Webinar - Governance Roles and Capacities of Ministries of Health Framework: Part 2 - An Ethical Perspective

Background

The Health Systems Governance Collaborative, the Alliance for Health Policy & Systems Research and the UHC Partnership are launching the WHO Working Paper - Addressing Governance Challenges and Capacities in Ministries of Health. We are celebrating this launch with a series of webinars.
 
The WHO Working Paper aims to help understand and strengthen governance capacities in Ministries of Health (MoHs) across the world. In ensuring and promoting health and wellness for their populations, MoHs have a complex array of governance roles and must carry out these roles against a rapidly changing and often volatile political, financial, ecological and/or health-threat related context. Despite growing attention being given to health sector governance – in LMICs and elsewhere – little attention has been devoted to the capacities of Ministries to actually undertake their governance roles. The WHO Working Paper focuses on four major dimensions of governance – performing de jure governance roles, preparing for and responding to changing contexts, managing stakeholder relationships, and managing values.
 
Regarding managing values, the Report states: “ In the end, as a governance body, the MOH must adopt and actively maintain certain values or principles [8]. Underlying these norms is the view that a shared approach to governance, involving “whole of government” and “whole of society,” is preferable to that of a narrow, overly centralized view of health and health governance [3]. This potentially includes processes that propagate values or principles such as accountability and transparency, participation and efficiency.”  (p.10)
 
Also accountability and transparency, fairness, participation, integrity, prudence and efficiency, and keeping the public’s welfare in mind…are critical roles for an MoH.
 
Are governance principles and ethical principles the same thing?  What do and could the concepts of fairness, integrity, prudence and efficiency mean?  Where is the role of social justice in all of this?  

Agenda

This webinar laster for 75 minutes. It was divided into the following four sections:

1. Introducing the framework: Veena Sriram gave an overview of the framework with a particular emphasis on the values management function. [15 minutes]
2. First invited response: Sridhar Venkatapuram discussed the two roles of MoH both to express social values as well as to shape social values, particularly regarding social equity and justice. [10 minutes]
3. Second invited response: Seye Abimbola discussed instances in which tensions may arise between two of the values that an MOH may be expected to espouse – justice and efficiency – as a reminder that an MOH is as much a governing entity as it is a governed entity. [10 minutes]
4. Open Discussion: Participants were invited to come forward and share reactions, insights, and experiences. [40 minutes] 

Executive summary:

In this second webinar accompanying the launch of the WHO Framework on Governance Roles and Capacities of Ministries of Health, we zoomed in on the specific governance dimension of ‘value management’.

Dr. Veena Sriram (University of Chicago) summarized the contours of the Framework. She outlined the ways in which it introduces the ‘values dimension’ as part of the vital ‘software of governance’. She introduced recent examples from the literature and pointed at future directions of dealing with this value dimension in governance. She detailed the main governance capacity requirements which come up in engaging with value management, involving personal, role, structural, performance and more systemic capacities. And she stressed the role of historical contexts, institutional norms and wider public norms in shaping the relevant importance of these capacities.

Building on the Framework, two commentators drew out a range of crucial topics that could help to enhance and enrich the discussion and sharpen its application further.

Dr. Sridhar Venkatapuram (King’s College London) entered into the dynamics of how the work at ministries should both reflect social values and functions, and at the same time lead some of these ethical deliberations. He ordered his comments around the substantive question of ‘what values exactly’ surface in Ministries’ governance work, how implicit values could be made more explicit and which tensions opposing values could create. He made a plea for thinking more sharply about concrete actions around how to get ethical deliberations going in policy settings, and build ‘capacity to articulate’ and – despite all the local specificities – share experiences around the globe.

Dr. Seye Abimbola (University of Sydney), drawing on his own work experience for several years at the Federal MoH level in Nigeria, built his explorative comments around the core question of how values/ethics, power and real change relate in real, day-to-day practice. He emphasized that MoHs are not only ‘governing bodies’, but that they themselves are also ‘governed’ and subject to a range of influences. He stressed in particular the influence of power structures, to which people/institutions may succumb. His plea was to connect the MoH ethical debates much more intelligently to the big governance questions of performance and corruption.

The discussions were rich and yielded some pivotal suggestions for future applications of the Framework. All speakers agreed that bringing out the underlying value propositions in MoH policies more clearly and building people’s capacities to do so, would benefit the UHC agenda. They also expressed great confidence that the MoH Governance Capacities Framework could support the much-needed capacity building in Ministries of Health.

The recording of the session can be found below:

Our speakers:

Veena Sriram

Dr. Veena Sriram is a Postdoctoral Scholar with the Center for Health and the Social Sciences at the University of Chicago.  Her research focuses on medical specialization, human resources for health and the politics of health policy in the context of low- and middle-income countries. Her research has been funded by the U.S. Fulbright Scholarship Program, the National Institutes of Health (Agency for Health Quality and Research), and the American Institute of Indian Studies. She completed her PhD in International Health from the Johns Hopkins Bloomberg School of Public Health, and has a Masters in Public Health from Columbia University. She grew up in Chennai, India and currently lives in Chicago, IL.

Sridhar Venkatapuram

Prof. Sridhar Venkatapuram MSc MPhil PhD is Associate Professor of Global Health & Philosophy at King’s College London, and Deputy Director of the King’s Global Health Institute. He has been at the forefront of global health ethics for over 25 years, starting with researching HIV/AIDS related human rights abuses in India for Human Rights Watch in the early 1990s. His expertise is in bringing together health sciences with philosophy to address concepts such as health equity, social justice, and human right to health. He has worked at a number of international health organizations including spending 2018-19 at the WHO, HQ- Global Health Ethics Unit.

Seye Abimbola

Dr. Seye Abimbola is currently a lecturer at the University of Sydney, a research fellow at The George Institute for Global Health, and the editor in chief of BMJ Global Health. He has over 10 years’ primary health care experience as a researcher, lecturer and practitioner — including as a physician in a rural community (2007-08), an academic at a medical school (2008-09) and researcher/program manager at the National Primary Health Care Development Agency (2010-date) all in Nigeria. In 2016, Seye completed a PhD titled “Institutional Analysis of Primary Health Care Governance”.