1. Abt Associates Inc. In collaboration with: Aga Khan Foundation BearingPoint Bitrán y Asociados BRAC University Broad Branch Associates Forum One Communications RTI International Tulane Universitys School of Public Health Training Resources Group Strengthening Health Governance through Policy Reform Susan Scribner Abt Associates Inc.

2. Overview Policy Process Getting Issues on the Policy Agenda Formulating and Legitimizing Policy Mobilizing and Accounting for Resources Conclusion

3. Policy Process Get issues on the policy agenda Mobilize and account for resources Implement policies and engage partners Monitor progress and impact Formulate and legitimize policy

4. Getting Issues on the Policy Agenda Political opportunity Global trends Domestic politics and priorities Advocacy Interest groups Policy champions Evidence base Policy solutions

5. Policy Agenda & Health Governance Health governance principles Transparent policy process Engagement with non-state actors Evidence of good health governance Exercise of citizens voice Responsive to public demands Responsible for public health priorities

6. Malaria Funding in Rwanda Context Rapidly increasing funding for HIV/AIDS Paris accord emphasis on alignment Evidence: NHA data show HIV/AIDS funding $47m vs. $18m for Malaria Minister of Health advocated to prioritize funding For interventions that save lives In alignment with the Health Sector Strategic Plan

7. Formulating and Legitimizing Policy Devil is in the details Involve all actors for implementation – government, providers, clients Tools and approaches to solicit input Health governance approach contributes to effective, efficient and accountable policies

8. Policy Formulation & Health Governance Health governance principles Sufficient state stewardship Accountability of key actors Evidence of good governance Transparency in policy making Efficient and effective service provision arrangements Institutional checks and balances

9. ART Policy Development in Uganda ART task force and technical subcommittees Widespread consultation Significant participation by PLWAs

10. Mobilizing and Accounting for Resources Significant new funding sources New funding modalities Mechanisms to increase accountability or reduce opportunities for corruption

11. Resources & Health Governance Health governance principles Financial accountability State capacity to track, mobilize and account for funds Evidence of good health governance Transparency in resource allocation Clear and enforceable accountability

12. Monitoring Out-of-Pocket Expenditures in Kenya NHA revealed 51% of total health expenditures from households (45% OOP) MOH budget increased 30% 2005/2006 Next round NHA will determine whether OOP decreased

13. Conclusion Process matters – can support or undermine health governance Evidence strengthens all actors to play their roles Need to facilitate participation, accountability Financial accountability does not ensure results Good outcomes demonstrate effective governance

14. Abt Associates Inc. In collaboration with: Aga Khan Foundation BearingPoint Bitrán y Asociados BRAC University Broad Branch Associates Forum One Communications RTI International Tulane Universitys School of Public Health Training Resources Group Thank you Reports related to this presentation are available at www.HS2020.org