LEADERSHIP FOR HEALTH SECTOR REFORM IN NIGERIA: NMAs Role

1
LEADERSHIP FOR HEALTH SECTOR REFORM IN NIGERIA
NMAs Role HERFONs Experience

• Presented by
• Dr. Ibrahim Y. Oloriegbe
• Executive Secretary
• Health Reform Foundation of Nigeria HERFON
• At the
• 5-Year Strategic Plan Dissemination Workshop, NMA
• 25 August 2006, Port Harcourt

2
Initial topic adjusted

• Initial topic HEALTH SECTOR REFORM IN NIGERIA
  experience of HERFON
• Adjusted to LEADERSHIP FOR HEALTH SECTOR REFORM
  IN NIGERIA NMAs Role HERFONs Experience
• Leadership is a virtue needed to implement any
  sectoral reform within the Health System
• System is about people, places, organizations and
  practices
• System is the sectoral vehicle for service
  delivery
• Nigerian Health Sector is perpetual
• System is more durable and sustainable

3
Health System

• WHO The people, institutions and resources,
  arranged together in accordance with established
  policies, to improve the health of the population
  they serve, while responding to people's
  legitimate expectations and protecting them
  against the cost of ill-health through a variety
  of activities whose primary intent is to improve
  healthIt is a set of elements and their
  relations in a complex whole, designed to serve
  the health needs of the population by fulfilling
  three main functions
• providing health care delivery
• dispensing fair treatment to all, and
• meeting the non-health expectations of the
  population

4
WHAT IS HSR?

• HSR is a sustained process of Fundamental Change
  in POLICY and INSTITUTIONAL arrangement, guided
  by Government, designed to improve the
  functioning and performance of the health sector
  and ultimately the health status of the
  population (Source Sikosana et al ,1997)
• HSR is a sustained purposeful change to
  improve the effectiveness, efficiency, equity and
  quality of the health sector (Berman 1995)

5
Key Characteristics of HSR

• Structural rather than incremental or
  evolutionary
• Change in Policy Objectives followed by
  Institutional Change rather than redefinition of
  policies alone
• Purposive rather than haphazard change
• Sustained and lengthen rather than one off.
• Political and top down process led by national,
  regional or local government
• Contents is marked by diversity rather than
  uniformity of measures
• Content is specific to a country and to its
  health system characteristic.
• Josep
  Figuerasetal 1997

6
What are the components of HSR? (1)

• 1. Enabling/Empowering
• Liberalize laws on Private Sectors
• Introduce Incentives for expansion.
• 2. Regulations
• Revising regulatory structure to protect
• consumers ensure minimum quality
• standards.
• 3. Financing
• User fees
• Community Financing
• Social Health Insurance

7
What are the components of HSR? (2)

• 4. Purchasing
• Creation of purchasing agencies management
  agreements with providers
• Introduction of competitive nonstructural
  relationship
• Reforming payment system.
• 5. Provision
• Decentralization of Health Service Management
• Increased autonomy of public hospitals
• Improved accountability to services user and
  population

8
Who are the key Actors in HSR?

• Government providing the Structure/regulatory
  insturments
• Patients/ Population - Pay for Health system and
  receive services
• Financial Intermediaries Collect funds and pay
  providers
• DOCTORS and other providers of health care
  Services
• - 1o, 2o, 3o level of care
• - Public or Private ownership. For
  profit or not for
• profit
• - formal or informal degree of
  organization
• - orthodox, allopathic, homeopathic
  medical system

9
Approaches to undertaking a HSR (1)

• 1. Establishing baseline information to enable
  the Description of the Health System
• Structure of HS Governance and Management
• Policy and Regulation Mechanism
• Financing Services, quality, distribution
• Human Resources Quality, quantity, performance
• Private Sector Size, quality, relationship with
  public role, regulation etc.

