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A New Approach for Assessing Health System Governance

Author(s): I. Mikkelsen-Lopez1, C. Baez-Camargo*2, E. Jacobs2, K. Wyss3, A. Lugon-Moulin2, D. de Savigny1
Affiliation(s): 1Public Health and Epidemiology, Swiss Tropical Institute, 2Governance, Basel Institute on Governance, 3Swiss Centre for International Health, Swiss Tropical Institute, Basel, Switzerland
Keywords: Governance, Health Systems

The 2007 WHO framework of health system building blocks identifies governance, financing, human resources, information, medicines and technologies and service delivery as the core sub-systems. Much work has focused on these building blocks, however concepts and methods for assessing governance of health systems are particularly lacking. This is especially problematic given that within the literature governance is recognized as a critical issue affecting health systems performance. Various institutions have measured selected aspects of governance in the past (World Bank Institute, Freedom House, Transparency International, WHO), yet only a couple have attempted to develop indicators specific for health systems. Based on the 2007 WHO framework, our research develops a general framework with a more comprehensive understanding of the dimensions of governance and how they are interrelated. We contribute to the notion that not all governance dimensions are qualitatively equal. We distinguish between governance attributes, governance outcomes and governance levers to show how within the health system these dimensions affect each other.

Results/Conclusions: In this framework accountability is the key governance attribute impacting on governance outcomes such as corruption, responsiveness, equity and efficiency. We develop a diagnostic tool that includes indicators to assess whether the appropriate accountability provisions exist across the health system and whether they are enforced. We also develop proxy indicators for key governance outcomes specific to the health sector which are grouped by WHO building blocks. Finally, we propose a set of governance levers which are possible intervention routes to address specific problems in governance. Based on the results of applying the diagnostic tool, these levers can be used to develop appropriate interventions that have stronger conceptual and empirical grounding. Therefore, the overall aim of our research is to build on the literature by developing a general conceptual framework to assess the impact of governance in health systems and ultimately health. We hope to highlight various outcomes of poor-governance so that interventions can be developed and targeted appropriately. This presentation will describe the Framework and we invite discussion on appropriate indicators and suggestions on how it can be applied.

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