Abstract
As countries strive to strengthen their health systems in resource constrained contexts, policy makers need to know how best to improve the performance of their health systems. To aid these decisions, health system stewards should have a good understanding of how health systems operate in order to govern them appropriately. While a number of frameworks for assessing governance in the health sector have been proposed, their application is often hindered by unrealistic indicators or they are overly complex resulting in limited empirical work on governance in health systems. This paper reviews contemporary health sector frameworks which have focused on defining and developing indicators to assess governance in the health sector. Based on these, we propose a simplified approach to look at governance within a common health system framework which encourages stewards to take a systematic perspective when assessing governance. Although systems thinking is not unique to health, examples of its application within health systems has been limited. We also provide an example of how this approach could be applied to illuminate areas of governance weaknesses which are potentially addressable by targeted interventions and policies. This approach is built largely on prior literature, but is original in that it is problem-driven and promotes an outward application taking into consideration the major health system building blocks at various levels in order to ensure a more complete assessment of a governance issue rather than a simple input-output approach. Based on an assessment of contemporary literature we propose a practical approach which we believe will facilitate a more comprehensive assessment of governance in health systems leading to the development of governance interventions to strengthen system performance and improve health as a basic human right.
Highlights
As countries strive to strengthen their health systems in resource constrained contexts, policy makers need to know how best to improve the performance of their health systems
Governance in the health sector Low- and middle-income countries are in an era of unprecedented expansion of financial resources for health, both from development assistance and government spending [1]
During the recent financial crisis, many donors and governments cut back funding for health [2], requiring health system stewards to pay more attention to the traceability of fund allocations
Summary
Development assistance and country spending in economic uncertainty. Seattle WA, IHME; 2010. 2. 3. Bradford CI, Linn JF: Global governance reform: Breaking the stalemate Washington DC: Brookings Institution Press; 2007. 5. Salamon LM: The New Governance and the Tools of Public Action: An introduction. Lee K: Global health promotion: how can we strengthen governance and build effective strategies? Hein W, Burris SC, Shearing CD: Conceptual Models for Global Health Governance. Walt G, Gilson L: Reforming the health sector in developing countries: the central role of policy analysis. Fattore G, Tediosi F: Attaining universal health coverage: the role of governance and management. In Attaining Universal Health Coverage, A research initiative to support evidence based advocay and policy making.
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