Leadership and governance
The leadership and governance of health systems, also called stewardship, is arguably the most complex but critical building block of any health system. It is about the role of the government in health and its relation to other actors whose activities impact on health. This involves overseeing and guiding the whole health system, private as well as public, in order to protect the public interest.
It requires both political and technical action, because it involves reconciling competing demands for limited resources in changing circumstances, for example with rising expectations, more pluralistic societies, decentralization or a growing private sector. There is increased attention to corruption and calls for a more human rights based approach to health. There is no blueprint for effective health leadership and governance. While ultimately it is the responsibility of government, this does not mean all leadership and governance functions have to be carried out by central ministries of health.
Experience suggests that there are some key functions common to all health systems, irrespective of how these are organized:
- Policy guidance: formulating sector strategies and also specific technical policies; defining goals, directions and spending priorities across services; identifying the roles of public, private and voluntary actors and the role of civil society.
- Intelligence and oversight: ensuring generation, analysis and use of intelligence on trends and differentials in inputs, service access, coverage, safety; on responsiveness, financial protection and health outcomes, especially for vulnerable groups; on the effects of policies and reforms; on the political environment and opportunities for action; and on policy options.
- Collaboration and coalition building: across sectors in government and with actors outside government, including civil society, to influence action on key determinants of health and access to health services; to generate support for public policies and to keep the different parts connected – so called "joined up government".
- Regulation: designing regulations and incentives and ensuring they are fairly enforced.
- System design: ensuring a fit between strategy and structure and reducing duplication and fragmentation.
- Accountability: ensuring all health system actors are held publicly accountable. Transparency is required to achieve real accountability.
An increasing range of instruments and institutions exists to carry out the functions required for effective leadership and governance. Instruments include:
- sector policies and medium-term expenditure frameworks
- standardized benefit packages
- resource allocation formulae
- performance-based contracts
- patients' charters
- explicit government commitments to non-discrimination and public participation
- public fee schedules.
Institutions involved may include:
- other ministries, parliaments and their committees
- other levels of government
- independent statutory bodies such as professional councils, inspectorates and audit commissions
- nongovernment organization "watch dogs" and a free media.
This section of the Leadership and governance profile is structured as follows:
To provide clear policy direction and leadership within the health sector, the Ministry of Health and Social Welfare elaborated a medium-term National Health Policy and National Health Plan along with other subsector policies and strategies. The current health policy is based on the primary health care approach with a goal of achieving the Millennium Development Goals and improving health outcome.
The Health Sector Coordination Committee serves as the steering committee of the sector and makes critical programmatic and financial decisions. Representation on this committee includes:
- the Minister of Health and Social Welfare with his four deputies and advisers;
- heads of all donors and international development partners coordinators from international and local nongovernmental organizations and civil society organizations;
- the private sector;
- multilateral and bilateral missions with health development objectives.
The Health Sector Coordination Committee is chaired by the Minister of Health and Social Welfare.
Apart from the Health Sector Coordination Committee, there are other governing bodies, including the Interagencies Coordination Committee, the Liberia Coordination Mechanism and the Pool Fund Steering Committee. The Interagency Coordination Committee on immunization is the coordination and decision-making body for immunization. The Minister of Health chairs the Committee while the Expanded Programme on Immunization manager serves as secretary.
The Ministry of Finance, Minister of Information, Cultural Affairs & Tourism, Ministry of Internal Affairs, Ministry of Planning and Economic Affairs, the European Union, Office of the United Nations High Commissioner for Refugees, Rotary International, United Nations Children's Fund, United States Agency for International Development, WHO and World Bank are members of the Interagency Coordination Committee.
Technical issues related to the Expanded Programme on Immunization are discussed and resolved at the Technical Coordination Committee meetings.
The Liberia Coordinating Mechanism oversees the Global Fund to Fight AIDS, Tuberculosis and Malaria implementation and makes critical decisions on technical and programme issues.
At the county level, the County Health and Social Welfare Team is the management structure and is headed by the County Health and Social Welfare Officer. This team is responsible for coordination of all activities at the health facility level.
A Health Management Information System Policy was formulated in 2009 to facilitate and ensure that policies and decisions are evidence based. This Policy provides clear direction for data generation, reporting and dissemination.
A national Human Resources for Health Policy and Strategy (2011–2021) was developed to tackle the issues of production, recruitment, retention, motivation, better planning, strengthening of the capacity of health training institutions, and improving quality and equitable distribution of the health workforce.
There is a 10-year Health Financing Policy and Strategy (2011–2021), formulated to ensure equitable and sustainable allocation of resources by levels of care. The Policy was designed to harness the right balance between preventive, curative and rehabilitative care and improve planning and budgeting, increase social protection and various funding mechanisms.