementing partners, the media and, if I’m really lucky, the beneficiaries. I’m a microeconomist at heart so the household level is where the action is – I want my work to make a difference at this level. It’s important to see—and make—the connection between the work you’re doing at the policy level, which can sometimes seem surprisingly removed from health outcomes.
In your opinion, what will be the most impactful global health initiative over the next few years which people should be aware of? I see less interest in the health SDGs in the countries I’ve visited and quite a bit of focus on universal health coverage (UHC) – we need to make the most of that interest. To me that means we have to be more integrated and collaborative across diseases and systems elements. I’d go so far as to say that we need to think less about HSS “building blocks” and more about the systems/processes for achieving UHC. Then if I could wish for an initiative it would be a global health private sector initiative. UHC will be unattainable without the effective engagement of the private sector in many countries. For example in Nigeria three quarters of all care is already delivered in the private sector with little to no support or oversight from government. Local Nigerian pharmaceutical companies can and have manufactured HIV anti-retroviral drugs at lower costs than the government imports them for. Coca Cola and mobile phone companies have managed to get their products into the hands of the same people we say are “poor” and “hard to reach”. Our argument for “investing” in the health sector would be so much more powerful and effective if we could position the health sector as an economic sector rather than just a chain of inefficient, run down, cash consuming public facilities which frankly, is how many governments see it. And yet, oftentimes ministries of health shy away from thinking about the private sector holistically (the “here be dragons” attitude) and instead settle for piecemeal public private partnerships and fragmented corporate social responsibility initiatives. We have got to figure it out!
Leulseged Ageze is the Chief of Party/Project Director for HFG’s Ethiopia program: Health Sector Financing Reform/Health Finance and Governance (HSFR/HFG). He has over 25 years of experience in strategic planning, appraisal, and the monitoring and evaluation of policy, programs, and projects for government and bilateral development agencies in Ethiopia. Over the last ten years he has been engaged in health sector reform. Prior to joining Abt Associates, Leulseged held senior positions in various Ethiopian government institutions. Leulseged obtained his BA in Economics from Addis Ababa University and his MSc in Development and Project Planning from the University of Bradford, UK. He has presented at several international forums including the UN Economic and Social Council, the American Public Health Association, the Global Health Council, and the Health Systems Research Symposium.
In your opinion, how does financing affect the health system at all levels? Financing, as one of the pillars of the health system, is critical to systems performance. If we take an analogy from the human body: while all other system components can be seen as the bloodlines, financing constitutes the blood which gives life to the functioning of the health system. In Ethiopia, prior to the introduction of health finance reforms, facilities used to run out of essential drugs and medical supplies in three months’ time because they didn’t have sufficient budget to buy the necessary stock throughout the year. After the reforms, budget shortages haven’t been an issue as facilities are allowed to retain and use their revenues, and drug stockouts are a thing of the past (as long as the supplies are available on the market). Increased revenues for facilities have also boosted staff morale—now they can prescribe the right kind of medicine and treatment for their patients without reservations. The reforms have also enabled health facilities to enhance their diagnostic and imaging capacities, since they can use retained revenue to purchase equipment needed to provide these services. As a result, the health service utilization of the population is increased over time. I feel that this clearly demonstrates how financing is central to health system performance at all levels.
What do you find most satisfying about working in the area of health financing and governance? Working in health financing and governance in general is most satisfying since there is an abundant opportunity to learn through the process of activity implementation. While we develop tools and guidelines for our government partners and counterparts to use in their day to day work, it is a process whereby we learn from the experiences of people using the tools, and apply that learning to improve the next iteration of tools and make them even more useful. More recently, with the introduction of community based health insurance, I have seen tremendous changes in the health-seeking behavior of the population. People who have been living for years with chronic diseases now have the opportunity to get treated. As someone who has been working in the health system for over a decade now, I find this incredibly satisfying and it is evidence that systemic change is key.
