Assessing Governance

1. FRAMEWORK FOR ASSESSING
GOVERNANCE OF HEALTH SYSTEM IN
DEVELOPING COUNTRIES: GATEWAY
TO GOOD GOVERNANCE
Najibullah Safi, MD, MSc. HPM
Reference: S. Siddiqi et al./Health Policy 90 (2009) 13-25

2. “… the exercise of political, economic and
administrative authority in the management of
a country’s affairs at all level” UNDP
… comprises the complex mechanisms,
processes and institutions through which
citizens and groups articulate their interest,
mediate their differences and exercise their
legal rights and obligation
Introduction

3. Introduction
• Governance is a key determinants of:
– Economic growth, social advancement and
overall development
– Governance of health system is the least well-
understood aspect of health system
• “Governance is perhaps the single most
important factor in eradicating poverty and
promoting development” Kofi Annan

4. • Health system governance concerns the
actions and means adopted by a society to
organize itself in the promotion and
protection of the health of its population
• Governance influences all other health
system functions, thereby leading to
improved performance and ultimately to
better health outcomes
Introduction

5. • Role of the state vs. the market in health
• Role of the MoPH vs. other ministries
• Actors in governance – public sector, civil
society and the private sector
• Static vs. dynamic health system
Issues in the governance of health system

6. • Health system governance principles
 Strategic vision
- Long term vision; comprehensive development
strategy including health
 Participation and consensus orientation
- Participation in decision making process; stakeholder
identification and voice
 Rule of law
- Legislative process; interpretation of legislation to
regulation and policy; enforcement of law, and
regulation
Framework for assessing governance

7. • Health system governance principles
 Transparency
- Transparency in decision making and allocation of
resources
 Responsiveness
- Response to population health needs at all level
 Equity and inclusiveness
- Equity in access to care; fair financing of health care;
disparities in health
Framework for assessing governance

8. • Health system governance principles
 Effectiveness and efficiency
- Quality of HR; communication processes; capacity for
implementation
 Accountability
- Internal and external accountability
 Intelligence
- Information: generation, collection, analysis,
dissemination
 Ethics
- Health care and research ethics
Framework for assessing governance

9. • Assessment levels
 National level (broader context)
 Policy formulation
 Policy implementation
• Source of information
 Published report
 Unpublished report
 Interviews
Framework for assessing governance

10. • Raising awareness
• Policy implication of assessing each
governance principle
• Point out issues at all levels
• Financial cost for improving health system
governance
Policy implication of assessing health
system governance

11. QUESTIONS?