UHC 2030: Working Together to Strengthen Health Systems Session 3 12th-13th December 2016, Geneva

Background In this session we will explore how a UHC2030 platform can best facilitate collaboration on health systems strengthening efforts and help to overcome any silos within the system

Moving beyond the rhetoric We will challenge everybody to move beyond the usual rhetoric of ‘harmonization agendas’ (Paris, Accra) to actionable health systems strengthening and collaboration. We will articulate how partnerships, networks and alliances can fruitfully engage in UHC2030

UHC invites us to rethink the political economy of health UHC in all its dimensions requires a revisiting of the political economy of health An important aspect of this new perspective is the Changing roles of ministries of health in the 21st century

Roles MoHs in the 21st century -1 Most recent literature on UHC underscores that UHC can only be achieved if countries take control of the oversight of their health systems and e.g. manage their own health finances. In many contexts, government decisions, service provision and the needs of the community are disconnected. Furthermore, the domestic governance space is overcrowded by an international agenda in any countries, creating parallel accountability. Health system governance requires functional accountability systems that are not donor driven but rather aim at supporting the social contract between citizens and the state. This makes revisiting the domestic governance space a vital prerequisite.

Roles MoHs in the 21st century -2 Conventional “command and control‟ approaches to the making and implementation of decisions are no longer effective Decision-making approaches dealing with multiple local, national and international actors in and outside the health sector are now seen as an integral part of coping with health system complexity Widespread movement of decentralization has increased the role and responsibilities of local governments Political changes (e.g. civil unrest, democratic elections etc.) or broader governance and institutional reforms outside the health sector (e.g. constitutional reforms, civil service reforms, labour laws, etc.) heavily influence how health systems operate .

Roles MoHs in the 21st century - 3 Ministries of health remain of central importance in the governance of health systems , but their roles increasingly shift from direct funders and providers of public health services to stewards of the entire health system, including both state and non-state actors. Despite this central role, ministries of health and health ministers still face an unsupported mandate in many countries where they are under-resourced and and struggle to meet their complex set of responsibilities in a fast-evolving environment

Questions Given broadly agreed stewardship role of the ministry of health, what does it entail in modern health systems? What does this new role mean for the health system functions (health financing, human resources, medicines, etc.)? What capacities are needed for an effective stewardship function? What are the changes in incentives needed to make it work? How can UHC2030 effectively work together on strengthening, supporting and fostering the stewardship function: what are the areas where more collaboration would be needed and add value.