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Better Governance in Healthcare Services Delivery: A Road to Universal Health Coverage

February 20-23, 2014

Sharm El-Sheikh

Egypt is at a crossroads since January 2011 revolution when citizens took to the streets demanding bread, freedom and social justice. Since then, citizens have been voicing their aspirations and strong demand for better governance, in particular transparency and accountability in services delivery. This workshop provides an interactive platform for diverse groups from government, civil society, and the private sector to engage in knowledge sharing to advance universal health coverage.

The National Workshop on "Better Governance in Healthcare Services Delivery: A Road to Universal Health Coverage” will take place in Sharm El-Sheik on February 20-23, 2014.  The workshop is being prepared in collaboration with the Ministry of Health and Population, the World Bank, the World Bank Institute’s Health Systems Practice, and Masr el Kheir Organization, the largest charitable CSO operating in Egypt. 

The workshop provides an interactive learning and knowledge sharing platform for diverse stakeholders for advancing universal health coverage through better governance, in particular accountability and transparency, in the performance of health systems and in the delivery of quality health care.  

It also seeks to support Egypt and align its efforts not only to address gaps in the health sector performance overall but also to contribute to the broader accountability and fairness that underpins the World Bank’s Strategy for the Health/Population and Nutrition Sector in the MENA region. 

The workshop includes a diverse audience from government, civil society organizations, private sector, and operational staff. 

The workshop will be followed by a Technical Expert Retreat for the newly appointed Task Force on Governance and Social Accountability in the Ministry of Health and Population to review the recommendations and identify the process and strategic directions for improving governance and accountability in healthcare services delivery, including the roles and responsibilities of the Task Force in this process. The Retreat will take place on February 23-24. 

Day One – February 20 (Thursday)

8:00 AM-8:30 AM

Registration

8:30 AM-9:00 AM

Welcome and Opening Remarks

Minister of Health and Population

Mr. Hartwig Schafer, Country Director for Egypt, World Bank

Dr. Enis Baris, Sector Manager, MENA Region HNP, World Bank

Dr. Maria-Luisa Escobar, Practice Manager, World Bank Institute Health Systems Practice (WBIHS) 

Session 1: Why are we here?

9:00 AM-10:30 AM

This session will provide an overview of what universal health coverage involves and its relationship with ultimate health outcomes as a basis for judging health system performance, citizen satisfaction, and financial protection in Egypt. We will consider how ideas of social justice can help identify reform priorities for health sector improvement efforts to achieve the goals of UHC.

Faculty: Prof. Marc Roberts, Harvard School of Public Health 

10:30 AM-11:00 AM

Coffee break

Session 2: Social Determinants of Health Status in Egypt

11:00 AM-12:30 PM

This Session will review the role that social determinants play in health care outcomes in general and in Egypt in particular. We will explore the processes by which policies aimed at influencing these factors are determined and how that helps explain the Egyptian situation. We will ask participants to explore which of these determinants they believe it would be both feasible and important to influence by public policy—and what policies might be adopted to accomplish such changes.

Faculty: Prof. Marc Roberts 

12:30 PM-1:30 PM

Lunch
Session 3: Why is the situation in health services delivery the way it is—service organization and the role of governance

1:30 PM-3:00 PM

This session will explore the organization and functioning of the health care delivery system in Egypt to see what role that plays in explaining critical outcomes. In particular we will explore the meanings, and inter-relationships of the terms ‘governance’, ‘transparency’ and ‘accountability’ and—examine what kinds of institutions and practices in a health care system can enhance accountability not only ‘up’ to managers but also ‘down’ to patients and ‘out’ to civil society organizations.

Faculty: Prof. Marc Roberts 

3:00 PM-3:30 PM

Coffee break

Session 4:  What is the situation in the transparency and accountability in health services delivery in Egypt?

3:30 PM-5:00 PM

Building on the previous session, we will begin with a discussion of the current situation in Egypt with regard to accountability and transparency—and the causes of that situation. Then we will move to small groups for participants to begin to explore areas and methods by which levels of transparency and accountability could be improved.

Faculty: Prof. Marc Roberts 

Day Two – February 21 (Friday)

8:45 AM– 9:00 AM

Summary of Highlights from Day 1

Session 1: Improving the Quality of Health Care

9:00 AM-10:30 AM

This session will explore what it takes to drive changes that lead to better delivery of quality healthcare. It will examine the role of clinical trials in determining optimal care, how the nature of medical education can lead to non-optimal variations in practice patterns, and the role of guidelines and pathways in producing evidence-based care. It will also explore the role of various practices designed to reduce the frequency of medical errors including checklists, surgical time outs, ‘sign the site’ rules, and barcodes for patients and medicines etc.

Faculty: Dr. Karl Lauterbach, Institute of Health Economics and Clinical Epidemiology, University of Cologne 

10:30 AM-11:00 AM

Coffee break

11:00 AM-12:30 PM

Continuation of Session 1

Discussion of the potential applicability of ideas presented earlier to the Egyptian context. 

