21.G. Round table: Strengthening national level health systems governance
Authors:   Organised by: European Observatory on Health Systems and Policies, WHO/Europe,   Chair persons: Matthias Wismar - European Observatory, Ihor Perehinets - Denmark
Published: October 2020

Abstract
Very often, important health system reforms are delayed, rendered ineffective or they simply go badly wrong. All too often this happens not because of a lack of money, health workers or health care facilities but because we adopt unfit ideas and decision and/or implement them insufficiently. The incapacity to develop, adopt and implement good decision is quintessentially the definition of bad governance.
If we are to develop our health systems towards Universal Health Coverage and health systems performance improvement, we will need to strengthen our health system governance.
Governance is vitally important to health systems reform and refers to how decisions are made and implemented - everything from the ability of policy-makers to take evidence-based and relevant decisions to their ability to implement policies and create alignment between different actors.
In this workshop we will share experiences from a governance spring course for policy makers from Eastern Europe and Central Asia. Connected to this we will also share preliminary results of a study on National Level Health Systems Governance.
The panelists will address five key issues The contribution of governance to Universal Health Coverage. This contribution will focus on a) the concept of governance defined as the way societies make and implement collective decisions and b) its 5 main domains including transparency, accountability, participation, integrity and capacity. (S Greer)Governance improvement needs in Eastern Europe and Central Asia: experiences from working with policy makers including countries like Azerbaijan, Georgia, Kyrgyzstan, Moldova Tajikistan, Ukraine and Uzbekistan. For purpose of peer-learning and contrasting experiences we have paired these countries with policy makers from Austria, Finland and Ireland (G Pastorino)Stakeholder participation in decision making and implementation: Very often, powerful stakeholders, like the medical profession, is over-represented and exerts immense veto power, while the voice of other professions, patients, and citizens remained unheard. What are the governance strategies and instruments to harness those underrepresented stakeholders for Universal Health Coverage? (G Fattore)Governing centralized and decentralized budgets in primary, social and hospital care: population-based health care in larger countries requires decentralization of part of the health care budget. What are the accountability lines and instruments that ensure that regional and local budget holders aligning with national policies for Universal Health Coverage? (L Hawkins)Governance contribution addressing corruption: According to surveys health systems are perceived prone to corruption. What is the contribution of governance to heal corruption and make the system work according to rules? (D Clarke)

Key messages
If we are to make progress towards Universal Health Coverage, we will need to strengthen health systems governance. Without strengthening health systems governance we will fail to manage stakeholders, budgets and corruption.