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Chapter 4 - Health System Governance

Concepts, Principles, and Practice

from Section 1 - Analyzing Health Systems: Concepts, Components, Performance

Published online by Cambridge University Press:  08 December 2022

By
Sameen Siddiqi  and
Shehla Zaidi
Edited by
Sameen Siddiqi ,
Awad Mataria ,
Katherine D. Rouleau  and
Meesha Iqbal
Sameen Siddiqi
Affiliation:
Aga Khan University
Awad Mataria
Affiliation:
World Health Organization, Egypt
Katherine D. Rouleau
Affiliation:
University of Toronto
Meesha Iqbal
Affiliation:
UTHealth School of Public Health, Houston
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Summary

The Chapter describes health system governance as the aggregation of principles and normative values within the political system in which a health system functions. There is increasing appreciation of the central role of governance in influencing all elements of the health system. The five key governance principles or elements in health are strategic vision, participation, accountability, transparency, and rule of law. These, and other, governance principles have an influence strategic planning and decisionmaking, regulation, partnerships, and insurance in health. Multisectoral governance in health involves government and non-government agencies to address multidimensional challenges of differing levels of complexity across multiple sectors. Ministries of health need to assume new responsibilities in the 21st century and adopt roles that include – de jure governance processes, preparation for and response to change in context, relationship management, and values management. More work is needed to delineate the scope and influence on all health system functions, assessment tools and monitoring indicators, and to develop interventions for improving governance of the health system.

Keywords

Health system governancestewardship in healthhealth governance and related theorieshealth system governance principleshealth system governance assessmentmultisectorality and health governanceaccountability and transparencyvision and participationL&MIC
Type
Chapter
Information
Making Health Systems Work in Low and Middle Income Countries
Textbook for Public Health Practitioners
 , pp. 51 - 66
Publisher: Cambridge University Press
Print publication year: 2022

