In March 2015, 30 participants from six countries finished the first edition of the joint GIZ/World Bank Leadership for Universal Health Coverage course. What did they learn and achieve?
Ceren Ozer, a World Bank expert in leadership, says there is growing realization that multilateral and bilateral partners often support development of technically sound reform strategies and plans but these do not lead to lasting reform and essential health care for the poor.
While working in Bangladesh, Ozer observed that lack of a shared vision of Universal Health Coverage (UHC) among key public, private and civil society stakeholders (e.g., government ministries, insurance providers and labour unions) was a bottleneck impeding implementation of ambitious plans. It was evident that key stakeholder group leaders needed skills that would help them eliminate this bottleneck and turn the plans into reality. She then worked with Jean-Olivier Schmidt, then head of the Bangladesh-German Health Programme, on outlining some of the basic elements of a new leadership programme.
In mid-2013, the World Bank and Germany’s GIZ agreed to establish the LUHC and provide key stakeholder leaders with the tools they need to build the multi-stakeholder agreement and commitment required to make UHC happen in their countries. The LUHC course is a joint GIZ/World Bank contribution to the P4H Network (see box). (For more background on the LUHC course, see our earlier ‘in focus’ article)
|The P4H Network and Germany’s commitment to UHCIn 2007, Germany hosted the G8 Summit in Heiligendamm where it joined with France to propose a new P4H Social Health Protection Network. The P4H (providing for health) Network now has four multilateral and nine bilateral member organizations supporting more than 30 partner countries as they develop or strengthen their own unique UHC systems .On behalf of BMZ and the Swiss Development Cooperation, GIZ is supporting the P4H Network with a dedicated GIZ project. Germany’s long-standing commitment to UHC was underlined when Chancellor Angela Merkel addressed the World Health Assembly in Geneva on 8 May 2015, saying health is a human right and turning that right into a reality is a priority of Germany’s current G7 Presidency.|
The first edition of the LUHC
Jean-Olivier Schmidt, now head of the GIZ project supporting the P4H Network, explains that each edition of the LUHC pulls a few key stakeholder group leaders from each of several partner countries into country teams. Pivotal events in the first edition were three four-day workshops:
- A June 2014 Kick-off Workshop in South Africa brought together stakeholder group leaders from six partner countries. An expert in innovation and behavior change facilitated while other experts provided support and information. By workshop end, the leaders were familiar with each other and also with the work plans each country team had developed and with the challenges and opportunities each country team faced.
- At a November 2014 Innovation Workshop in Kenya, the country teams reflected on experiences in their workplaces and health systems since the first workshop. With support from their peers and LUHC coaches they gained new insights into their challenges and opportunities. Each country team then developed a Collective Action Initiative with new approaches to accelerating progress towards UHC in their countries.
- At a final March 2015 Collective Action Lab in Turkey, the leaders reflected on their achievements and formed communities of practice for continuing collaboration.
Between workshops, the LUHC experts visited the six participating countries to provide hands-on support to steering committees, working groups and individual organizations. Throughout, they supported peer-coaching and mentoring for collective action.
Reviewing results: the Nigerian LUHC team’s experience
On 6 May 2015, more than 50 multilateral, bilateral and partner country representatives ─ some linked via worldwide web ─ met in Washington DC to consider preliminary results of an on-going evaluation of the first edition.
Dr. Francis Nwachukwu Ukwuije, Head of Health Care Financing in Nigeria’s Federal Ministry of Health, was one of seven stakeholder group leaders in the Nigerian team. He says the first edition helped them narrow their focus to their main challenges, including low public health expenditure and lack of health insurance for any but 5 percent of all Nigerians. This narrowing helped them agree on common goals and galvanize them as a team of change agents.
With their new shared vision, they formed a steering committee and a working group and set 100-day targets for action. Within those 100 days, they drew in leaders from other key stakeholder groups, including labour unions and the Ministry of Finance and, for the first time, got them all focused on UHC as a goal that served all Nigerians’ interests.
The Nigerian team extended warm thanks to Turkey’s Ministry of Health. As hosts of the Action Lab, the Ministry had taken participants on tours to see for themselves how UHC works in Turkey. This was very inspiring, of immense practical help and only the beginning of a Turkish-Nigerian partnership for UHC.
The 6 May meeting found that some country teams had achieved more than others but all country teams had achieved positive results. For example, the Zambian team had developed a Communications Strategy for Social Health Insurance and led a nationwide consultation with more than 1,000 people.
Tim Evans, Senior Director for the World Bank’s Health, Nutrition and Population Global Practice, chaired the meeting. He observed that “lack of political will” is not, in general, a useful way of framing the problem facing those aiming to achieve UHC. It is better to break the problem down into the specifics of how best to engage all key stakeholder groups in processes whereby they agree on situation analyses, strategies and plans and commit themselves to playing their parts in collective action. The LUHC is showing how this can be done.
Drawing lessons from LUHC’s first edition
Among the lessons learned from the first edition are:
- Country teams achieve better results if they are larger and their members are strong leaders of diverse stakeholder groups.
- Facilitators, coaches and mentors help participants reflect on their own strengths, weaknesses, interests and motives. Participants find this is key to their understanding each other’s perspectives and finding common ground and common cause.
- The course brought together the different areas of expertise that exist within both the World Bank and GIZ, e.g. on political economy analysis and leadership development, demonstrating the advantages of multilateral/bilateral collaboration. The first-hand experience they gained from visiting a host country with a proven track-record on UHC (Turkey) provided participants with a stimulating environment to reflect on their own countries’ UHC ambitions.
Building on lessons learned, the second edition is tentatively scheduled to kick-off in late 2015. Four Asian countries will participate and each will carefully select seven or more strong leaders from key stakeholder groups as their LUHC team members.
At the 6 May meeting Ursula Müller, Executive Director for Germany at the World Bank Group, noted that Germany’s Health Insurance Bill of 1883 laid the cornerstone of the world’s first UHC scheme. She stressed that as a pioneer, Germany will continue to be committed to supporting other countries in their progress towards UHC.
by Stuart Adams