Governance is The Big Enabler for Stronger Health Systems

James A. Rice, Project Director, LMG

The clear and transparent decision-making process required for good governance has been shown to create the conditions in which those who deliver, manage and lead health systems are more likely to have access to the quality people, medicines, equipment and resources they need to expand health service utilization that leads to better health outcomes.

Photo: Glenn Ruga/MSH

In the days leading up to the September 30 - October 3, 2014, Third Global Symposium on Health Systems Research, 50 thought leaders on health sector governance from several countries and diverse organizations gathered in Cape Town, South Africa for the Third Annual Governance Roundtable.  The purpose of the Roundtable was to explore trends and factors that encourage effective governance in the health sectors of low-resource countries. Representatives from the Leadership, Management and Governance Project, the Health Policy Project, the Health Finance and Governance Project, CapacityPlus, Transparency International, USAID, WHO, DfID, prominent international academic centers, and representatives from Ministries of Health in Afghanistan, Kenya, and South Africa came together for one and a half intensive days of dialogue and knowledge exchange. Many representatives then stayed on for the Third Global Symposium on Health Systems Research to further explore the potential that good health governance has for strengthening health systems.

Here are the key takeaways from nearly a week of in-depth conversations about good governance for health:

  1. Governance principles, practices, and processes must be central to the work of health systems strengthening, if we want to achieve health gains that are both significant and sustainable.
  2. Good governance will not just happen, as many political, social, and economic factors can derail health sector programs. Adopting these five practices can dramatically improve the governance of health systems in low-resource countriesAdopting these five practices can dramatically improve the governance of health systems in low-resource countriesCreate a culture of accountabilityEngage diverse stakeholders in governance decision making processesSet a shared strategic direction for the organization/institutionCarefully steward scarce resources; and Continuously improve the work in the above four practices
  3. While much health sector governance is done in the public sectors of low-resource countries, there must also be effective support for civil society organizations that can help hold accountable those who are engaged in governance processes in the public sector.
  4. Good governance for health must engage and support more women and marginalized groups who have not traditionally been included in health sector decision-making processes.
  5. There must be expanded investment not only in interventions to develop the governance infrastructure and the capacity of the individual members of governing bodies, but also in studies that demonstrate the value of and celebrate the work and accomplishments of the governing bodies in building a viable and well-functioning health system.

This edition of the LMG Newsletter examines insights from this exploration of good governance for health that took place during the week. We welcome your comments and suggestions related to stronger governance practices and capacity development in this area.