Abstract
BackgroundGood governance may result in strengthened performance of a health system. Coherent policies are essential for good health system governance. The overall aim of this research is to provide the best available scientific evidence on principles of good policy related leadership and governance of health related rehabilitation services in less resourced settings. This research was also conducted to support development of the World Health Organization’s (WHO) Guidelines on health related rehabilitation.MethodsAn innovative study design was used, comprising two methods: a systematic search and realist synthesis of literature, and a Delphi survey of expert stakeholders to refine and triangulate findings from the realist synthesis. In accordance with Pawson and Tilley’s approach to realist synthesis, we identified context mechanism outcome pattern configurations (CMOCs) from the literature. Subsequently, these CMOCs were developed into statements for the Delphi survey, whereby 18 expert stakeholders refined these statements to achieve consensus on recommendations for policy related governance of health related rehabilitation.ResultsSeveral broad principles emerged throughout formulation of recommendations: participation of persons with disabilities in policy processes to improve programme responsiveness, efficiency, effectiveness, and sustainability, and to strengthen service-user self-determination and satisfaction; collection of disaggregated disability statistics to support political momentum, decision-making of policymakers, evaluation, accountability, and equitable allocation of resources; explicit promotion in policies of access to services for all subgroups of persons with disabilities and service-users to support equitable and accessible services; robust inter-sectoral coordination to cultivate coherent mandates across governmental departments regarding service provision; and ‘institutionalizing’ programmes by aligning them with preexisting Ministerial models of healthcare to support programme sustainability.ConclusionsAlongside national policymakers, our policy recommendations are relevant for several stakeholders, including service providers and service-users. This research aims to provide broad policy recommendations, rather than a strict formula, in acknowledgement of contextual diversity and complexity. Accordingly, our study proposes general principles regarding optimal policy related governance of health related rehabilitation in less resourced settings, which may be valuable across diverse health systems and contexts.
Highlights
Good governance may result in strengthened performance of a health system
36 articles were included in this study, as outlined in six of these documents were larger reports, such as the World Report on Disability [11], and were subsequently excluded with regards to extraction of context mechanism outcome pattern configurations (CMOCs), these reports provided useful information for explaining and expanding on findings within the context of previous research and theory
Context mechanism outcome pattern configurations and statements To illustrate the process of the extraction and syntheses of CMOCs from the literature, and the development of CMOCs into statements, first, outlined in Table 3 are the synthesized CMOCs for a sample included study
Summary
Good governance may result in strengthened performance of a health system. Coherent policies are essential for good health system governance. The overall aim of this research is to provide the best available scientific evidence on principles of good policy related leadership and governance of health related rehabilitation services in less resourced settings. Good governance may result in strengthened performance of a health system, including effective delivery of health services, and improved health outcomes [2, 3]. Policymakers in less resourced settings are required to know how to most effectively strengthen the performance of health systems [5]. Coherent but flexible policies, which weave together health related human rights and opportunities, are essential to promote good governance and leadership of health systems
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