Dr. Beverly Ho comments our WHO Working Paper “Addressing Governance Challenges and Capacities in Ministries of Health”
In reaction to the launch of the WHO Working Paper “Addressing Governance Challenges and Capacities in Ministries of Health”, the Health Systems Governance Collaborative asked some seasoned health governance and policy persons to provide feedback. Herewith the reflections of Dr. Beverly Ho, Director for Health Promotion Bureau and Special Assistant to the Secretary of Health for Universal Health Coverage at the Department of Health - Philippines.
1. What are the most vital challenges in building governance capacities in Ministries of Health that occupy you today?
BLH: First, it may be good to acknowledge that a lot of the governance challenges are inherent to the governance structure across all ministries - for example, the four highest ranks (Secretary, Undersecretary, Assistant Secretary, and Director) positions require appointment by the President, thereby making the process highly political. This has implications on say, how fast the overall agenda or specific policy directions change with new appointments. Appointed officials also typically bring a team from outside the civil service – and seldom are there available positions to absorb outstanding junior staff once the co-terminus appointment expires. Second, with the fast-changing landscape of health-driven largely by the exponential growth of the private sector and technological innovation, the government needs to move away from strict command and control towards a more agile, flexible type of governance model. The latter requires a diverse skill set, typically not available in the health sector or not inherent in health professionals. For example, most management positions in the Philippine Department of Health are tied to professional qualifications (‘medical officer’ vs generic division chief or senior manager), which is a barrier for other cadres (lawyers, economists, public administration specialists etc.) to rise up the ranks and take on key management positions or to consider the DOH as a possible career option.
2. From your daily experience, does the MoH capacities framework presented in the Working Paper make sense? If so, what general relevance could it have in your daily practice? If not, what are you missing?
BLH: The framework captures a lot of what we - as implementers - think about and which are often under-appreciated. By demystifying the topic, I am hopeful that this report will raise the profile of the issue, stimulate the partners to reflect how they design and implement capacity building programs, and trigger governments to take concrete steps forward.
3. Could you see specific practical applications of the framework in your daily governance practice? What purpose could this framework fulfill there? What further elaborations would the framework need, seen from your practical experience, in order for it to have practical relevance for you and your colleagues and become 'actionable'?
BLH: I personally would like to pursue the questions such as (1) who actually determines, whether a certain capacity needs to be out-sourced or rather be built from within, (2) how can we address retention issues when the trained (MOH) staff is recruited by the trainer (development partners), and (3) how can we fund these?
KEY QUESTIONS FOR FURTHER COLLABORATIVE DISCUSSION:
How to use the framework to stimulate development partners (and governments) to reflect more critically on how to design government capacity-building programs?
To use the framework to have a much more critical discussion on who determines which capacities matter, and who actually benefits?
Beverly “Bev” Lorraine Ho is the Director for Health Promotion Bureau and Special Assistant to the Secretary of Health for Universal Health Coverage at the Department of Health - Philippines. Immediately prior, she was Chief of Research Division of the Health Policy Development and Planning Bureau where she worked to provide the evidence needed to support health system reform by designing innovative research grants and building institutional capacity for policy research. These efforts have significantly contributed to the passage of key legislation on sugar-sweetened beverage tax, tobacco tax and universal health care, and the institutionalization of the health technology assessment process. She has also worked in the Philippine Health Insurance Corporation and has provided technical assistance to the government of the Philippines and the Greater Mekong Subregion on health financing, maternal and child health, and health impact assessment. She co-founded Alliance for Improving Health Outcomes, a non-profit working to raise the profile of public health and develop a critical mass of public health professionals. Bev is a fellow of the Maurice Greenberg World Fellows Program at Yale University, the Equity Initiative, and the Atlantic Institute. She holds an MD from the University of the Philippines and an MPH in Health Policy and Management from the Harvard T.H. Chan School of Public Health as a Fulbright Scholar.