In your opinion, what will be the most impactful global health initiative over the next few years which people should be aware of? I believe ”universal health coverage” will be the most impactful global health initiative over the next few years. While countries have had varied levels of commitment in the last five years or so, currently universal health coverage (UHC) has become a means to galvanize governments to ensure healthy and productive societies since it is included in the 2030 Agenda for Sustainable Development as part of Sustainable Development Goal 3 which seeks to ensure health and well-being for all, at every stage of life. With increased service coverage, expanding services for more segments of the population and providing financial protection are at the heart of UHC. Much is expected from health financing experts to come up with options for financing health service delivery and pinpointing the most appropriate indicators to gauge achievements in UHC.
Dr. Désiré Boko
Dr. Désiré Boko is the Chief of Party for HFG’s program in Haiti. He brings over 24 years of experience in health care and policy to the project. Prior to joining Abt Associates, Dr. Boko served as a primary care physician and a Regional Coordinator of the National AIDS Control Program for nine years in Côte d’Ivoire, later working as a humanitarian affairs coordinator for the UNFPA and then as a program officer and activity lead for the UNDP. Dr. Boko joined Abt Associates in 2007 and the HFG project in 2012. Dr. Boko served as Chief of Party for HFG’s Côte d’Ivoire program from until 2014 and was then appointed Chief of Party for HFG Haiti. A medical doctor by training, Dr. Boko also holds an MBA with a concentration in Health Program Management.
In your opinion, how does effective governance contribute to stronger health systems? First and foremost, I would like to point out that good governance is inextricably associated with tangible results in all sectors—political, social, economic, etc. The health sector is no exception. Effective health governance has three dimensions: responsibility (better stakeholder coordination and accountability), decision-making that is geared towards the rationalization of available resources, and the use of management tools to assess the performance of health interventions and policies. Effective governance contributes to stronger health systems because by being more responsible, health actors contribute to ensuring equitable access to quality health services and health care for the population. By optimizing the use of available resources, these actors help to ensure that services and care are provided efficiently. And finally, by ensuring that good governance practices are well performed, said actors safeguard the efficiency and durability of services provided.
What do you find most satisfying about working in the area of health financing and governance? Working in health financing and governance responds to my personal belief that being proactive at the health systems level is essential to the improvement of the population’s health status. My daily work is in line with this vision, and it is a great source of satisfaction to me. Interventions targeted by HFG in the areas of financing and governance will contribute significantly to the MSPP’s efforts to make the Haitian health system more efficient. Indeed, “financing” and “governance” are essential pillars for strengthening health systems, especially for low-income and developing countries. It is these essential elements that make HFG’s work so important in Haiti, even beyond the health sector objectives. Through HFG’s support of health financing and governance interventions, the Government of Haiti is also progressing in the implementation of wider, national-level reforms such as a performance management system for all civil servants and a national restructuring of all ministries’ Programming and Evaluation units. HFG’s support has also helped increase the capacity of the MSPP to coordinate and manage the entire health sector, and it will allow Haiti to eventually have its first national strategies for HRH and health financing. I am delighted to be part of a great team engaged in this adventure of developing political and strategic documents, creating governance tools, and transforming institutions.
In your opinion, what will be the most impactful global health initiative over the next few years which people should be aware of? I would say that the most important initiative is public-private partnerships (PPP) in the health sector. A government with limited resources simply cannot be the sole provider for all the health facilities necessary for its population. In the context of global health, one of the solutions to this challenge lies in the implementation of bold and innovative PPP policies. Depending on the country context, these policies could apply to: contracting, joint ventures, supply/demand financing, telemedicine, franchising, social marketing, public-private hybrids, community health insurance, and more. PPPs should be considered, especially since they have a key role in the promotion of universal health coverage, particularly in low-income countries where a large segment of the population lacks access to needed health services. Indeed, PPPs could improve access to health services, promote equitable access to health care by reducing household expenditure, guarantee better quality services, ensure more efficiency, offer regulatory opportunities, and enable greater resource (financial, human, material) mobilization. Their impact could contribute considerably to the achievement of Goal 3 of the Sustainable Development Goals.
