Dr. Didier Houssin 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. Didier Houssin
1. What are the most vital challenges in building governance capacities in Ministries of Health?
DH: In my view, there are three main challenges with regard to the building of governance capacities.
The first one is to find a good organizational mode to link science and politics. For sound public health measures, political decisions should be based on science. However, political decisions cannot be exclusively based on scientific evidence. The second challenge is to make sure that all stakeholders can have their say at some time in the conception of health policies. The third has to do with the role of national State governance capacities to implement health security measures, and to prevent and correct inequalities in the access to preventive and curative health care.
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?
DH: This is a good document, which certainly will be useful to those concerned in developing countries. It is concise enough, provides a clear distinction between governance and capacities. And is full of precise information, rich in examples and references.
3. Could you see specific practical applications of the framework in your own 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'?
DH: My first comment is that the fundamental mission of the MoH should never be forgotten and stated upfront. The MoH is a political and administrative institution which has as its core mission: to protect and promote the health of a population. In that sense, the MoH must be considered as a major instrument of public health. Citing public health at the outset attaches this work to the human reality which is in the background of any MoH.
As it stands, the Working Paper does not yet provide a fully synthetic view, showing what might be the ideal representation of a MoH having the main components necessary for a good governance. This could be put in a figure, for example. Sure, I do recognize that such a figure is not easy to draw. The contexts are so different that several figures would probably be necessary (for example, different figures for federal States than for more centralized States). You do not want to give the impression that you suggest the replication of the model of a developed country. Nevertheless, I anticipate that the practical reader, in the end, would like some further visualization, mainly about the organizational aspects of governance. Let’s see if we can develop that for different contexts.
KEY QUESTIONS FOR FURTHER COLLABORATIVE DISCUSSION:
- Governance capacities and ‘insecurity’
- Governance capacities and dealing with ‘inequities’
- Engaging in ‘further visualizations’ of a synthetic view, using the framework as it stands
Prof. Didier Houssin is a senior health practitioner, researcher, health administrator and policy expert. Professor of Surgery since 1988 at the Paris Descartes University, he is since 2016 also the President of the Assistance Publique – Hopitâux de Paris (AP-HP) International, and a frequently engaged Senior Advisor to the WHO.
Prof. Houssin started his long career as resident, then chief resident and lecturer, at the AP-HP (Greater Paris University Hospitals). In 1982, he became research officer at the French National Institute of Health and Medical Research (Inserm), a post which he held until 1988. From 1994-2003, he was the Chief Executive Officer at the Etablissement français des greffes (French Agency for Transplantation). From 1998-2003, he also worked as Chief of the department of surgery at the Cochin Hospital, AP-HP (Greater Paris University Hospitals). In 2003 he was appointed Director of medical policy, AP-HP until 2005. Simultaneously, he held the post of Vice-president of the Scientific Council at the René-Descartes University, Paris (2001-2005). From 2005-2011, prof. Houssin was Director general for Health at the French Ministry for Labour, Employment and Health; and involved with the Interministerial delegation against pandemic flu. From 2011-2015, prof Houssin was Chief executive Officer of the French High Council for the evaluation of research and higher education (formerly the Agency for the evaluation of research and higher education (AERES)). Due to this rich practical and political experience, prof. Houssin served on numerous WHO commissions as Senior Advisor, notably during a number of pandemics.