Health

System
Framework
and
Building
Blocks

LEADERSHIP AND
GOVERNANCE
WHO-BUILDING
BLOCKS OF HEALTH
SYSTEM The six building blocks
contribute to the strengthening of
health systems in different ways.
leadership/governance and health
information systems, provide the
basis for the overall policy and
regulation of all the other health
system blocks. Key input
components to the health system
include financing and the health
workforce. A third group, namely
medical products, technologies
and service delivery, reflects the
immediate outputs of the health
system, i.e. the availability and
distribution of care.
 LEADERSHIP
 Effective leadership ensures the existence of strategic policy frameworks, effective
oversight and coalition-building, provision of appropriate incentives and attention to
system design and accountability.
 Dimensions of good leadership/Governance are:

RESPONSIVENESS- INTEGRITY-
linking health policy promoting ethical
and expenditures with management and
public priorities standards among health
professionals.

OVERSIGHT- ACCOUNTABILTY-
TRANSPARENCY- clarifying delineation
conducting regular
increasing public access of authorities for
reviews of the results of
to health health programming
health investments
and expenditure
 GOVERNANCE
WHAT IS GOVERNANCE ?
GOVERNANCE IS “ensuring strategic policy frameworks exist and are combined with effective oversight, coalition
building, the provision of appropriate regulations and incentives, attention to system-design, and accountability“

Governance in the health sector refers to a wide range of steering and rule-making related functions carried out by
governments/decisions makers as they seek to achieve national health policy objectives that are conducive to
universal health coverage. Governance is a political process that involves balancing competing influences and
demands. It includes:

detecting and articulating regulating the establishing

maintaining the behavior of a wide
correcting the case for transparent
strategic direction range of actors -
undesirable health in from health care and effective
of policy
trends and national financiers to accountabilit
development and
distortions development
health care y
implementation providers mechanisms.
 THE ROLE OF GOVERNANCE

 Beyond the formal health system, governance means collaborating

with other sectors, including the private sector and civil society, to
promote and maintain population health in a participatory and
inclusive manner.
 In countries that receive significant amounts of external
development assistance, governance should also be concerned with
managing these resources in ways that promote national leadership
 Contribute to the achievement of agreed policy goals and
strengthen national health systems.
 While the scope for exercising governance functions is greatest at
the national level, it also covers the steering role of regional and
local authorities.
 Corruption reflects poor governance and can be used as one proxy
measure. Good governance includes the capacity of governments to
formulate and implement sound policies, manage resources and
provide services efficiently.
 Policy making, decision making, and oversight are important
elements for governance.
BUILDING BLOCKS INTERACTION

SYSTEM INPUTS SERVICE DELIVERY OUTPUTS OUTCOMES

 INDICATORS FOR
MEASURING HEALTH SYSTEM
 GOVERNANCE
RULES-BASED INDICATORS

measure whether countries have appropriate policies, strategies and codified approaches for health system governance. In
the health systems context, these indicators include the existence, for example, of a national essential medicines list or a
national policy on malaria control. They are part of a larger class of indicators called governance determinants

 OUTCOME-BASED INDICATORS

measure whether rules and procedures are being effectively implemented or enforced, based on the experience of
relevant stakeholders. For health systems, examples may include the availability of essential medicines in health
facilities or the absenteeism of health workers
 CORE INDICATOR : TUBERCULOSIS 

 In March 2017, the
Government of India (GoI) announced that
the new aim about TB in India was
the elimination of TB by 2025. Elimination
as defined by the World
Health Organization (WHO), means that
there should be less than 1 person with TB for
a population of a million people.
 WHAT COULD YOUR COUNTRY ACHIEVE BY FOCUSING ON
GOVERNANCE AND LEADERSHIP
When done effectively, improved governance & leadership can contribute to an array of
downstream effects including:​

INPUTS:
SYSTEM: Drugs & SERVICE ACCESS:
Governance & supplies.​ DELIVERY:  Availability of OUTCOMES:
effective policy OUTPUT:
leadership.​ Facility Population Health status,
health care EFFECTIVE responsiveness to
Health financing.​ infrastructure.​ health services SERVICE people,
Information management​ HIGH QUALITY COVERAGE​ equity, efficiency,
Adjustment to
population systems​ Facility PRIMARY HEALTH resilience of health
health Workforce​ organization CARE​​ system.

Funds​
CORE INDICATORS:HIV HEALTH-
EXISTENCE OF A NATIONAL HIV
STRATEGY OR POLICY
 UNGASS INDICATORS IS THE NATIONAL COMPOSITE POLICY INDEX
 VISION –a world with zero HIV case by 2030
 GOAL of national HIV strategy is to reduce new HIV infection
 Increase access to care and optimize health outcomes for people living with HIV
 Reduce HIV related heath disparities and health inequalities
 FRAMEWORK FOR ELIMINATING HIV BY 203
1.By testing and treatment
 Ensure that 90% of people living with
HIV knows their HIV status.
 Ensure that 90% of people living with
HIV know their HIV status
 Ensure that 90% of people living with
HIV ,and who are on treatment achieve
viral load suppression.

2.Financial sustainability

3.Innovation
 FRAMEWORK FOR
Reported

ELIMINATING malaria
cases per
WHO

MALARIA BY 2030 region

from 1990–
2017.