Karishmah Bhuwanee is a Health Economist for the HFG Project, specializing in resource tracking methodologies such as Health Accounts, Public Expenditure Reviews, and National AIDS Spending Assessments. Karishmah has over ten years of experience in health financing including results-based financing for health and public financial management and has worked in Barbados & Eastern Caribbean, Burundi, Cambodia, Haiti, India, Malawi, and Senegal. She holds an MSc in International Development Management (London School of Economics), and a BA in Economics and Management (Oxford).
In your opinion, why is resource tracking crucial for any country embarking on health system reforms? As individuals, we know that it is good practice to budget our personal finances and track how we spend them. This helps us to make sure we have enough money for the future, and to make adjustments along the way in order to achieve our goals. The same applies for a health system. It is important for the government to know how much money it has spent for health and how, in order to plan for the future. For example, was enough funding allocated and spent on health in a given year—and if not, how can a ministry of health raise additional financing? Was money spent on the health goods and services that will meet national priorities and should resources be re-allocated for this? Are resources being raised in a way that doesn’t cause undue financial burden for households? Tracking spending helps a country to step back and evaluate its spending, and make adjustments in order to meet key objectives like universal health coverage. It can also help countries to benchmark themselves against their peers and identify potential areas to improve efficiency. This brief goes into more detail: Follow the Money: Making the Most of Limited Health Resources.
What do you find most satisfying about working in the area of health financing and governance? I enjoy analyzing financial and health data to produce evidence that informs good decision-making for health. One key decision by a ministry of health that increases funds for health or re-allocates resources more efficiently, can positively impact a large group of the population relatively quickly. Health financing analysis has helped countries to introduce social health insurance schemes, strategic purchasing mechanisms, or revenue retention schemes for facilities, that have had large-scale impacts in a relatively short period of time. It is rewarding to work with ministries of health and see them use the tools and information you have shared with them to make informed decisions so that more of the population access quality health services.
In your opinion, what will be the most impactful global health initiative over the next few years which people should be aware of? More of a concept than an initiative, I think a focus on efficiency will be key. Using existing funds in a smarter way—informed by context-specific data like Health Accounts—will become increasingly important as countries try to provide quality care to all of their citizens. This means looking at how we can allocate existing resources to those initiatives that maximize health impact, and identifying ways to reduce wastage of funds. I’m not saying that raising additional funds for health isn’t also important, but this is not always possible due to various external economic and political factors. In these situations, achieving technical and allocative efficiency can also help to improve health outcomes. Many times, the best way to get more funding is to maximize how you use the funds you already have.
Lisa Nichols serves as Country Manager for the HFG Project’s Haiti, Mali, and Cote d’Ivoire programs. She is a Principal Associate at Abt Associates with over 25 years of experience in managing and evaluating international public health programs that address maternal and child health, malaria, reproductive health, and family planning in complex cultural environments. Prior to coming to the HFG project, she spent 14 years as a field-based program manager of relief and development programs, primarily in Africa. She holds an MPH in International Health Policy and Programs from George Washington University.
- In Haiti, we have been able to assist the Haitian government in identifying the location of health personnel by type and category which will help them in responding to emergencies such as Hurricane Matthew and in eliminating waste and fraud in the HR payroll.
- In Mali I had the privilege of being at the district/regional level and national level dissemination of the Health Systems Assessment and a Management Assessment of the Ministry of Health cabinet. This was the result of a major effort by a dedicated and tenacious team who was there during a major security incident in 2015 and much upheaval following. HFG will use the HSA and MA recommendations to assist the Ministry of Health in Mali with revising the national health strategy.