10
Approaches to undertaking a HSR (2)

• Disease Burden and how they are addressed
• Accessibility - physical and financial
• Equity assessment
• Health infrastructure
• Health indicators
• Economic performances other related government
  policies
• Diagnosis/ Identification of key problems

11
Approaches to undertaking a HSR (3)

• 3. Utilize HSR CONTROL SWITCHES to design
  responses
• Policy/Regulation, i.e. decentralization,
  commercialization, autonomization, etc.
• Financing User fees/IGR Utilization, resource
  allocation, tax Insurance, incentives
• PPP Contracting ,subsidizing, regulation
• Equity measures exemption, minimum package
• Consumer education

12
What are the challenges of HSR? (2)

• Where HSR initiatives involve significant adverse
  economic impact on people, efforts should be made
  to encourage government and businesses to create
  new opportunities for affected persons
• Responsibilities for various HSR activities must
  be defined and allocated among all responsible
  parties in a clear and definitive way
• Regulatory considerations should be addressed
  early in the HSR planning process

13
What are the challenges of HSR? (3)

• Enhancing the utilization of internal resources,
  acquiring outside expertise, and providing
  training to ensure successful HSR initiatives
• Better integration of the perspectives of the
  health community into HSR initiatives e.g.
  establishment of sectoral and inter-sectoral
  coalitions
• HSR opportunities should be competitively
  structured to the maximum extent feasible
• Stakeholders in HSR should develop new mechanisms
  for covering costs

14
HSR in Nigeria 2003-present (1)

• 7 Strategic Thrusts of Nigerias HSR Agenda
• Improving the stewardship role of Government
• Strengthening the National Health System and its
  Management
• Reducing disease burden
• Improving Health Resources and Management
• Improving access to quality health service
• Improving Consumer awareness and Community
  involvement
• Promoting effective partnership, collaboration
  and coordination

15
HSR in Nigeria 2003-present (3)

• Some Accomplishments of the HSRP
• New National Health Policy
• New National Health Act
• NHIS
• Restructuring of Ministry of Health - Ongoing
• States undertaking HSR
• Primary Health Care Reform - MDGs Agenda and
  blue print to improve Primary Health Care
• Addressing the issue of Routine Immunization
• New Private/ Public Partnership Policy
• Donors Coordination
• Tertiary Health Care Reform

16
Functions/Roles of Actors (1)

• Government and or professional groups
• Setting and enforcing standards
• Monitoring the behaviour, performance of
  providers and insurers (where they exist)
• Defining an appropriate package of services and
  or benefits.
• Regulations to encourage efficient and equitable
  financing and delivery of services and to
  constrain cost inflation
• Safe guarding and promoting public health

17
Functions/Roles of Actors (2)

• The Citizenry
• As patients knowing their responsibilities and
  rights
• As payers - insurance, exemptions etc.
• As part of reformed managing and policymaking
  structures

18
Functions/Roles of Actors (3)

• Financial Intermediaries
• Collecting payments from patients (user)
• Payment to providers, i.e. act as purchases of
  services
• Act as Providers occasionally

19
Functions/Roles of Actors (4)

• Roles of Providers, i.e. The Doctor and Others
• Adapting to the spirit and concept of
  decentralization, competition, diversity of
  ownership and reforms at all levels of care
• Embracing evidenced-based health care quality
  improvement
• Paying more attention to the most vulnerable
  groups to enhance their health indicators
  MMR,IMR, under-five MR, etc.
• Maintaining accurate HMIS for System Indicators
  such as waiting period, bed occupancy, admission
  rates, plans availability, HR system, etc.

