Abstract
BackgroundIn the international agenda, it has become common to assert that the assessment of health system governance using a practical tool is crucial. This approach can help us better understand how health systems are being steered as well as to identify gaps in the decision-making process and their causes. The authors developed a new assessment tool, the Health Policymaking Governance Guidance Tool (HP-GGT), that was designed to be conceptually sound and practical. This tool enables policy-makers and stakeholders to systematically review and assess health system governance at policy-making level. This article presents first use of the HP-GGT in Lebanon, together with generated results, recommendations, and discusses how these results improve governance practices when initiating new health policy formulation processes.MethodsThe HP-GGT, which is a multidimensional structured tool, was used retrospectively to assess and review the process used to develop a new mental health strategy; this process was compared against consensus-based good governance principles, focusing on participation, transparency, accountability, information and responsiveness. The assessment was conducted through face-to-face interviews with 11 key informants who were involved in the development of the strategy.ResultsThe HP-GGT enabled policy-makers to reflect on their governance practices when developing a mental health strategy and was able to identify key areas of strengths and weaknesses using good governance practice checklists given by the questions. The insights generated from the assessment equipped the national policy-makers with a better understanding of the practice and meaning of policy-making governance. Identifying weaknesses to be addressed in future attempts to develop other national health policies helped in this regard. Using the tool also increased awareness of alternative good practices among policy-makers and stakeholders.ConclusionsAssessing a health policy formulation process from a governance perspective is essential for improved policy-making. The HP-GGT was able to provide a general overview and an in-depth assessment of a policy formulation process related to governance issues according to international good practices that should be applied while formulating health policies in any field. The HP-GGT was found to be a practical tool that was useful for policy-makers when used in Lebanon and awaits applications in other low- and middle-income countries to further show its validity and utility.
Highlights
In the international agenda, it has become common to assert that the assessment of health system governance using a practical tool is crucial
The general findings from the Closed-ended questions (CEQ) section are presented in the traffic light tables, where they highlight that the accountability and responsiveness principles were more red than green, participation was mostly green and transparency was mostly yellow
SWOT analysis was conducted to complement the findings presented in the traffic light study since it was based on the themes that emerged from the Open-ended questions (OEQ), which gave some details about the contextual factors that affected the governance process of the mental health strategy (MHS) development that reflected the opportunities, as well as the challenges/threats, that were faced and the reasons for the gaps that were identified (Table 4)
Summary
It has become common to assert that the assessment of health system governance using a practical tool is crucial. Policy-makers give more attention to governance issues related to how to decide to distribute resources, how to prioritise services and how to choose where to provide them by developing the policy content in terms of goals and intentions, and less attention to how to choose to organise and deliver services, whom to consult, and how to define and target social groups. They select indicators and benchmarks for policy evaluation, which is concerned with the process of how the policy was set and what tools and methods were used to do so [2]. This conceptual approach follows the normative claims about what constitutes ‘good’ HSG in policy-making circles
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