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.
- 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.
- The World Health Organization’s Smart Governance for Health and Well-being: The evidence
- Linking governance mechanisms to health outcomes: A review of the literature in low- and middle-income countries (subscription required)
- The NHS Leadership Academy’s Principles for Good Governance
- The recent study on health finance and governance by Sara Bennett of Johns Hopkins