Mostafa Hunter, governance and private sector expert, Egypt

"Our job is first to acknowledge complexity and understand it, then use our knowledge to make it practical and reach out to the practitioners."

Originally an eye surgeon and lecturer of Ophthalmology at Cairo University, for more than 15 years now Mostafa has fully tuned into his passion for governance. Not shy of the tough topics like anti-corruption, he is striding out to really address health systems governance issues with a sense of urgency.

“For me, health systems governance is a core passion. Firstly, I worked with the Egyptian Institute of Directors to develop programs for the health sector. Later on, I created an NGO called “Healthcare Governance and Transparency Associations” and worked with the Centre for International Private Enterprise. We published the Principles and Guidelines for Governance in Hospitals, as the first of their kind on a global scale.

I then moved into anti-corruption as an entry point for governance reform and we worked with UNDP to launch a new approach for corruption risk management at the sectoral level which is currently being applied in several countries.T his approach brings together multi-stakeholders from the governance and anti-corruption community on one side, and the health community on the other side to assess corruption risks at specific decision points within the health system and develop targeted plans to mitigate them.

To me, the core of what governance aims to achieve is to safeguard equity and integrity over the coming decade. In the context of the evolution of the health care system and everyone pushing for UHC, people are not necessarily aware that this has massive implications on the governing structure of health systems in many countries. Countries which would not pick up on reforming the institutional set-ups quickly and would not strengthen their stewardship and regulatory capacities can end up with increasing inequity and their vulnerability to corruption, which ironically is the opposite to what we are trying to achieve.

If you pool more public money this would improve financial coverage and inclusion. However, without having the governance capacities in place to tackle risks related to strategic purchasing and managing a public-private mix in service delivery, this might increase the vulnerability to corruption, inefficiency, and inequity.”

"I believe there has to be a complete shift in the mindset of the governance community in their approaches, and any attempt to recycle what was there already will fail."

Mostafa is keen to point out that there needs to be a radical change in the way that health systems governance is being conceived and promoted and he sees a crucial role that the Collaborative should play in that.

“I believe there has to be a complete shift in the mindset of the governance community in their approaches, and any attempt to recycle what was there already will fail. What hasn’t functioned over the last two decades will not function now. Even what previously has functioned might not be applicable anymore. There were achievements, yes, but the context in which these achievements happened is completely different from what we are experiencing now. Healthcare systems are growing to be more complex and dynamic than they used to be, and the speed of change is increasing exponentially.

Now due to the revolution in information technology, globalization, the displacements of populations around the globe, financial crises etc, we are in an era where we need to start fresh and need to do something that really matters to countries on the path to UHC. We, as the health governance expert community, have the ethical and historical responsibility to lead the needed paradigm shift.

The governance community can do some very concrete things. The first is to build consensus and conceptual clarity, as the stakeholders we are speaking to in health systems might really be confused among the different schools of thoughts and approaches and lose sight on how to tackle governance deficits on the ground.

We should acknowledge complexity; the topic at hand will never be simple because health systems are complex. Any attempt to deny this complexity is doomed to failure. Our job is first to acknowledge the complexity and to understand it, then to use our knowledge, expertise and collective wisdom to make it practical, and reach out to the practitioners. The Collaborative should be positioned at the interface between the complexity of governance and its applicability in countries. The work should be focused on developing evidence-based practical solutions that can be easily digested and applied.

Above all, we need a sense of urgency for governance interventions. The current situation dictates quick responses. I believe we should also be bold and advance anti-corruption as an entry point for governance reform; it’s time to put this at the heart of the matter, not try to hide it or not name it . We can no longer assume that we should first bring governance reforms and concepts like accountability and transparency to countries, then corruption will simply disappear. We need to make things much more tangible and concrete and we need to tackle corruption heads-on in combination with other governance reforms in order to have a real impact on the ground.”