Health Systems Research Shapes Governance Impact

This post also appears on the LMG for Health blog.

There is a growing pool of studies that good governance matters as “The Big Enabler” for health systems strengthening.

Health systems researchers in the Capetown, South Africa, Third Global Symposium on Health Systems Research explore the theory of change that guides governance interventions: a solid governance infrastructure enables sound management of health systems, which increases the probability that health services will be better used and health outcomes will improve.

Both policy makers and health service providers have become interested in how good governance increases the probability that health services will be better used for better health outcomes.

But why do they believe that?
How is it possible that better governance can yield better health?
I think the short answer is… it cannot UNLESS certain conditions are available. Conditions like:
  • structures for governance decision-making (governing bodies of various types and sizes) that have clear terms of references and effective leadership;
  • participants in the governing processes that understand their roles and responsibilities;
  • decision-making processes that understand and effectively accomplish the 4+1 practices of:
    • create a culture of accountability;
    • engage diverse stakeholders;
    • set strategic directions;
    • steward scarce resources; and then
    • continuously improve the above practices.
  • leadership staffing that supports and enhances the work of the governing bodies;
  • enough resources that allow governing decisions to actually get implemented; and
  • a context and culture that has rule of law and ethics that demand results and transparent decision-making.
Where is the evidence that smart governance matters?
These substantial studies show the power and value of good governance to enable the work of those who deliver, manage and lead health services organizations:

Patient-Centered and Integrated Services (PCIS): Is it Primary Health Care (PHC) by another name?

This morning, October 1, 2014, a panel that was moderated by Edward Kelley, Director for Service Delivery and Safety at the WHO, introduced and explored the rationale and strategic directions outlined in a new WHO strategy on People-Centered and Integrated Health Services. The strategy outlines four core priorities for health systems: empowering users and population groups; strengthening engagement and accountability; coordinating services and setting and implementing system priorities. The principles that underpin the strategies include: country led and owned process; equity focused; people’s voices are heard; recognition of interdependence of different levels of health system; learning and action cycles.

A provocatively interesting question from the audience was: what is the difference between PCIS and PHC? And what have we learned from the failures of PHC to make the new PCIS strategy successful. Part of the solution lies in the ability of the research and policy community to use evidence to articulate a compelling case on the need for change – basically demonstrate that the current models of care are fragmented and are excluding many people and creating a culture of “us” and “them”. It also emerged that the narrative for change should not necessarily be premised on cost-containment but bringing people to the center of the health system, with strong emphasis on responsiveness and people’s perspectives. Once a coalition of support has been established, the next step is to invest in implementation know-how and the governance infrastructure that is required to make it happen, and to understand what works by doing.