- Cote d’Ivoire is one of HFG’s oldest country programs and I have been lucky to be a part of it since it launched in 2013. We are the “go to” experts in health financing and human resources for health (HRH) in the country—our Cote d’Ivoire HRH Advisor, Auguste Allet, was recently given a full scholarship from Health Systems Global to attend their symposium in Vancouver and present our work!
In your opinion, what is the relationship between infectious diseases like Ebola and health systems strengthening interventions? HFG in Cote d’Ivoire was given funds to assist with preparation for Ebola and other health pandemics. The preparation was focused on HRH, financing, training, and financial management. Because of our deep knowledge and experience with the health system for improving care and treatment for HIV, we were in an excellent position to examine how other health service delivery areas could benefit, such as preparedness for Ebola and other diseases. Our success in task shifting and for guiding Cote d’Ivoire to become one of the first countries in West Africa to apply task shifting for HIV care and treatment can be applied to malaria and other case management.
What do you find most satisfying about working in the area of health financing and governance? The most satisfying aspect is working with the excellent staff in our country programs. They are truly national experts and respected individuals who understand health financing and governance and are able to participate in national decision-making. This has contributed to our growth as a program, as a strong ally with the USAID Mission and PEPFAR in high level discussions on funding and governance. For example, we assisted the US Embassy to formulate a request for additional HIV funding in Cote d’Ivoire, which was announced by the Cote d’Ivoire government during a high level UNAIDS meeting.
In your opinion, what will be the most impactful global health initiative over the next few years which people should be aware of? Definitely Universal Health Coverage—and that UHC is not “one-size-fits–all.” Countries have developed a mix of strategies to get to UHC; some are based on community resilience activities such as community-based health insurance and some are primarily based on subsidies and private sector approaches. It is about what works in that country and its systems. Systems that embrace and bring together these different packages will be the key to achieving UHC in these countries. HFG has been influential in the dialogue and policy development around UHC and expanding coverage—contributing to community health strategies and task shifting policies, and a host of other activities aimed at increasing access to quality, affordable, healthcare for all.
Dr. Noël Nahounou is Chief of Party for HFG’s program in Côte d’Ivoire. He has spent the last eight years with Abt Associates, first as a technical advisor for health decentralization and governance in Côte d’Ivoire under HFG and its predecessor project. Previously, Dr. Nahounou worked as Health District Director in Côte d’Ivoire for 12 years, where he worked in health district management, programs for HIV prevention, family planning, and maternal and child health. Dr. Nahounou is a Medical Doctor and received his MPH from the Institute of Tropical Medicine in Antwerp, Belgium.
HFG conducted an evaluation of the governance of the Ivoirian health sector in which we found significant deficiencies in health governance. As a result of the evaluation, the government decided to develop governance tools to improve oversight and accountability of the health sector. HFG also supported the development of a capacity building plan for governance and organized trainings on governance and accountability to over 100 health system personnel from all levels (central, intermediate and district). This support was referenced in Madame Minister of Health Dr. Raymonde Goudou Coffie’s speech at the Ministry of Health’s High-Level Meeting in January 2016, reflecting on achievements from 2012 to 2015. I am very proud that my team has contributed to such important work in our country’s health system.
In your opinion, how does effective governance contribute to stronger health systems? I’ll use the example from Côte d’Ivoire I mentioned previously. The evaluation we conducted along with the Ministry of Health and the Office of the Inspector General identified several weaknesses in the governance of the health system. Findings included the widespread use of informal payments and a lack of financial recordkeeping.
The identified problem areas due to poor governance are found beyond Côte d’Ivoire in many other countries, especially in Africa. Effective governance can address these shortcomings and help build better systems. For example, the adoption of measures to crack down on informal payments and absenteeism; the establishment and institutionalization of accountability mechanisms making managers truly accountable for the public resources under their departments; and building the capacity of civil society to participate in the overall governance of the health system and to ensure social accountability.
