Framework for assessing governance

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

“… 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

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

• Health system governance concerns theactions and means adopted by a society toorganize itself in the promotion andprotection of the health of its population

• Governance influences all other healthsystem functions, thereby leading toimproved performance and ultimately tobetter health outcomes

Introduction

• 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

• Health system governance principles Strategic vision

- Long term vision; comprehensive developmentstrategy including health

Participation and consensus orientation- Participation in decision making process; stakeholderidentification and voice

Rule of law- Legislative process; interpretation of legislation toregulation and policy; enforcement of law, andregulation

Framework for assessing governance

• 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


• Health system governance principles Effectiveness and efficiency

- Quality of HR; communication processes; capacity forimplementation

Accountability- Internal and external accountability

Intelligence- Information: generation, collection, analysis,dissemination

Ethics- Health care and research ethics


• Assessment levels National level (broader context) Policy formulation Policy implementation

• Source of information Published report Unpublished report Interviews


• 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

QUESTIONS?

Healthcare

Framework for assessing governance