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References

World Health Organization. Everybody Business: Strengthening Health Systems to Improve Health Outcomes. Geneva, World Health Organization, 2007. www.who.int/healthsystems/strategy/everybodys_business.pdf (accessed November 11, 2020).Google Scholar
Dodgson, R., Lee, K., Drager, N.. Global health governance: a conceptual review. 2002. https://apps.who.int/iris/handle/10665/68934 (accessed December 22, 2020).Google Scholar
Transparency International Global Health. Health system governance. 2021. https://ti-health.org/health-system-governance (accessed December 26, 2021).Google Scholar
Balabanova, D., Mills, A., Conteh, L., et al. Good health at low cost 25 years on: lessons for the future of health systems strengthening. Lancet 2013; 381(9883): 2118–2133.Google Scholar
Saltman, R. B., Ferroussier-Davis, O.. The concept of stewardship in health policy. Bull World Health Organ 2000; 78(6): 732–739.Google ScholarPubMed
Travis, P., Egger, D., Davies, P., et al. Towards better stewardship: concepts and critical issues. 2002. www.who.int/healthinfo/paper48.pdf (accessed October 11, 2020).Google Scholar
Rauch, C. F. Jr., Behling, O.. Functionalism: Basis for an alternate approach to the study of leadership. In Hunt, J. G., ed., Leaders and Managers. New York, Pergamon, 1984, pp. 45–62.Google Scholar
Koontz, H.. The management theory jungle. AMJ 1961; 4(3): 174–188.Google Scholar
Pratt, J. W., Zeckhauser, R. J.. Principals and Agents: The Structure of Business. Boston, MA, Harvard Business School Press, 1985.Google Scholar
World Bank. From crisis to sustainable growth: sub-Saharan Africa – a long term perspective study (English). https://documents.worldbank.org/en/publication/documents-reports/documentdetail/498241468742846138/from-crisis-to-sustainable-growth-sub-saharan-africa-a-long-term-perspective-study (accessed June 12, 2020).Google Scholar
World Bank. Governance: the World Bank’s experience. https://documents.worldbank.org/en/publication/documents-reports/documentdetail/711471468765285964/governance-the-world-banks-experience (accessed June 14, 2020).Google Scholar
Kaufmann, D., Kraay, A., Mastruzzi, M.. The worldwide governance indicators: methodology and analytical issues. Hague J. Rule Law 2011; 3(2): 220–246.Google Scholar
Brinkerhoff, D. W., Bossert, T. J.. Health governance: principal–agent linkages and health system strengthening. Health Policy Plan 2014; 29(6): 685–693.Google Scholar
Greer, S. L., Wismar, M., Figueras, J.. Strengthening Health System Governance: Better Policies, Stronger Performance. Milton Keynes, Open University Press, 2016.Google Scholar
Samuelson, P. A.. The pure theory of public expenditure. Rev Econ Stat 1954; 36(4): 387–389.Google Scholar
Pyone, T., Smith, H., van den Broek, N.. Frameworks to assess health systems governance: a systematic review. Health Policy Plan 2017; 32(5): 710–722.Google Scholar
Lokot, M., Bou-Orm, I., Zreik, T., et al. Health system governance in settings with conflict-affected populations: a systematic review. Health Policy Plann 2022; 37(5): 655–674.Google Scholar
Reidpath, D. D., Allotey, P.. Structure, (governance) and health: an unsolicited response. BMC Int Health Hum Rights 2006; 6(1): 1–7.Google Scholar
Lee, K., Kamradt-Scott, A.. The multiple meanings of global health governance: a call for conceptual clarity. Global Health 2014; 10(1): 1–10.Google Scholar
Woods, N.. Good governance in international organizations. In Lyon, A. J., Stiles, K., Edgar, A., et al., eds., Global Governance: A Review of Multilateralism and International Organizations. Leiden, Brill Nijhoff, 1999.Google Scholar
McSherry, R., Pearce, P.. Clinical Governance: A Guide to Implementation for Healthcare Professionals. Chichester, Wiley, 2011.Google Scholar
Marshall, A. I., Kantamaturapoj, K., Kiewnin, K., et al. Participatory and responsive governance in universal health coverage: an analysis of legislative provisions in Thailand. BMJ Glob Health 2021; 6(2): e004117.CrossRefGoogle ScholarPubMed
Madon, S., Krishna, S.. Theorizing community health governance for strengthening primary healthcare in LMICs. Health Policy Plann, 2022; 37(6): 706–716.CrossRefGoogle ScholarPubMed
Abimbola, S., Negin, J., Jan, S., et al. Towards people-centred health systems: a multi-level framework for analysing primary health care governance in low- and middle-income countries. Health Policy Plan 2014; 29(Suppl. 2): ii29–ii39.Google Scholar
Stoker, G.. Public value management: a new narrative for networked governance. Am Rev Public Adm 2006; 36(1): 41–57.Google Scholar
Mikkelsen-Lopez, I., Wyss, K., de Savigny, D.. An approach to addressing governance from a health system framework perspective. BMC Int Health Hum Rights 2011; 11(1): 13.Google Scholar
USAID. The Health System Assessment Approach: A How-to Manual, Version 2.0. Washington, DC, USAID, 2012. www.hfgproject.org/wp-content/uploads/2015/02/HSAA_Manual_Version_2_Sept_20121.pdf (accessed December 11, 2020).Google Scholar
Siddiqi, S., Masud, T. I., Nishtar, S., et al. Framework for assessing governance of the health system in developing countries: gateway to good governance. Health Policy 2009; 90(1): 13–25.Google Scholar