What do you find most satisfying about working in the area of health financing and governance? I attribute my satisfaction to working in this field to two things. First, I enjoy being part of a project that is full of people with great minds and skills that works across activities and countries. Second, it is incredibly satisfying to see my team’s work lead to actual reforms within the health system, across our activities. For example, earlier this year, HFG was asked by the Ministry of Health to assist in their development of a business case for increased funding for health, to be used as an advocacy tool for the Ministry of Finance. The technical note developed by HFG was used by the US Ambassador to Côte d’Ivoire to successfully appeal to the Prime Minister for increased resources for health. Recognition by both the Ministry of Health of Côte d’Ivoire and by the USAID Mission here, has helped HFG to be effective in our work.
In your opinion, what will be the most impactful global health initiative over the next few years which people should be aware of? Everyone is talking about universal health coverage these days. I think it is very important, especially in our low-income African countries. We know that in most of our countries the poverty rate is relatively high. In my opinion, the adoption of universal health coverage as a target can only be beneficial. It should help to reduce barriers to users of health services—especially the most vulnerable—improve the quality of health services in our countries, contribute to reducing health inequities, and minimize health-related economic risks.
There is also the question of domestic resource mobilization (DRM) for health financing which is crucial for countries who currently receive the majority of their health program funding from international donors. Some implementing partners believe that the new trend will be reduction of external donors’ support in the coming years, which will require that these countries are prepared to take on the funding themselves. DRM is a key part of the HFG project’s mandate, and the project is working with country partners across the continent to develop strategies to mobilize resources locally to finance the health sector. This past month, HFG organized an international workshop on this very topic, held here in Abidjan. Participants from Bangladesh, Ghana, Tanzania, Peru, the US, and Cote d’Ivoire came together to address DRM strategies in LMICs. I am happy and proud to be part of the team working to achieve this vision in Cote d’Ivoire.
Jocelyne Nkongolo is Chief of Party for HFG’s Democratic Republic of the Congo (DRC) program. Prior to joining HFG, Jocelyne worked with several organizations across the development spectrum, with a focus on finance and governance. She was a Senior Public Finance Expert for the World Bank’s Enhancing Government Capacity Project in DRC, and worked with DAI and RTI International on the Programme de Bonne Gouvernance project. Jocelyne worked on measuring the implementation of the National Strategy for Decentralization and Roadmap for Capacity Building in pilot provinces within the DRC.
To give a brief background, in 2006, the new constitution made several institutional reforms based on the principles of decentralization, allowing provinces authorities that had previously been held at the national level. While much conceptual work on the reform has been accomplished, there is still much to be done, especially in the area of institutional strengthening. HFG is assisting in the implementation of the reforms at the central and provincial levels. Key to the institutional reforms is ensuring a common understanding of decentralization by key decision-makers. Over 80 participants attended the recent training; over half of the participants were central and division heads of departments. I’m proud to say that the workshop was a huge success, with participants urging HFG to hold another similar training in the future. It shows that we are addressing a real need, and that the right people are getting the information they need to work at the provincial and national levels.
In your opinion, how does effective governance contribute to stronger health systems? Effective governance can contribute to strengthening health systems when the standards and rules established to ensure effective management and decision-making are aligned with greater clarity and transparency. In order to effectively work to strengthen health systems, it is important to strengthen the normative aspects, improve regulation and oversight, and provide overall direction and coordination with active stakeholder participation. At the donor level, it is important that funding is not duplicative, and aligns with the health system and context in the country. Donor funds help partner countries like DRC bring global targets, like universal health coverage, to reality.
What do you find most satisfying about working in the area of health financing and governance? What pleases me most about my job is that I get to manage important changes in the different health system structures (Central Departments, Provincial Divisions of Health) that HG supports in the DRC. It is so satisfying to see change in people who were previously accustomed to working in a culture of bad management, with few rules or guidelines. This is what we are engaged in with the three central directorates within the Ministry of Health. Many other health organizations in the country also lack training on institutional and organizational development best practices. Close to two years into the implementation of our activities in DRC, we are discovering many more that want to work in consultation with HFG to bring about better management and capacity development practices in their organizations. As for the Ministry itself, we have received continued expressions of satisfaction from the HFG technical support, which is also very satisfying!
