CSR360

Posted: Wednesday 5 November 08, 12.11pm GMT

For this article, we have applied a six-steps game for health reform in Ecuador (as an application case). Ecuador has been effective in reducing the Children Mortality Index from 50 to 15 (per 1000 children born alive), between the years 1982 to 2003, based in a fiscal strategy (financed by oil resources), but still faces challenges of efficiency in the health sector. The sector is in much need of reform and modernisation as 80% of the population is still not part of a health insurance scheme.

With the signing of the Statement of the Millennium (September, 2000), Ecuador compromised to comply with efficiency in order to reach four goals related to the health of its population: i) to reduce in two thirds, between years 1990 and 2015, the mortality of the children less than 5 years; ii) to diminish the maternal mortality in three quarters; iii) to stop, for the year 2015, the propagation of the HIV/AIDS; and, iv) to stop, for the year 2015, the incidence of malaria and other serious illnesses. It is evident that the compliance of these efficiency goals depends in good measure on stakeholder’s coordination for the most socially profitable assignment of scarce resources.

Institutional coordination can be drafted as a game where Public Sector, Private Sector, NGOs, Communities, Global Players, and Media play different roles in a cooperative game towards efficiency with six steps:

1. Regulatory game:

Analysing the requirements for the legal strengthening and better coordination of public institutions, like the Social Security Institute, Ministry of Health, National Planning Authority, and Local Governments, among others. In this case, the game consists in the determination of the incentives and roles of each public player, searching for the regulatory equilibrium of the game in which the roles (and budgets) get defined, creating the basic vertex of the complex reform process.

2. Interaction with private actors:

This second game has to do with the strengthening of the process of financing and the surrender of accounts among public and private sectors (public/private partnerships). The game, in this case, can be better played through the creation of a fund of health fiscally financed and publicly managed but mainly privately executed. The fund game would consist of determining the incentives of the players to include themselves as part of diverse sub-funds designed as alternatives administered publicly or privately, depending on the financial capabilities of the system; all these sub-funds should fulfill a single accounting restriction (for sustainability) and some other general legal rules of transparency, targeting and quality (previously agreed among all the actors convoked to a Hexagon Dialogue Instance).

3. NGOs surveillance game:

The third game requires the definition of the incentives for NGOs and Civil Society in order to play as stakeholders and third party observers, guaranteeing specially, the accomplishment of their role in observation, verification, and enforcement of the public-private partnership reached after games 1 and 2. A specific public fund for these activities should exist.

4. Media Coverage:

The fourth game includes a role for media, that cross-checks the role of NGOs and reduces incentives to get captured by practices that could corrupt not only the public/private partnership, but the NGOs observers, verifiers and enforcement actors from civil society. The role of the media should be reinforced with legally based transparent and total access to information, in order to create noise (sometimes even scratching) in case of failure. This is a powerful incentive to act correctly and play the three previous games in a responsible and cooperative way.

5. Community Involvement:

This part of the game is required for having empowerment of inhabitants in rural areas, indigenous communities, and urban slums, where health coverage is a normally unfulfilled basic need. The legal empowerment of community representatives as proper players creates incentives for media, NGOs, public and private actors to play responsibly their institutional roles. This game is based in a small dose of participative democracy, where community leaders play their legal role as information trustees and entitled monitoring authorities for reporting the advance of health indicators in their zones (definition of a baseline, and periodic assessment of fulfillment of health targets). If these indicators advance as expected and convened, then it is expected that community leaders would serve as political links with the majority of the Nation’s population (community inhabitants living in poverty). Their vote reward for effective politicians and public sector authorities (in next elections) will create a career concern model and a community/public sector link in the game. The same, if the failure comes from private sector providers, then a dynamic of dialogue about funds and sub-funds should be allocated, creating the space for distension and quality/efficiency improvement of the system.

6. International Organizations

Finally, there is a role for international organizations. The incentive for them is to act as honor guests and external observers/supporters, creating technical assistance projects and providing supplementary funds for making sure of the transparency and appropriateness of the reports on the success or failure of the regulatory, financial, participatory, communicational, and communitarian games. The experience of international actors would, as well, create distension in the dialogue arena, and would allow international cooperation agents to fulfill their mandates of harmonization and alignment with the Nations’ policies.

As a conclusion, health sector reform, and achievement of better health indicators is something where multiple stakeholders games can be played and organised properly, and where best practices in CSR Economics can be applied, no matter where.

The Hexagon Theory was conceived by the author during his time as “Chevening Fellow” in Responsible Business (2006) at University of Nottingham’s ICCSR (International Centre for Corporate Social Responsibility). For more information about the application of Hexagon Theory, please contact .(JavaScript must be enabled to view this email address)