20
What are the Doctors challenges in placing these
roles?

• Understanding the relationship between the HSR
  and the Doctor
• Adjusting to the roles and potential
  contributions of the Doctor in public and or
  private sectors in line with national HSR goals
  and objectives
• Understanding the barriers to HSR
• Preferring solutions and next steps

21
Expected outcome of the Doctor s Role

• increased life expectancy above SSA level
• Drastically reduced MMR, IMR, etc.
• Improvement in all areas of the health sector
• Better health for all Nigerians

22
What Doctor will produce the outcome?

• The five-star doctor
• Care provider
• Decision-maker
• Communicator
• Community leader
• Manager

23
The Leadership Challenge in the Nigerian Health
Sector

• how do we ensure Better Health for All Nigerians?
• how do we effectively tap into all the potential
  resources at our disposal human, social
  (goodwill) and material?
• how do we coordinate the various roles that may
  exist in the health sector for each form of
  leadership market, bureaucracy, heroes,
  democratic and professional?
• and ..

24
What is needed now (1)

• Reforming/restructuring of health services
  approaches through objective analyses of needs
  and opportunities, and aimed at improving health
  workers capacities in order to strengthen the
  healthcare system in a sustainable manner
• Enthronement and institutionalization of
  evidence-based healthcare activities at al levels
• Regular evaluation and review of our health
  sector policies and practices, experience and
  innovations, within and between institutions,
  professions and professionals African
  Peer-Review Mechanism example

25
What is needed now (2)

• Better training and firm national policies that
  would manage our so-called brain drain, i.e.
  sincere and realistic strategies for dealing with
  migration of health staff to developed countries
  Ghanaian examples
• A broadly based popular movement for the health
  sector, which crosses all sections of our society
  and which draws on our history, our mythology,
  our traditional values and the collective
  consciousness of our society

26
Imperative for a movement... (1)

• Development of measures of individual leadership
  for health promotion
• Ultimate accountability for both clients and
  practitioners
• Leading change from the top line towards the
  bottom
• Providing leadership through the outside edge,
  i.e. leadership need to focused on three key
  things
• the task they are trying to achieve
• the team they have to achieve it
• the individuals in that team

27
Imperative for a movement (2)

• Clients/patients, stakeholders and health people
  acknowledge the critical role of the leadership
  of the health sector movement
• A movement that must speak clearly about the
  interests of the health sector
• Emphasis on teamwork as against unnecessary
  hierarchies
• Leadership in academic medicine, delivering
  capabilities/skills and conditions for success

28
Imperative for a movement... (3)

• Plays a father figure by
• Putting health and wellbeing on the front line
• Helping the health sector to remain in priority
  positions
• Spearheading the development of improved models
  of services in the sector
• Providing national and global public health with
  new and future crop of leaders
• Supporting others to access more opportunities
• Emphasising the value of critical thinking within
  the health sector

29
Who do we turn to now?

• the one who has the capacity to bell the cat
• the one who controls the bull in the China
  warehouse
• the one who has a prime stake in the wellbeing
  of the society
• the one who controls the most
• the one that is most indispensable to all the
  other kinds of leadership
• the one who is in the best position to mobilise
  the health professions in a concerted manner
• . the NMA!

30
Why the NMA?

• ARTICLE 2 AIMS AND OBJECTIVES http//nigeriannma
  .org/aims.htm
• (b) To promote the advancement of Health, and
  allied Sciences
• (e) To co-operate with organisations anywhere in
  the world which have similar aims and objectives
• (f) To consider and express views on all
  proposed legislations and national issues
  especially those affecting health care delivery
  system and medical and dental education in
  Nigeria
• NMA - the custodian of the peoples health!

31
HERFONs Name

• HEalth Reform FOundation of
  Nigeria

32
HERFONs Vision

• To be the leading organization on health sector
  reform that contributes to a Health System that
  delivers quality, effective, efficient, equitable
  pro poor health services that leads to
  improvement in the health status

33
HERFONs Mission

• To initiate, promote, facilitate, support and
  monitor sustainable reforms in the Nigerian
  Health Sector towards better outcomes and
  development in Nigeria

1/ To promote and support the existence of a
Health System in Nigeria that delivers an
effective, qualitative, equitable and affordable
health services which produce health outcomes
that is best in Africa
34
HERFONs Overall Objectives