In your opinion, what will be the most impactful global health initiative over the next few years which people should be aware of? The most important initiative, in my opinion, is the launch of the Global Financing Facility (GFF) to end maternal and infant mortality by 2030. DRC is a pilot country of the GFF. Launched by the United Nations and the World Bank, the goal of the GFF is to “accelerate global efforts to end preventable maternal and child deaths and improve the health and quality of life of women, children, and adolescents by 2030.” The GFF provides financing that is smart, scaled, and sustainable. It looks promising to bring about major positive impacts.
Fred Rosensweig is HFG’s Capacity Building Advisor. As a senior consultant with over 35 years of experience, he specializes in improving health-focused programs in developing countries through organizational assessments, institutional capacity-building programs, training systems development, and increased involvement and commitment of key stakeholders.
In your opinion, how is organizational capacity building crucial to stronger health systems?
While not always fully appreciated, ultimately programs and services are provided through organizations. And if these organizations are weak organizationally and managerially, they will not be effective. This is the case with health systems just as it is in other sectors. There are two dimensions of how organizational capacity building is an essential aspect of health systems strengthening. One is building the underlying organizational and management capacity that an organization needs in order to function—having a clear direction and plans for carrying it out, clearly defined roles and responsibilities, effective leadership and management, effective teams, accountability, and capacity to engage stakeholders. The second is strengthening the institutional capacity to sustain technical interventions like health accounts, costing exercises, internal controls, human resources management, etc. Take the sustainability of a program to accredit nursing schools as an example: In addition to having a system of accreditation, there must be an organization with the mandate, institutional capacity, adequate numbers of trained staff, and sufficient resources to carry out the function. Addressing these institutional dimensions will greatly contribute to the sustainability of health systems strengthening interventions.
What do you find most satisfying about working in health financing and governance?
What is most satisfying to me is to watch an organization that is key to the health system, but is performing poorly, be transformed into an effective organization. My own experience has shown me that this kind of transformation in most developing countries takes two to three years of sustained organizational capacity building. When you see staff become engaged and motivated, and the organization able to do important things it couldn’t do before, it’s very satisfying.
In your opinion, what will be the most impactful global health initiative over the next few years which people should be aware of?
I’d like to see a global initiative aimed at strengthening the institutional capacity of ministries of health. Because of the nature of health systems strengthening, ministries of health are our natural counterparts. Most of the organizational capacity building work we do is aimed at specific operating units in the MOH. Yet those units work within the larger ministry, which if weak organizationally, will constrain what can be done with a specific operating unit. The MOH comprises the larger organizational system and strengthening it will pay dividends when we work with specific units. I would like to see a global initiative aimed at addressing this issue.
Dr. Gafar Alawode serves as Chief of Party for HFG Nigeria. Formerly Deputy Chief of Party, Dr. Alawode is an experienced public health practitioner and a seasoned program manager, having managed several donor-funded health projects in Nigeria and other countries. He holds a medical degree from the University of Ilorin in Nigeria and a MSc. in Tropical Medicine from the Liverpool School of Tropical Medicine.
In your opinion, how does effective governance contribute to stronger health systems? Governance is the driver—steering the other building blocks of the health system. It is difficult, if not impossible, to achieve improved health outcomes that are equitable, efficient, and affordable, without appropriate governance, even at the level of basic health service inputs. As many low- and middle-income countries (LMICs) strive to achieve universal health coverage (UHC), concerted efforts should be made to put governance at the forefront. Effective governance also sets the stage for mobilizing additional domestic resources for health.
