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https://www.youtube.com/watch?v=z6r-JNk0fEY&feature=em-share_video_user

Leadership for Universal Health Coverage

World Bank, Washington DC, May 6 2015

Partners in:

Ceren Ozer, World BankEconomist, Leadership Learning and Innovation

Brigitta Villaronga, GIZHead of Leadership Development

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Origins

This is the beginning. Olivier starts with a personal connection storyrevealing the roots--Bangladesh example. Linking the concrete the case to the fact that UHC 1. complex 2. multi-stakeholder and therefore requires Leadership [add or deepen]

Thank you for your presence. Where does all this orgininate from? As garment threads a carpet revealing a pattern in the end, I can see that our product today emerged actually from many many threads in the past weaving together a coherent story and pattern. Let me begin to tell you where for me the issue of leadership and UHC has come into play. Back in 2007 Olivier was working in Bangladesh in the health sector in with the biggest SAWP $5 billion together with WBG was TF manager. we couldnt bring the government to do what the they were intended to do. Needs were obvious. Poor people couldn t access health services this was obvious in your day to day life as we commuted between our residential area and the places we worked and interacted with the people around you. It wasnt only about the poor only. The wife of a Bangladeshi colleague of mine fell in coma during birth delivery and from then onwards started a suffering journey in which the health care costs absorbed all the financial ressources of the rather affluent middle-class family. The issue of reforms also in the Health financing area was addressed as a topic in the health SWAp but ir remained on paper. There was leadership issues behind. Let me open what I mean by leadership here [Shared vision, cooperation to achieve national goals, raising the profile, sustainable coalitions]: there was no real dialogue engage in working togethether let alone collaborating, between DPs and government and within government between MoH and MoF and other stakeholders such as private sector. There was always a reform agenda on engaging private sector but they were always in their tranches. From then onwards, leadership issues became key to me. And I can say, that retrospectively looking: had I had the chance to have such a programme in Bangladesh I am sure it would have helped the sector not only between the actors in the country but also between development partners and the counterparts.One day a chance to learn more about leadership work.

Ed Campos, whom we lost last year who founded the leadership program at the WBG and I talked to Olivier. From other candidate sectors this is where we felt most strongly the pull where leadership and coalition building could truly have transformational impact.

Build on Oliviers example, its not only about technical issues. Building coalitions. From whats wrong to how question .

Bangladesh was a learning ground for me and Ed Campos. We often wondered 30% disbursement rates during a transitional technocratic government led by a former Bank staff. Money wasnt spent because of these blockages. Entranchement in sectors and silos.This all merged into a program. Leadership theory of change.

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LeversLeadership skills for improved communication, dialogue and trust buildingEstablishing effective collaboration mechanisms across sectorsHigh-level thinking partnership and support from subject-matter and leadership expertsLearning by doing and demonstration of successful implementation via Collective Action Initiatives in-countryPeer learning and knowledge exchange

Program supports the country teams in their reform process via several levers:- Leadership skills for improved communication, dialogue and trust buildingMoving towards UHC requires a varied number of stakeholders to effectively work together across sectors; in particular health, social and finance; and at political and technical levels. Leaders need to introduce sustainable mechanisms to model, cultivate and improve communication, dialogue and trust across sectors.- Establishing effective collaboration mechanisms Collaboration among relevant ministries (e.g. Health, Finance, Labor) and other groups (in the case of Nigeria for example between central authority and states; and, in the case of Kenya between central and counties) is a key requirement to advance UHC agenda forward; often, there is scope for improving the mutual understanding of goals, roles and relevance of the different government and private sector stakeholders. - High-level thinking partnership and support from subject-matter and leadership expertsWhile leaders are often experts in the UHC field, mentorship on how of coalition building and implementation by experienced UHC practitioners is critical.- Learning by doing and demonstration of successful implementationCountry teams launch 100-day Collective Action Initiatives with clear results.- Peer learning and knowledge exchangeCountry teams learn from each others experience and establish a support network. Also with inclusion of ex-Health Minister of Turkey as thinking partner and field visits in Turkey during workshop 3, there was an element of South-South learning, participants learned from the experience of Turkey and Turkish reformers.

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Why the how matters?

A program approach to leadership and advancing reform agenda

A 9 month intensive engagement with 3 face-to-face workshops, in-country team work and coalition building, and coaching support

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Leadership for UHC Edition 1.0

NigeriaEthiopiaKenyaUgandaZambiaSouth AfricaSierra LeoneEbolaTanzaniaChange of staff

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Nigeria: A country team example

Nigeria

Kafayat BukolaHealth Insurance OfficerLagos StateAbubakar KokoCEO PHC Dev AgencyKebbi StateJonathon EkeDeputy CEONational Health Insurance Scheme (NHIS)Peter DamzaPlanning OfficerFed. Ministry of HealthOlalekan OlubajoChief Health EconomistFed. PHCDAFrancis UkwuijeHead Health FinancingFed. Ministry of HealthIdriss AlhajiZonal Executive OfficerNHIS

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Quotes from participantsOur problem was our shared understanding of what UHC is what it will take to domesticate a global agenda for [our country] and run with it; and also the fact that we have unfocused policy dialogue on UHC. Once we had those two, we were able to strategize It actually helps me to listen to them instead of me preaching at them or giving them the solution [Now I ask the] person who is delivering the service for our clients, how is it for you? [] How can I give you support, so that you can deliver that service better. Yes, when we did the stakeholder mapping, it truly changed my view about them. [] we do use a lot of the stakeholders mapping to know within the group we intend to engage.