Lewis, M., Pettersson, G.. Governance in Health Care Delivery: Raising Performance. Washington, DC, World Bank, 2009.CrossRefGoogle Scholar
Siddiqi, S., Jabbour, S.. Health system governance. In Jabbour, S., Yamout, R., Giacaman, R., et al., eds., Public Health in the Arab World. Cambridge, Cambridge University Press, 2012.Google Scholar
Wenar, L.. Accountability in international development aid. Ethics Int Aff 2006; 20(1): 1–23.Google Scholar
Freire, D., Galdino, M., Mignozzetti, U.. Bottom-up accountability and public service provision: evidence from a field experiment in Brazil. RAP 2020; 7(2): 2053168020914444.Google Scholar
Björkman, M., Svensson, J.. Power to the people: evidence from a randomized field experiment on community-based monitoring in Uganda. Q J Econ 2009; 124(2): 735–769.Google Scholar
Uzuegbu, C. P., Nnadozie, C. O.. Henry Fayol’s 14 Principles of Management: implications for libraries and information centres. JISTaP 2015; 3(2): 58–72.Google Scholar
McFarland, D. E.. Management Principles and Practices, 4th ed. New York, Macmillan, 1974.Google Scholar
Hamra, R., Siddiqi, S., Carmel, E., et al. Assessing the governance of the health policy-making process using a new governance tool: the case of Lebanon. Health Res Policy Syst 2020; 18(1): 1–6.Google Scholar
Kanchanachitra, C., Tangcharoensathien, V., Patcharanarumol, W., et al. Multisectoral governance for health: challenges in implementing a total ban on chrysotile asbestos in Thailand. BMJ Glob Health 2018; 3(Suppl. 4): e000383.Google Scholar
Siddiqi, S., Aftab, W., Siddiqui, F. J., et al. Global strategies and local implementation of health and health-related SDGs: lessons from consultation in countries across five regions. BMJ Glob Health 2020; 5(9): e002859.Google Scholar
Aftab, W., Siddiqui, F. J., Tasic, H., et al. Implementation of health and health-related sustainable development goals: progress, challenges and opportunities – a systematic literature review. BMJ Glob Health 2020; 5(8): e002273.Google Scholar
Bhutta, Z. A., Siddiqi, S., Aftab, W., et al. What will it take to implement health and health-related sustainable development goals? BMJ Glob Health 2020; 5(9): e002963.Google Scholar
Marano, N., Arguin, P., Pappaioanou, M., et al. Role of multisector partnerships in controlling emerging zoonotic diseases. Emerg Infect Dis 2005; 11(12): 1813.Google Scholar
Rasanathan, K., Damji, N., Atsbeha, T., et al. Ensuring multisectoral action on the determinants of reproductive, maternal, newborn, child, and adolescent health in the post-2015 era. BMJ 2015; 351: h4213.Google Scholar
Zaidi, S., Bhutta, Z., Hussain, S. S., Rasanathan, K.. Multisector governance for nutrition and early childhood development: overlapping agendas and differing progress in Pakistan. BMJ Glob Health. 2018; 10(3): e000678.Google Scholar
Ruckert, A., Schram, A., Labonté, R., et al. Policy coherence, health and the sustainable development goals: a health impact assessment of the Trans-Pacific Partnership. Crit Public Health 2017; 27(1): 86–96.Google Scholar
Centers for Disease Control and Prevention, Centro Latino Americano de Investigaciones en Sistemas de Salud, Pan American Health Organization, World Health Organization. Performance measurement of essential public health functions. 2000. www.paho.org/hq/dmdocuments/2010/EPHF_Guidelines_Applying_Instrument_Performance_Measurement.pdf (accessed December 11, 2020).Google Scholar
World Health Organization. The World Health Report 2000: Health Systems – Improving Performance. Geneva, World Health Organization, 2000. www.who.int/whr/2000/en (accessed November 14, 2020).Google Scholar
Bettcher, D. W., Sapirie, S. A., Goon, E. H.. Essential public health functions: results of the international Delphi study. 1998. https://apps.who.int/iris/handle/10665/55726 (accessed December 11, 2020).Google Scholar
Alwan, A., Puska, P., Siddiqi, S.. Essential public health functions for countries of the Eastern Mediterranean Region: what are they and what benefits do they offer. East Mediterr Health J 2015; 21(12): 859–860.Google Scholar
World Health Organization, Regional Office for Europe. Review of public health capacities and services in the European Region. 2012. www.euro.who.int/__data/assets/pdf_file/0010/172729/Review-of-public-health-capacities-and-services-in-the-European-Region.pdf (accessed December 11, 2020).Google Scholar
Centers for Disease Control and Prevention. Health in all policies. 2016. www.cdc.gov/policy/hiap/index.html (accessed December 24, 2021).Google Scholar
Sriram, V., Sheikh, K., Soucat, A.. Addressing governance challenges and capacities in ministries of health. 2020. https://hsgovcollab.org/system/files/2020-05/FINAL-WEB-3442-OMS-HSGF-WHO-WorkingPaper.pdf (accessed November 13, 2020).Google Scholar
Yuan, B., Jian, W., He, L., et al. The role of health system governance in strengthening the rural health insurance system in China. Int J Equity Health 2017; 16(1): 1–20.Google Scholar
Taylor, R. M., Alper, J.. Exploring Partnership Governance in Global Health. Washington, DC, National Academies Press, 2018.Google Scholar
Siddiqi, S., Iqbal, M., Aftab, W.. Review of the governance of public sector hospitals in Pakistan: lessons for the future. WHHS 2019; 55(3): 7.Google Scholar

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