12:30 PM -2:00 PM

Prayers and Lunch


Session 2:  Strengthening Transparency, Participation and Accountability in Health Services Delivery

2:00 PM—3:30 PM

This session will provide an overview on the concepts of transparency and participation and how they contribute to accountability and effectiveness of health services delivery. It will discuss the strategies and tools that can be applied to that end. It will also provide insights on how citizen engagement and feedback mechanisms can help strengthen the quality of policy making and services delivery.

Faculty: Mr. Jeff Thindwa, Practice Manager, World Bank Institute Social Accountability Practice 

3:30PM-4:00 PM

Coffee Break

4:00 PM– 5:00 PM

Continuation of Session 2

Participants identify 3 priority areas for improving transparency, accountability and participation in the delivery of quality health care services. 

Day Three – February  22 (Saturday)

8:45 AM-9:00 AM

Summary of Highlights  from Day 2

Session 1: Fostering an Enabling Environment for Social Accountability in Health Services Delivery 

9:00 AM-10:30 AM

Building on the discussions on transparency, accountability and participation in Day 2, this interactive session will provide an overview of salient elements for fostering an enabling environment for citizen engagement, and the roles of both supply-side and demand-side actors in creating and sustaining it.

Participants identify 3 priority areas for strengthening the enabling environment for citizen engagement to improve service delivery and the roles that demand-side and supply-side actors can play.

Faculty: Mr. Jeff Thindwa; Ms. Marilou Bradley, Sr. Operations Officer, World Bank Institute Health Systems Practice 

10:30 AM-11:00 AM

Coffee Break

Session 2: Advocacy Tools and Multi-stakeholder Process for Improving Health Services Delivery and Advancing Goals of Universal Health Coverage (UHC) 

11:00 AM-12:30 PM

Achieving change will require effective advocacy yet too often would-be change agents wind up talking mainly to themselves. This session will discuss the basics of effective persuasion directed at those who DO NOT agree with you and the application of these ideas to achieving sustainable improvements in health services delivery and advancing the goals of UHC. It will discuss the role of multi-stakeholder process in facilitating convergence among stakeholders with diverging views.

Faculty: Prof. Marc Roberts, Ms. Marilou Bradley 

12:30 PM -1:30 PM

Lunch

Session 3: Building Accountability and Fairness in Egypt’s Health System 

1:30 PM-3:30 PM

This interactive session will build on the content of the previous sessions to develop solutions of how Egypt can build fairness and accountability into its health system. It will start with an overview of the new World Bank strategy for MENA which has fairness and accountability as its two building blocks and then will work with participants to evaluate how fair and accountable health systems in Egypt presently are and discuss ways in which they can be enhanced. It will look at fairness in the three outcomes of a health system—health status, financial protection, and responsiveness and accountability through the three actors—the patient, payor, and provider. The recommendations from this session will feed into the development of a White Paper for the health sector in Egypt.

Faculty: Dr. Aaka Pande, Health Economist; Dr. Amr El-Shalakani, Health/Population/Nutrition Unit for MENA Region, World Bank 

3:30 PM – 4:00 PM

Coffee break

Session 4: Advancing Universal Health Coverage and Improving Social Justice through Increased Transparency, Participation and Accountability in Health Services Delivery 

4:00 PM—5:00 PM

Group Work: Building on the group work in Days 1 to 3, participants complete their overall action plans/recommendations for supporting improvements in health services delivery through increased transparency, participation and accountability in health services delivery.

Facilitators: Prof. Marc Roberts, Jeff Thindwa, Aaka Pande , Amr El-Shalakani, Marilou Bradley

Day 4 – February 23 (Sunday)

8:45 AM-9:00 AM

Summary of Highlights  from Day 3

Session 1:  Group Presentation of Recommendations

9:00 AM-10:45AM

Each group will present their action plans for increasing transparency, participation and accountability in health services delivery. This will be followed by discussions in plenary.

Facilitated by Ms. Marilou Bradley 

10:45AM – 11:15AM

Coffee Break

11:15 AM – 12:15 PM 

Next Steps and Closing Remarks

Ministry of Health and Population

World Bank 

12:15 PM- 12:30 PM

Workshop Evaluation

Participants complete Workshop Evaluation Forms. 

12:30 PM-2:00 PM

Lunch

2:00 PM

End of Workshop

  • Marc Roberts (PhD)

    Marc Roberts (PhD) is an emeritus Professor of Political Economy and Health Policy at the Harvard School of Public Health, where he served as a member of the Departments of Health Policy and Management and Global Health and Population for more than 35 years. Having received his PhD in Economics in 1970, Professor Roberts taught in various schools at Harvard – including Arts and Sciences, the Kennedy School of Government, and the Law School until retiring in the summer of 2013. He is the author or co-author of 6 books and approximately 50 articles, including as lead author (with three Harvard colleagues) on the 2004 publication, Getting Health Reform Right, the book that has served as the basic reference guide to the World Bank’s Flagship training efforts ever since. For the last two decades he has taught and consulted about health sector reform in nearly 40 countries and on every continent except Antarctica—including long term cooperation with World Bank partner institutes in Budapest, Beirut and Bangkok. His recent projects include leading a now-concluded three year effort to provide management training to hospital administrators in Egypt and an on-going project to provide training to newly appointed District Health Managers in South Africa. He has also been one of the leaders of efforts by WHO/Euro to develop a research program and training course on the problems posed by the increase in NCDs for health systems in that region. In addition to various publications drawing on his NCD work, he is also currently finishing a book on the ethical problems of pricing high cost biotechnology drugs.

