Abstract
Good governance (GG) is an important concept that has evolved as a set of normative principles for low- and middle-income countries (LMICs) to strengthen the functional capacity of their public bodies, and as a conditional prerequisite to receive donor funding. Although much is written on good governance, very little is known on how to implement it. This paper documents the process of developing a strategy to implement a GG model for Health Technology Management (HTM) in the public health sector, based on lessons learned from twenty years of experience in policy development and implementation in Benin. The model comprises six phases: (i) preparatory analysis, assessing the effects of previous policies and characterizing the HTM system; (ii) stakeholder identification and problem analysis, making explicit the perceptions of problems by a diverse range of actors, and assessing their ability to solve these problems; (iii) shared analysis and visioning, delineating the root causes of problems and hypothesizing solutions; (iv) development of policy instruments for pilot testing, based on quick-win solutions to understand the system’s responses to change; (v) policy development and validation, translating the consensus solutions identified by stakeholders into a policy; and (vi) policy implementation and evaluation, implementing the policy through a cycle of planning, action, observation and reflection. The policy development process can be characterized as bottom-up, with a central focus on the participation of diverse stakeholders groups. Interactive and analytical tools of action research were used to integrate knowledge amongst actor groups, identify consensus solutions and develop the policy in a way that satisfies criteria of GG. This model could be useful for other LMICs where resources are constrained and the majority of healthcare technologies are imported.
Highlights
Problems with governance in low- and middle-income countries (LMICs) can lead to ineffective and conditional donor aid, the waste of scarce resources and societal disillusionment with public institutions
The results showed that 85% of actors believed that healthcare technology management (HTM) was failing in all components of the Temple-Bird Healthcare Technology Package System (TBHTPS) framework
Through analyzing the failures of previous HTM and public procurement (PP) policies, it was clear that power positions in HTM are complex, and that a lack of political will had kept some previous policies from being implemented
Summary
Problems with governance in low- and middle-income countries (LMICs) can lead to ineffective and conditional donor aid, the waste of scarce resources and societal disillusionment with public institutions. It leads to a lack of available resources for, and accessibility to, health care, which affects the poor and marginalized most [1]. The aims of our study were to develop detailed and validated insights into HTM problems at the local, meso- and macro-level, to help design—alongside policy makers, hospital managers, maintenance technicians, donors and users of healthcare technologies—policy actions to. We present the principles of the developed GG Implementation (GGI) model, followed by its phases, general aims, the research activities that can be utilized during each phase, and a description of how the policy development process proceeded in Benin
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