What do you find most satisfying about working in the area of health financing and governance? Health financing and governance is very important work; addressing some of the most fundamental problems affecting health systems in developing countries. In my opinion, if countries get governance and financing of their health system right, they are more likely to achieve the best possible health outcomes for a given level of health investment. The HFG project in particular works across the health systems strengthening building blocks to address health system challenges in ways that will allow partner countries to ultimately improve the health of their people. Some useful resources are the recent studies on tax reforms and government health spending, and the Ministry of Health/Ministry of Finance toolkit.
In your opinion, what will be the most impactful global health initiative over the next few years which people should be aware of? Having read the African Development Bank’s publication, “Health in Africa over the Next 50 Years,” among other papers and perspectives on the global health landscape of the future, I lean towards sustainable financing for UHC as the most impactful health initiative over the next few years. The ever-changing global health landscape is at a point where addressing the underlying systems and country-ownership are of the utmost importance. It is premised on a confluence of factors including but not limited to: global clamor for UHC, dwindling donor health financing, a favorable economic outlook, and fiscal reforms in developing countries.
- Resource Mobilization Strategy Sets Nigeria’s Rivers State on Track to Sustain HIV and AIDS Response
- HFG At Work in Nigeria
- Partnering with Nigeria to Adopt Technology for Rapid, Effective TB Response
- Mobilizing Domestic Financial Resources for HIV/AIDS – State Level Experience from Nigeria
Christopher Lovelace is a Principal Associate (International Health) at Abt Associates. Mr. Lovelace has over 35 years of experience in public service, focusing primarily on public policy, health financing, and governance. He provides technical direction to HFG and directs the Bangladesh, Ghana, Ukraine, Global TB, and Asia Bureau teams. Previously, Mr. Lovelace served as Director of Health, Nutrition and Population at the World Bank. He has overseen major health sector reforms leading to improved effectiveness of health systems in Kyrgyzstan, Canada, New Zealand, and several countries in Africa.
In your opinion, how does effective governance contribute to stronger health systems? Enhanced governance is the “secret sauce” to achieving real, lasting impacts in health. It’s turning good technical solutions—which are also essential—into effective decision-making and accountability. Too often governance is ignored because people feel that it is either irrelevant or too hard. Good governance is not easily measured; there often are sensitivities among country counterparts to criticism of current practices, and it is not always black and white. It is an essential part of the journey toward universal health coverage (UHC).
What do you find most satisfying about working in health financing and governance? We are making progress in governance inch by inch. We have produced global tools and templates to support better health governance globally (for example, our guides A Toolkit for Ministries of Health to Work More Effectively with Ministries of Finance, and Tools to Help Civil Society Engage in Health Finance and Governance) and I think the HFG project is having much greater health governance impact in country programs than we originally thought. People tend not to always label support for enhanced governance as governance activities in themselves (e.g. enhanced public financial management, engaging civil society in accountability structures, improving transparency and accountability in decision-making, the role of governance in achieving health coverage and enhancing quality).
In your opinion, what will be the most impactful global health initiative over the next few years which people should be aware of? It is great that the global community, and many individual countries, have embraced UHC. There is much that HFG can support in progress towards countries achieving this important global objective. Ironically, for someone like me who has been around for a *few* years, it seems a bit like “old wine in a new bottle.” Nonetheless, it is very exciting that achieving access for all to quality essential health services with financial protection—particularly for the most vulnerable— is now at the table with inclusion in the post-2015 Sustainable Development Goals. Global objectives are vitally important but only when embraced by countries. The multi-sectoral aspects of health will also need to be emphasized with perhaps the traditional sector having a more modest sense of leadership. New challenges will also emerge, like health system resilience in the face of new or re-emerging pandemics and climate change.
- Tackling the Challenge of Financial Sustainability: Ghana’s National Health Insurance Authority
- Developing Good Governance for Health
- HFG At Work in Ghana
- HFG At Work in Bangladesh
- Tools to Help Civil Society Engage in Health Finance and Governance
- Bridging the Gap between Ministries of Health and Ministries of Finance
- 2015 Asia Regional Flagship Course: The Challenge of Universal Health Coverage
Heather Cogswell works on the HFG project as a health resource tracking specialist, designing and implementing health resource tracking processes in developing countries with a focus on local ownership and integration with existing information systems. Ms. Cogswell has extensive experience collecting, working with, and analyzing data, and also has economic modelling and costing experience. She holds her MPH and MBA from Johns Hopkins University.