• To promote and support the existence of a Health
  System in Nigeria that delivers an effective,
  qualitative, equitable and affordable health
  services which produce health outcomes that is
  best in Africa
• To promote and support a Nigerian Health System
  that leads to the attainment of Health Related
  MDGs by 2015 viz
• i) Reducing under 5 mortality by 2/3 MDG4
• ii) Improving Maternal Health
• iii) Combating HIV/AIDS, Malaria and TB
• iv) Developing Global Partnership as it
  concerns drugs

35
HERFONs Approaches to HSR

• Advocacy and Communication
• Capacity building and Technical Assistance
• Research and Policy Analyses
• Operating a Health Resource Centre
• Maintain a sustainable organizational that can
  deliver on programmes

36
HERFONs Activities in HSR (1)

• Supporting state coalition o
• IEC
• 2nd national health Summit to set national health
  agenda for Nigeria, 2007-2011
• Produce disseminate documents on Health Agenda
  for 2007-2011 to Stakeholders Political
  parties, CSOs, prof. Association

37
HERFONs Activities in HSR (2)

• Change Management Training
• HSR workshop for stakeholders/coalition members
• Management training programmes
• Senior Executive Health Leadership Conference
• PPRHAA
• Health Sector Need Assessment for States
• Scholarship and training activities to
  Stakeholders

38
HERFONs Activities in HSR (3)

• Health Bill passage
• Nigerian Health Review
• Promoting research on Health Care Financing
  /Insurance
• Maternal Mortality studies in Rivers State
• Study of ARV activities in Nigeria

39
Accept this challenge (1)

• to use its large store of specialised knowledge
  and skills to sort out the complexities within
  the health sector by always thinking, speaking
  and or acting in the best interests of the
  clients/patients, communities and the larger
  society
• accusations of abuse of privilege, economic
  exploitation, unethical and unprofessional
  behaviour which have contributed to the erosion
  of public confidence in the health system, would
  gradually be requiem

40
Accept this challenge (2)

• Produce good managers in various areas of the
  health sector, with the ability to switch between
  different styles of leadership as and when
  necessary
• Ultimately ensure Total Security in the health
  sector personnel, services, materials,
  facilities, clients/patients, organisations and
  government
• And move the Nigerian Health Sector

41
From chaos to coherence (1)

• A study at Cornell University's Johnson Graduate
  School of Management found that compassion and
  building teamwork will be two of the most
  important characteristics (that leadership) will
  need for success a decade from now - Doc Childre
  and Bruce Cryer
• Leadership in a health sector with self-security,
  can push power and authority downstream and
  develop centers of innovation and excellence at
  all levels of the system- Doc Childre and Bruce
  Cryer

42
From chaos to coherence (2)

• Blessed is the leader who seeks the best for
  those he serves - Unknown
• The only test of leadership is that somebody
  follows - Robert K. Greenleaf
• Therefore, leadership in the health sector should
  not be about the magnetic personality. It should
  not be all about "making friends and influencing
  people - that seems like flattery.

43
Conclusion

• Leadership for Health Sector reform in Nigeria
  should imply developing a shared and achievable
  vision for the sector based on peculiar
  circumstances, lifting this vision to higher
  heights, raising the health sectors performance
  to a higher degree, building a health sector that
  is beyond its normal limitations, and enthroning
  a sustainable health system that delivers
  improvements in the standards of living and life
  expectancy of the clients/patients
• From HERFONs experience in the past 3 years, one
  organization stands in the best stead to offer
  this leadership, the NMA!

44
Count HERFON in

• As you accept the role of providing the
  leadership that will enthrone an efficient and
  productive health system for the implementation
  of appropriate Health Sector Reform in Nigeria
  towards the realization of Better Health for All
  Nigerians, please count HERFON in.
• Thank you
• Dr. Ibrahim Oloriegbe
• Port Harcourt
• 25 August 2006