Reactions from DPs in countryChange was pronounced in the participant: more humble approach to colleagues, listens more; [he] is a person who likes to learn and who likes to apply learnings quite possible that changes have been triggered by programChange [to more inclusive behavior] not necessarily observed in the participant, but difficult in [the countrys] context, which is very hierarchical, but delegation to others was good.The Collective Action Initiative was perfectly aligned with national work-plan, assured through participation of the right people in the team 100% positive responsesfrom what observed, it seemed great, could not have been much better. 100% positive responsesOn individuals learning resultsOn the initiatives alignmentOn info from organizers

Participant feedback: Overall usefulness of the Program

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Our Learnings and Insights

In the first place, we have learnt from each others approaches a lot. And participants said they benefitted from the programme. Concerning operational aspects:Country and Participants selection is the keyMonitoring the impact, were learningStrong connection to operations

Bigger transformation direction of this prototype and involvement of complex challenge stakeholders: support LSC through a more systemic intervention, focusing on all relevant stakeholders and their attitude/mind-set (heart of the leader) as well as rules of the game; bringing together different constituencies and broader set of stakeholders/their perspectives

Success is when important steps are done towards UHC, triggered by the leadership-program

Major challenges: Alignment and collaboration between different constituencies (depending on commitment of project managers who stick to their believes that bringing together approaches adds value to the whole)For the future: Learn from the lessons of 1.0

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What are your thoughts?How can we deepen this work (we have the next edition coming up)? How is this relevant or useful for our book project?What lessons are emerging for institutional cooperation that may be relevant for system change work?

Brigittas questions:What was new for you ?

Anything that moved you specially?

More/less convincing parts of the story?

What was missing?

Suggestions for the future of this collaboration?

What else?

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Thank you for your attention

Additional slides

Developing competencies of leadersDeepen understanding of value-base of UHC reformFair choices in UHC reformDrill-down on values

Gain competency in analysis of political-economy of UHCAdaptive ChallengesConstraints to collective actionImprove coalition building & consensus brokering skills Stakeholder analysisCommunicating resultsWorking across sectorsImprove learning from success & failureResults Action LearningStructured project reviewStrengthen willingness to seek & ability to give peer adviceTraining of different methods of peer adviceHelp leaders to strengthen their resolve & commitmentEstablish personal connectionReflection exercises

Leadership for UHC Edition 1.0

This is the slide that does two things: it talks about scoping, and it talks about wpo were the countries and participants. Olivier: Starting from our impressions We had this explatory phase, went back to client countries asked them on the utility of the proposed program on leadership. Francaphone aFrica, the feeback Joy got from flagship course.

Connection with Health GP and in each country recognize the involvement of Bank TTLs and country offices. As well as Africa team.

For every country please enter all the participants and their designation. 17

Target groupKey issue: Variety across organizations, sectors, age, gender enough to create constructive friction but not to bring deadlock

InstitutionLevelMinistries of Health, Labor, Finance. Planning, Prime Ministers Office, AIDS Commissions, etc.Director Level or above, those responsible for Policy, Planning and ImplementationHealth Insurance / Social Security Funds Directors General / Chief Executive Officers, & Deputies Civil Society / Medical Associations / Trade Unions / Employer AssociationsDirectors General / Chief Executive Officers, Managing / Executive DirectorsParliament: Committee responsible for Health / Social ProtectionMembers of ParliamentHealth Service Providers (Associations, Tertiary / Teaching Hospitals)Directors General / Chief Executive Officers, Managing / Executive Directors

Leadership in Health Programs

ProgramHarvard Ministerial Leadership in HealthAspen Institute Ministerial Leadership for Global Health WB / GIZ Leadership for UHCTarget GroupHealth and Finance MinistersHealth Ministers and Senior Ministry Officials (federal level only)Senior officals from central and local Government Ministries and Agencies (esp. Insurance); Civil Society leaders; provider & professional associationsFormat3 Forum Meetings per year between Ministers, combined planning and implementation, a small number of countries receives In-Country Follow-Up (Ministers and senior level ministry officials)Accompanied through country leads for 5 years (recruitment through applications): 3 stagesIdentification of ObjectivesCommunication StrategyTechnical Assistance3 meetings and on-demand technical support for 1 Collective Action Initiative in 1 yearContentLeadership effectivneess but mostly Techical Focus: Priority Setting, Ressources Mobilization, M&E, Planning; for a project focused on efficiency in procurement, supplyFocus: Health Financing (in general), Donor Harmonization, Reproductive Health Social Change & Collective Action; leadership competencies & commitment for UHC: cross-sectoral coalition-building, stakeholder analysis, inclusiveness, team leadership

Approach to EvaluationIn-country Development Partners InterviewsParticipant in-depth interviewsLevel 1 evaluationsResultsTo be completed by end JuneLeadership & commitmentCollective Action Initiative

What Changesswaddell@networkingaction.net21Steve Waddell

Natural Environment

Memes, values, beliefs

Social-Political-Economic Structures

Technology

Individual

Change StrategiesNameSupporting ChangeForcing ChangeCo-creating ChangePaternalistic ChangeComponentsGenerative powerDegenerative powerGenerative loveDegenerative loveDynamicEmpoweringRaising upConfrontingViolenceCollaboratingCo-evolvingMinor changeMaintaining status quoRequirementWillingness to share powerWillingness to ignore harmWillingness of everyone to changeWillingness of disempowered to settle for minor improvementPopular termsNoblesse obligeUpliftmentForcingCo-productionPaternalismBeing bought off Archetypal strategiesCommunity organizingRights legislationLegal casesEducationState forceStrikes (capital, labor)DemonstrationsMulti-stakeholder foraPublic engagementSocial labsReinforcing legal casesFinancial pay-offsConsultation

Systemic Change Process Map

Version 2013.8.25 Dr. Joe Hsueh, Academy for Systemic Change

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