In your opinion, how do cost-effectiveness studies contribute to stronger health systems? Leaders need evidence to make informed decisions on how to spend their scarce health resources while getting the maximum value for money. Cost-effectiveness studies are one tool that can help leaders make data-informed decisions around health investments. Smarter investments contribute to stronger health systems.
What do you find most satisfying about working in health financing and governance? Contributing to health systems strengthening is crucial for ensuring access to essential health services and improving health outcomes, but, at times can feel removed from the men, women, and children that our work is ultimately impacting. One of HFG’s recent reports shows linkages between health systems strengthening interventions and measureable impacts on health outcomes. It is incredibly satisfying to see evidence of the tangible link!
In your opinion, what will be the most impactful global health initiative over the next few years which people should be aware of? The issue of improving the efficiency of service delivery seems to be a theme that runs through several different activities that I’m currently working on. For example, we have been providing technical assistance to regional and district hospitals in Botswana around outsourcing. Hospitals consume a significant proportion—generally 50 to 70 percent—of a country’s total health budget with a sizeable portion of hospital budgets going toward operations. If hospitals are able to streamline and gain better value-for-money by outsourcing operations services, there is potential to improve not only hospital operations and efficiency, but to strengthen the larger health system as well.
So what’s next? I am currently leading Botswana’s 2013/14 Health Accounts exercise–this is the first time that Botswana is conducting Health Accounts using the updated SHA 2011 methodology. The study is expected to be completed in early 2016. I also serve as a member and secretariat for Health Systems Global’s Translating Evidence into Action thematic working group. We’re planning a series of webinars and developing a user-friendly inventory of knowledge translation and cross-constituency engagement tools to help reduce the gap between what health systems researchers know and what policymakers put into action.
September 9, 2015
Dr. Benjamin Johns has worked in health economics and finance since 2001, with a heavy emphasis on cost-effectiveness, health insurance, evaluation and research, data analysis, econometrics, and financial and actuarial analyses. Dr. Johns has co-written over 25 articles in peer-reviewed journals, and published three book chapters. He holds a PhD in International Health from Johns Hopkins University, an MPA from Syracuse University, an MA from Bowling Green State University, and a BA from Binghamton University. He is one of the lead authors of Impact of Health Systems Strengthening on Health.
In your opinion, how does research contribute to stronger health systems? Strong health systems are based on strong evidence. There are, of course, multiple kinds of evidence which need to be synthesized into decisions about policy and implementation, and regular feedback loops and discussions in order to make the evidence salient to people’s actions. The challenge is twofold – identifying the types of evidence needed at a given point of time in order to influence actions, and figuring out how to incorporate the evidence into the ongoing discussion. Entering the discussion is really the ultimate goal.
What do you find most satisfying about working in health financing and governance? I am most satisfied when I think that we produced a piece of work that is scientifically sound to the best of our ability and budget, and that is relevant to ongoing discussions. I should note that for most of our work, ‘being relevant to ongoing discussions’ is very reliant on the good work that is done by our in-country colleagues.
In your opinion, what will be the most impactful global health initiative over the next few years which people should be aware of? Though I haven’t worked in Africa much over the last year or two, I think it is largely the future of what has traditionally been ‘global health’ – donor and multilateral work. In Asia, most countries (with a few exceptions) are well on their way (if not fully “there”) towards funding and running their own health systems. The challenge in light of this greater ‘decentralization’ of global health is twofold. First, how to organize public health preparedness in a context where public health authorities work as equals in terms of decision-making power in their own countries, having vastly different resources at their disposal. The second challenge will be how to organize continued learning from each other.