Health Governance and Leadership in WT

outlines
• Health post reform Implementation Guideline
(HPRIG)
• Community score card (CSC)
• Ethiopian Health Center Reform Implementation
Guideline (EHCRIG)
• Good governance index (GGI)
• Woreda management standard (WMS)
 Session Objective

• At the end of the session participants able to understand:

• Kebele level measurement indicators
• PHCU level measurement indicators
• Woreda level measurement indicators of the
leadership and governance category of WT
 Overview
Leading people,
Managing work, & never changed over time

Governing organizations
Nevertheless, L+M+G:
have evolved considerably overtime
theories, to meet the challenges of rapid and
philosophies dramatic societal changes.
practices

Therefore, balancing and integrating these three distinct, but hostile paths is
always essential.
 …cont’d
Ethiopia launched L+M+G program, since 2011 VIA MSH:

Fundamental principles:
–Focus on Health outcomes,
–Practice leadership at all levels,
–You can learn to lead,
–Leadership is learned over time,
–Sustain progress through management systems,
 …cont’d
Leader Shifts perspective
From…  To…

Individual heroics  Collaborative actions

Despair and cynicism  Hope and possibility

Blaming others for problems  Taking responsibility for challenges

Scattered, disconnected activities  Purposeful, interconnected actions

Self-absorption  Generosity for common good

 Transformation in equity and quality of
health service delivery
 Information revolution
 Transformation in Health Workforce
 Transformation in health financing

 Transformation in leadership
Introduction to Health Post-Reform
Implementation Guideline (HPRIG)
 Introduction to the (HPRIG)
Basic HPs Comprehensive
• The HPRIG builds on the HEPO roadmap, HEPO HP
Implementation Manual and HPs standards to Five Chapters Seven Chapters
set minimum management standards for the
Health Posts (HPs). 1. HP leadership, In addition of BHPs
governance and CHPs have:
management 1. Pharmacy
2. HEP services services
3. Infection Prevention and 2. Human
• It is organized into 5/7 chapters. Control (IPC), Clean and resources
Safe Health Facilities
(CASH),
• Each chapter provides: 4. Community engagement,
• Minimum set of performance/operational 5. Community health
standards information, and
• Guidance on how to implement those monitoring and
evaluation.
standards.
36 standards 55
 Monitoring implementation of HPRIG
• For every chapter, there is an embedded
checklist to track the application of the
standards. Because:
• HP’s staff do self-assessments as part of
retaining accountability.
• For improving the availability and quality of
health services
• To monitor the progress of the
implementation of HEP optimization.

• Excel-based tracking tool is prepared for both

Basic and Comprehensive HPs.
Community score card (CSC)
 Governance of CSC

Health Extension Workers (HEWs): plan and assist the clients counsel to conduct
community discussions with 1-30 Health Development Groups (HDGs).

Client council: plan and coordinate CSC discussion, share score card results to facilities
and follow-up actions.

Health Centers : move urgently to action and closely follow-up to address community
concerns and low score areas.

Woreda Level: Establish client councils at facilities, aggregating scores for the woreda
and report to RHBs, ensure adequate response to community.
Conceptualizing CSC
Definition
 Community score card identified
as an approach in HSTP
A Community Scorecard is a
community-led governance tool  Experiences from; Ethiopia
which brings primary health care Social Accountability Program
facilities, local government (ESAP), Rwanda, Tanzania,
structures and the community to Malawi, Egypt
promote accountability and
responsiveness to community
needs.
 Manual developed customizing
the approach to Ethiopian context

 Assessment to verify validity of

the customized approach
conducted
 CSC framework
Community
Community Score
Score Card
Card Framework
Framework

JSC
JSC

FMOH
FMOH

Community Score Card Report flow

Accountability for action

Regional/Zonal
Regional/Zonal Score
Regional
Regional Health
Health Bureau/
Bureau/
Score card
card Report
Report

Administration
Administration Zonal
Zonal Health
Health Dept
Dept

Score
Score card
card Report
Report Woreda
Woreda Health
Health Office
Office

Woreda
Woreda Administration
Administration

Feedback Health
Health Center/Primary
Center/Primary Hospital
Hospital

Feedback Client
Client
Town
Town hall
hall meetings
meetings Council
Council

HEW
1-30 HDA
Step1: CSC indicators
1. Caring, respectful and
compassionate care.
Capture
common 2. Waiting time for provision of
community health care services
grievance
areas 3. Availability of medicines,
diagnostic services and
medical supplies.
Reflect
HSTP 4. Infrastructure of health
priorities facilities
5. Availability and management
To be of ambulance services
revised with
emerging 6. Cleanliness and sanitation of
issues and health facility
context
Step2: Establishing social accountability
client councils
• The Client Councils
• Client Councils will be will be composed of
established for every various community
primary health care groups, such as
facility (primary women’s &, youth
hospitals, health groups, associations
centers) by the woreda and others

