Jack: Hi, everyone, and welcome to this week's lecture.
We'll be discussing the importance of boards
and good governance to global health organizations.
In global health, boards of directors or boards of trustees
are groups of community, business, and health sector leaders
who play a crucial role in creating the conditions
within which people who deliver and manage health services
are more likely to succeed.
This module covers a wide range of concepts
related to boards and good governance,
with the intention of helping health system leaders,
especially those in low-resource countries,
explore the power of the board to improve their systems
and health outcomes.
In particular, this module goes over the five key practices
and 11 essential elements of a board,
as well as touching upon the importance
of the sustainable development goals
to the development of good boards.
To begin with, and I apologize
for the formatting on the slide,
we'll discuss the concept of smart governance for health,
and smart governance describes leadership
that is stakeholder engaged, mission-driven,
accountable to beneficiaries and resource providers,
mobilizes resources to support the mission,
and demonstrates transparency in all plans
and decision making aimed at accomplishing the mission.
This practice enables leaders and organizations
to be as successful as possible.
As we've discussed before,
the American College of Healthcare Executive Code of ethics
addresses a manager's responsibility to numerous communities
that a manager finds himself in contact with.
These are the organization, the employees,
patients or others served, and the community and society.
It's also important to note that good governance
enhances stronger health systems and greater health impact.
Good board work not only helps health sector leaders
better accomplish their work,
but it also has benefits for health systems
and the populations they serve.
Good governance creates the conditions in which the, quote,
"Eight rights improve health systems
to achieve better outcomes."
These rights are the right number of health workers,
the right quality of health workers,
the right mix of health workers,
the right facilities in which people can work,
the right budgets and financing,
the right medicines, equipment, and supplies,
the right clinical care protocols,
and the right cultural appropriateness of care.
The idea of good governance can be a shallow false promise,
and one that's often broken if it's not understood
and demanded by all those who lead, manage,
and deliver health services.
Good governance does not just happen
because you hope it will.
Hope is not a strategy.
Good governance is more likely to be achieved
if you make a personal commitment
to explore the many facets of good and poor governance,
then take actions to embrace the good and combat the poor.
The sustainable development goals
and the millennium development goals helps to pave the way
for better governance.
The sustainable development goals were published
by the United Nations, and lay out benchworks
that the global community should try to accomplish.
These include no poverty, zero hunger, quality education,
care for the Earth and the oceans, et cetera.
There's a number of goals, and they can seem lofty
and hard to achieve,
but that's one reason why sustainable government is so key
to be able to attain these goals
in an ethical and uncorrupt way.
So now when we talk about governance,
there's numerous different levels that that takes place at.
The textbook separates them into four basic levels,
ranging from global to local.
The first, the global level, the macro governance,
refers to governance across nation states,
such as the World Health Organization,
the World Trade Organization, and the Global Fund.
These are often called multilateral organizations,
and they have stakeholders in many different countries.
The next level, the meso level,
refers to national leadership and national governance,
so within a nation state.
It's usually entrusted to Ministry of Health,
though some countries might have a mix of entities
engaged in health matters,
like the Ministry of Higher Education,
the Food and Drug Administration,
the Environmental Protection Agency,
and the Ministry of Youth or Women.
Next, the micro level refers to governance
via oversight of institutions, public or private,
within a country's health sector,
such as governing body for hospitals, health care centers,
or provincial district health councils.
And finally, the nano level of governance
refers to governance within institutions or organizations.
That's like a hospital organization in South Africa
that might have governing bodies
for each community hospital.
Most leaders are going to deal with governance
at institutional levels, but it's important to understand
all four levels of governance.
So next, it's important to note
that governance is a key enabler of health.
So as we've discussed,
governance can benefit health systems,
and this flow chart outlines one of the ways
in which good governance, good leadership, good management,
and good governing can improve health systems
through strong management systems,
enhancing the overall work environment,
and creating responsive health systems
that can use resources effectively.
These can in turn lead to lower costs and better qualities,
and result in sustainable health outcomes
that help to meet sustainable development goals.
So now it's interesting to think about
how your career might interface with smart governance.
I know we won't all go on to become leaders
of global health organizations, but you'll interact
with governing structures in numerous ways.
You might be serving on a board
or you might be subject to a board's policies,
and wherever you fall, it's important to understand
these key concepts, especially in ways
that you might be able to offer guidance
and suggestions on ways to make governance better.
So now we'll talk a little bit about the roles
and responsibilities of different members of a board.
Although legislation and regulations may guide
the forming of the governing body,
the terms of reference are often very general
with few concrete guidelines.
Managers should expect to help draft these guidelines
for the composition and work of their governing boards.
The fundamental role of a governing board
is to protect the mission of the organization
by accomplishing certain essential oversight duties.
Each board member's primary responsibility is to refine
and serve the organization's mission by developing,
monitoring, and enforcing specific guidelines
in six key areas:
quality performance; financial performance;
planning performance; management performance,
governance effectiveness;
and community relations and advocacy.
So now we'll get into some essential practices
of good governance.
The first is to create a culture of accountability.
Good boards must establish
and sustain a culture of accountability
through the following activities:
cultivating your personal accountability;
nurturing the accountability of your organization
to its stakeholders;
fostering internal accountability in your organization;
measuring performance; sharing information;
using technology to support accountability;
and providing smart insight and oversight, among others.
Next, it's important to develop stakeholder engagement.
Engagement must be optimized to ensure willingness
to help implement decision support.
Activities that will help
to ensure good stakeholder engagement are as follows:
extend sincere stakeholder invitations
and achieve sincere stakeholder engagement;
building trust; engaging with patients;
collaborating with other sectors;
and practicing gender-responsive governance.
Next, it's very important to set a strategic direction
in an organization.
Different activities that can help to promote this
are defining the target population health goals,
establishing a shared vision among key stakeholders,
creating a successful strategic plan,
and reporting progress to the key stakeholders.
Next, stewardship of resources
is of utmost importance in any organization.
Resources like labor, equipment, supplies, money,
and other things are often in scarce supply.
Activities that help to promote their efficient use
are as follows:
wisely raising and using resources;
practicing ethical and moral integrity;
measuring performance;
and eradicating corruption, among others.
And finally, continuous improvement
of the aforementioned principles is very important.
So improvement of the above practices helps
to sustain an effective and high-performing board.
Different activities that help to promote this
are cultivating governance competencies,
building diversity in the board,
performing regular governance assessments,
and making governance policies,
and using different cutting edge technologies.
Finally, the infrastructure of an organization
and its governance structure matters.
So there's various key systems and infrastructure elements
that will affect people's ability to participate effectively
in governance decision making processes and practices
to maximize the vitality of organizations
and their governing bodies.
These include the size and structure of the board,
the excellent committees, the board information systems,
the job descriptions, the orientation process,
and ongoing assessment and refinement.
These elements are described in depth
in the textbook chapter this week.
And finally, I'll leave us with a question.
One possible difficulty or obstacle that can arise
in an organization is the governing body
improperly trying to influence the hiring of relatives.
And I encourage you to think
as we reflect on the readings this week, why is this bad
and what can be done to fix, prevent, or inoculate this?
And what specific cultural factors
or setting factors might play a role
in the different strategies to combat this,
depending on where your organization is working?