This guest blog was cross-posted from Global Health Guru, and written by Tiaji Salaam-Blyther

Yesterday, I served on a panel at the Global Health Landscape Symposium organized by the Global Health Council. A hearty thanks to Christine for inviting me! The event was well-attended and generated wonderful discussion. I am one of those weird people that actually enjoys public speaking. The part that excites me the most is the Q & A session. Part of me can’t wait to get the formal presentation over with so that I can hear from the audience. I love the dialogue, which provides me an opportunity to hear what other’s are thinking.

I especially love when the seasoned professionals ask questions. One woman who had been in the development space for decades, asked a question about district-level capacity to handle large injections of foreign aid. Before asking her question, she talked about how managerial skill constraints at the district level  complicated efforts to successfully carry out health agendas that were developed at the national level.

Decentralization can get messy and has proven to both advance and interrupt global and national health agendas. The bilateral HIV/AIDS program President’s Emergency Plan for AIDS Relief (PEPFAR), provides support for decentralization in many countries and has indicated in its documents that the strategy expands access to health care, facilitates accountability, and improves efficiency. On the other hand, implementation of national policy agendas have been stymied by decentralized authority. In Nigeria, for example, state leaders blocked implementation of a national health insurance scheme promoted by the federal government.

Governance was not intended to be the focus of the presentation, but it certainly came up several times in the Q & A session. As did accountability and transparency. I’m convinced they’d read my blog page on domestic resource mobilization before attending the conference (just kidding). But clearly, governance, accountability, and transparency are a critical element of health system strengthening.

All in all, the symposium generated wonderful discussion and afforded me the opportunity to engage with the broader global health and development community. I look forward to sharing more in future arena.