• Client Councils coordinate

• In ESAP woredas
and lead social
social accountability
accountability activities
committee will serve
as a Client Council
 Step3: Conducting the community
scorecard
• Client council, HEWs and PHCU will plan and coordinate CSC
Who & • Community scorecard discussion will be conducted in every health post
When with 1-30 development groups facilitated by client counsel with the
assistance of HEWs quarterly
• A discussion facilitation guide will be used to help structure the
discussions and scoring.
• The score cards will use a rating scale for each indicator preferably color
How coded (1=Very low, 2= low, 3=ok, 4=Good, 5=Very good).
• Client councils will collect the scores of multiple health posts and
compile a score for the health facility they are responsible for.
• The woreda health office will collect scores for primary health care
facilities and aggregates woreda score.
CSC rating scale
Step 4: Facility visit and feedback
• The client councils will visit primary health
care facilities and share aggregated score
cards to reflect on and further review
feedback from the community.
• During the visits clients counsel will enquire
on score and comments provided by the
community.
• The scores will be shared to staff,
management teams of the health facilities and
governing boards to ensure adequate
attention and preparations for action.
Client Councils
 Step 5: Community interface meetings

Town Hall Meeting/ • Town hall meetings and community

Community Conference conferences will be used to discuss the
community score card results.
• Community town hall meetings provides
an opportunity to further discuss
feedback given by the community.
• Client council members, health center
directors and woreda health offices will
present plans to address concerns raised
by the community and commit to provide
continuous updates on progress.
Step 6:Taking action and follow-up

• Health facilities: implement

Client actions to respond to community
Council
grievances.
• Woreda health office: ensure
health facilities develop plan of
Woreda actions and implement activities to
Accountability Health
Health
Office
for Action facilities respond to feedback given by the
community.
• Client council: follow up and hold
woreda health office and facilities
Community to account.
• Community: active participation
in town hall meetings to follow-up
service improvements and
highlight emerging issues and
concerns.
Ethiopian Health Center Implementation
Guideline (EHCRIG)
 Transformation in equity
and quality of health
service delivery
 Information revolution EHCRIG
 Transformation in Health
Workforce
 Transformation in health
financing
 Transformation in
leadership
Chapters in the revised EHCRIG
1. Leadership, 8. HC Infr. And
governance and HCF
facility mgt.
2. Health center
linkages 9. MEM
3. Patient flow 10. HRM
4. MNCH
11. Quality
5. Pharmacy
6. Laboratory
governance
131 standards& QI
7. IPC 12. HMIS
Good Governance Index (GGI)
 Good governance index (GGI)
• Index of selected key indicators to monitor/track Good governance
• In health center 19 key good governance indicators are selected
• Addresses public grievance, service delivery and health system building
components.
• Implementation of this key indicators need due attention and follow up at
all levels
• comprehensive indicators
• cannot show extent of each problem at the institutional level
• Help us to know the level of general good governance level status
• good governance is crucial for existence of institution and country
S.no Description Wt.
I Response to public grievance 40
1 Client satisfaction rate 10
2 Proportion of client complaints solved 4
3 Proportion of CBHI insured patients who received all the 6
prescribed drugs

4 Proportion of non-CBHI insured patients who received all the 5

prescribed drugs

5 Proportion of patients who had all the prescribed laboratory 9

tests

6 Card loss rate 6

S.no Description Wt.

II Service Delivery 23
7 Proportion of emergency patients triaged within 5-minutes 5

8 Proportion of patients discharged from the emergency room 6

within 24 hours

9 Proportion of outpatient facilities started service at 02 :30 6

10 Household CBHI enrollment rate (new +renewed +fee 6

waivered)
S.no Description Wt.
III Health system 37
11 Tracer drugs availability rate 4
12 Drug wastage rate 3
13 Proportion of lab tests available according to the PHCG 4
14 Staff satisfaction rate 6
15 Budget utilization rate 3
16 Perfect order fulfillment rate 5
17 Percentage of PMT/QI meetings conducted 4
18 Percentage of HC Governing boards meetings conducted 4
19 Percentage of community -facility interface meeting facilitated for 4
the reporting period
Cumulative good governance index result 100
GGI monitoring
Woreda management standard (WMS)
 District Health System

District health system is a self-contained segment of the national health system

including

• Governmental or non-governmental health facilities

• Health workforce

• Hospital at the first referral level

• Leadership and governance support services

 District Health System - Ethiopia

• WHO district health system is equivalent to woreda health system in Ethiopia

• Woreda health office leads the woreda health system in Ethiopia

• WMS objectively measures the management performance of woreda health

office

• Strengthening woreda health office aligns with the woreda transformation

agenda of the HSTP
Woreda Health Office Roles and Responsibilities
 Woreda management standard (WMS)
Five domains
• Structural and Organizational Capacity (9 standards, 34 measurements)
• Service Delivery (5 standards,13 measurements)
• Community Engagement (5 standards,14 measurements)
• Coordination with other sectors (3 standards, 8 measurements)
• Performance Management (5 standards, 13 measurements)
• 27 standards
• 82 Measurements
• 1-3 verification criteria for each measurement
• Apply “all or none” principle for verification of each measurement
WMS monitoring
Thank you.