In November 2015,the
Prime minister of India
joined 17 Asia pacific
leaders in endorsing a
plan and roadmap to
eliminate malaria

In February 2016, the

Government of India
formally launched the
National Framework for Reported
Malaria Elimination malaria
(NFME), which outlines
the strategies elimination
death per
of malaria from India by WHO
2030 region
from
1990–
In 2017, India launched 2017.
its five-year National
Strategic Plan for Malaria
Elimination. This is a
landmark plan to fight
against malaria shifting
the focus from “control”
to “elimination”.
 LEADERSHIP AND GOVERNANCE ROLE IN MALARIA

Manage the development of

evidence-based, strategic, and
operational plans for the
malaria program

INTERVENTIONS

Role of Leadership in Malaria Community engagement- Fish-based larval control-

• Build and maintain
partnerships among in-country
and international stakeholders
who have key roles in SME
system operations
awareness programs through folk Gambusia is a species of
SME The role of a leader in • Develop, regularly update,
harmonize, and communicate theatre, media and workshops larvivores fish used for mosquito
malaria SME is to develop and SME plans that include
identified data needs,
control
communicate a clear and standardized indicators, and
data collection procedures and
convincing vision of SME and tools

to encourage the involvement Surveillance-

Insecticide based vector
and commitment of the team and control- routine vector surveillance to
all key actors. insecticide spraying(IRS) and identify local breeding grounds
insecticide treaded nets of mosquitoes

ICMR Initiative MERA India-

• Support a unified and effective
SME system through planning
• Adopt SME planning and
The purpose of MERA India is to identify, articulate,
and implementation of activities
implementation processes into prioritize and respond to the research needs of the country
and SME capacity building at
individual, organizational, and
national process to eliminate malaria from India by 2030
system levels
Understanding Leadership with the help of COVID pandemic!

The speed and scope of the coronavirus crisis poses extraordinary challenges for leaders in today’s vital institutions.

On March 11, 2020, the spread of the SARS-CoV-2 was declared a pandemic by the World Health Organization. World
leaders, healthcare executives and clinical leads struggled to establish ‘best practice’ models and strategies.

Leadership compartmentalisation-
 Planning and coordination
 Situation monitoring and assessment
 Communication
 Funding, PPE and testing
 Mitigation and containment
 Predictive mathematical modelling
 COVID-19 surgical adaptation phases

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7366988/
 EXEMPLAR LEADERSHIP:
South Korea became the second most infected country after China by early March. To handle the pandemic, they undertook a massive
public and private sector effort to fashion a national response. They controlled their outbreak without imposing a nationwide lockdown.

South Korea's strategies to beat COVID-19 were combination of strong

national leadership and coordinated response. Their key strategies included:
 Being prepared and acting quickly.
 Testing.
 Tracing.
 Triage.
 Transparent communication with the public.

Bhilwara district of Rajasthan also proved to be an effective model of good

leadership and governance. It was the epicentre of the coronavirus in Rajasthan
until aggressive containment measures were taken by the administration to limit
the spread of the virus.
During times of crisis, communicative and efficient leadership
and governance can strengthen public health approach.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7366988/
 COMPARISION OF COUNTRIES
MEASURES TAKEN DURING PANDEMIC

TAIWAN
6% of its gross GDP

a) Being alert and proactive c) Taking quick

and decisive
b) Setting up commander center actions

f) Educating public
e) Ensuring
d) Using technology g) Learning from
availability of
to track and test past experiences
supplies

https://www.nbcnews.com/health/health-news/what-taiwan-can-teach-world-fighting-coronavirus-n1153826
 UNITED STATES
17% of US GDP

DRAWBACKS :
a) initial unresponsiveness
b) failed implementation

c) capacities in hospital didn’t increase

d) variation in cost of treatment

https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019

https://www.cfr.org/backgrounder/comparing-six-health-care-systems-pandemic
KERALA
Stanford University ranked Kerala as second-best performing state
pathbreaking planning and action
.
number of tests increased significantly

severity of location was analysed

proper monitoring of test results

involvement of government

providing social security

followed community-based approach

proper surveillance system

education on health
 CASE STUDY OF
INDIAN UT DELHI ON
LEADERSHIP AND
POLITICAL WILL
TOWARDS HEALTH
SECTOR
 Budget Allocation
 Strengthening healthcare system by network of
Mohalla clinic, polyclinic and tertiary care
hospital
 Free medication and free 30 surgery in every
government hospital
 Bike ambulance
 Campaign for dengue
#10hafte_10din_10bje
 Responsive helpline 1031 for complain and
suggestions
 POOR GOVERNANCE AND LEADERSHIP
PRACTICES IN INDIA

 Health workforce Absenteeism from public sector, bribe for transfers, promotion

Bribes for examination

 Medical education,
training and research
Substandard medicines, blood supply without testing, bribe to
inspecting authority
 Regulations and inspection
Corrupt tendering process for infrastructure, medical
 Infrastructure and medical procurements
resources
Political influence over it
 Policy and strategic
planning
CONCLUSION
How to enhance effective leadership and governance practices in healthcare

 Evidence based and transparent policy making with feedback

 Effective linkage between centre and states
 Clear and enforceable accountability
 Responsible leadership and strong decentralized management
infrastructure upto district level
 Efficient and effective regulatory framework
 Transparent resource allocating
 Responsiveness to public needs
 Leaders from medical fraternity
 Coalition between private, public, international agencies and various
funding agencies
 Team members-Group 4
• Dr Ashish Panghal
• Dr Astha Poddar
• Ms Avani Anand Garde
• Dr Ayushi Goel
• Ms Ayushi Kashyap
• Dr Ayushi Mathur
• Ms Ayushi Srivastava
• Ms Barnali Roy
• Mr Debarghya Sarkar

LET’S ROOT FOR EACH OTHER AND WATCH EACH OTHER GROW

THANK YOU