Health Systems Research Shapes Governance Impact

Jim Rice

Former LMG Project Director

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.

Both policy makers and health service providers have become interested in how good governance increases the probability that health services will be better used for better health outcomes.
But why do they believe that?
How is it possible that better governance can yield better health?
I think the short answer is... it cannot UNLESS certain conditions are available. Conditions like:
  • 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.
Where is the evidence that smart governance matters?
These substantial studies show the power and value of good governance to enable the work of those who deliver, manage and lead health services organizations: