Ms. Precious Matsoso 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 Ms. Malebona Precious Matsoso
1. Which are the most vital challenges in building governance capacities in Ministries of Health that occupy you today?
MPM: For me, the political environment and legislative context constitute the first layer of challenges. Governance issues are context specific. Capacities should reflect this and be responsive to local settings. The political and legal contexts of South Africa are dynamic and very relevant to consider. The second major challenge in building strong governance capacities is considering the broader societal engagement, and a country’s efforts to achieve social cohesion. We have relative strength and the availability of clear governance tools in the health sector in South Africa. There are also a lot of legislative provisions. But without social cohesion no tools by themselves will suffice to address a country’s problems. A third area of concern is governance at microlevel. The areas which may require deeper focus for governance capacity-building are the citizens’ or clients’ actor-capacity and the degree of community participation. Sure, there are legislative provisions that deal with governance at micro- and meso-levels. But further investment in governance capacity development requires much more attention to be paid to these levels. They are closer to the population: promoting community participation at micro-level is key.
2. From your daily experience, does the MoH Governance 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?
MPM: There are aspects of the framework that are very useful with an eye on improvements in my country. Other aspects are already sufficiently addressed. I think the tensions between political aspirations and societal needs and the discourses that arise at that particular interface are often still neglected. Issues are sometimes being reduced to mere administrative problems and ditto solutions. This is not right. In a nutshell: You can't solve political problems administratively. I have been looking where in the MoH governance framework you deal with this? For instance, the tension between the WHO member states’ diverse political contexts and the WHO Secretariat’s ability to respond to these hugely diverse settings. If you do this merely administratively this causes tensions. Is there a solution for such real-life issues in the Framework?
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'?
MPM: The most immediate application that springs to my mind are in the formal training of hospital boards and clinic committees, and in real community-participation settings. We need exposure of all managers and leaders in the multiple spheres of government to this new governance and sense of diverse stakeholder management and public participation. Sure, tools do exist, but tools alone are not enough, we need new processes of engagement.
4. Any further points?
MPM: I would like to refer you to our publication on health reform: “The South African Health Reforms 2009-2014”. It contains a chapter by Levendal and others on governance which makes specific reference to health governance and good governance. This publication, even though a few years old, is still very useful for thinking through actionable governance.
KEY QUESTIONS FOR FUTURE COLLABORATIVE DISCUSSION:
How do we develop governance capacities closer to the population and people’s needs?
How do we grow governance capacities dealing with fostering social cohesion?
- How do we engage in capacity-building in decentralised government agencies, local agents, with real community participation?
- What about governance capacities of Local MoH, hospital boards, clinical committees?
Ms. Malebona Precious Matsoso was Director-General in the Department of Health of South Africa, a position she has held from June 2010 to November 2019. She has a Master’s degree in Law and Ethics from the University of Dundee, a degree in Pharmacy from the University of the Western Cape, and a post-graduate diploma in Health Management from the University of Cape Town. Ms Matsoso has worked at management level in both the public and private sector. She was Director in public health innovation and intellectual property in the office of the Director- General of the WHO. Additional leadership positions she held include her appointment as a head of the Medicines Control Council, her membership of the National Research Ethics Council of South Africa and being the Director of the Essential Drugs and Traditional Medicines Programme for the Department of Health of South Africa. Ms Matsoso has been a member of various advisory panels locally and internationally, with a primary focus on improving access to medicines. She served as the Chair of the Executive Board at World Health Organization from 2015-2016.