  • Karl Lauterbach (MD, PhD, MdB)

    Karl Lauterbach (MD, PhD, MdB) is the Director of the Institute of Health Economics and Clinical Epidemiology at the University of Cologne, Adjunct Professor of Health Policy and Management at Harvard University and a member of the German Bundestag (Parliament). A medical doctor by training, he holds a Ph.D in Health Policy and Management (supervised by Economics Nobel Laureate Armatya Sen) from Harvard. Professor Lauterbach’s expertise covers a wide range of topics in health policy, including cost-effectiveness research, evidence based medicine and quality research. Professor Lauterbach is author of more than 100 scientific articles in peer-reviewed international journals in the field of health economics and health policy. His books include standard teaching books for students of health politics and medical students in Germany. Within his international academic networks he advised governments and governmental agencies in Europe, the United States, and the Middle East. He is one of the leading politicians for future health care reforms in Germany and an international consultant for health care reforms worldwide and continues to look for new challenges to learn and consult internationally in health policy.

  • Jeffrey Thindwa

    Jeffrey Thindwa is Manager of Social Accountability Practice in the World Bank Institute. He joined the World Bank in 2000 as Senior Social Development Specialist, and has worked across the Bank's regions promoting the use of social accountability mechanisms to improve public governance, and performance of Bank funded operations. The Social Accountability Practice engages and empowers key stakeholders: media, parliaments and civil society, strengthening their capacity to make public policy, budgets and programs more effective and accountable in servicing citizens, with priority focus on access to information, open and inclusive budgeting, and third party monitoring and citizen feedback. Prior to joining the Bank, Mr. Thindwa worked with civil society organizations for 17 years.

  • Aakanksha Pande (MS, PhD)

    Aakanksha Pande (MS, PhD) is a Health Economist with over 14 years of global health experience at the World Bank where she specializes on health nutrition and population issues in the Middle East and North Africa. She co-authored the new health sector strategy for MENA- “Fairness and Accountability in Health Systems and Health States: Transforming Aspirations into Action in the Middle East and North Africa (2013-2018)”. Her background is in statistics and the evaluation of health sector programs which she has worked on in Egypt, Mexico, India, Pakistan, Yemen and Sri Lanka. Her work has been published in peer reviewed academic journals and as book chapters including the recent World Bank publication on “Non-communicable Diseases Risking Your Health”. She has guest lectured on global health and statistics at Harvard University, Tufts University and Cornell University. She holds a PhD in Evaluative Sciences and Statistics (Harvard University), a master’s in Global Health and Population (Harvard), a fellowship in global health (Cambridge University), and an undergraduate degree in molecular biology (Yale University).

  • Amr el-Shalakani (M.B.B.ch, M.Sc, MBA, and TQM)

    Amr el-Shalakani (M.B.B.ch, M.Sc, MBA, and TQM) has recently joined the World Bank as a Health Specialist. Before that, he served as the Manager of the Technical Office for the Minister of Health and Population, Egypt. Dr. Shalakani gained his Medical degree from Cairo University, and went on to family practice for 3 years before completing a 5 year residency program in Obstetrics and Gynecology. He is currently the Research Coordinator for the regional chapter of the International Society for Pharmaco-Economics and Outcomes Research- ISPOR. Dr. Elshalakani worked in the core implementation team for the pilot study of the Egyptian Social Health Insurance program, before moving on to work as a personal assistant to the Heads of the Curative Care Sector (MOHP) and the Egyptian Health Insurance Organization before joining the Minister’s Technical Office. He served in various committees including the National Committee for drafting the law of the Social health Insurance System, the National Committee for the feasibility and registration of new immuno-modularity and Rheumatologic treatments and the National Committee for drafting the Medical Cadre law.

  • Marilou Bradley (M.A.)

    Marilou Bradley (M.A.) is a Senior Operations Officer with over 30 years of development program design, implementation, and evaluation experience at the World Bank. Since joining the World Bank, she has collaborated in numerous lending operations in health, education and social protection sectors in over 35 countries in the Africa, Latin America, Asia and Middle-East and North Africa regions. In 2010, Ms. Bradley joined the World Bank Institute Health Systems Practice (WBIHS) where she collaborates in the design and development of multi-stakeholder capacity development initiatives at global, regional and country levels, focusing on collaborative governance, social accountability and transparency in health systems and healthcare services delivery. Ms. Bradley is leading WBIHS' capacity development program for the Middle-East and North Africa region.