Governance is a collective process of making decisions for organizations or health systems. Governance is (1) setting strategic direction and objectives; (2) making policies, laws, rules, regulations, or decisions, and raising and deploying resources to accomplish the strategic goals and objectives; and also (3) overseeing and making sure that the strategic goals and objectives are accomplished.
Governance for health is governance done with an objective to protect and promote the health of the people the ministry or the organization serves.
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Governance is robust when (1) the decisions are based on information, evidence, and shared values; (2) the process is transparent, inclusive, and responsive to the needs of the people the ministry or the organization serves; (3) those who make and those who implement decisions are accountable; (4) the strategic objectives are effectively, efficiently, ethically, and equitably met; and (5) the vitality of the ministry or the organization is maintained.
Our Leading, Managing and Governing for Results Conceptual Model suggests how leadership, management and governance practices can enhance the performance of health systems to save lives and achieve significant and sustainable gains in the health status of populations.
Our review of literature and recent surveys and interviews of the health leaders in the field define the following four governing practices as essential to smart governance.
- Cultivate Accountability: English | French
- Engage Stakeholders: English | French
- Set a Shared Strategic Direction: English | French
- Steward Resources: English | French
- Continuous Governance Enhancement: English | French
Governance in the context of health has come into sharper focus during the past decade. It has become one of the essential factors in the pursuit of stronger health systems and greater health impact. There is an emerging body of evidence demonstrating that effective governance improves health outcomes. Conversely, poor governance overall, and especially in the health sector has contributed to poor health outcomes. It undermines the vitality of a health system, and makes it less effective, less efficient, less equitable, and less responsive to people it is intended to serve.
A compelling piece of evidence comes from the research conducted by Björkman and Svensson (2009) in 50 rural communities of Uganda in which community monitoring of health care providers improved health outcomes; communities with governance intervention saw a significant increase in the weight of infants, and as much as a 33 percent reduction in mortality rates of children under five years of age.
LMG Project is helping the ministries of health and health sectors in Afghanistan, Benin, Cote d’Ivoire, Ethiopia, Haiti, Honduras, Libya, and Vietnam enhance their governance. In Afghanistan, we work with the Ministry of Public Health on enhancing governance in the ministry as well as enhancing health governance in the provinces, districts and communities.
In Cote d’Ivoire, we are working with HIV/AIDS Country Coordinating Mechanism to develop its capacity for governance, oversight, and monitoring. In Benin, we are partnering with the Ministry of Health in strengthening their advocacy, policy formulation, and regulation functions. We are working on governance of contracting and referral networks in Haiti, governance of transition in Vietnam, governance of human resources for health in Ethiopia, and governance of rehabilitation services in Libya.
Our health governance support will soon begin in Egypt and other countries in the Middle East and North African Region, Angola, Malawi, Nigeria, Uganda, Zambia, Bangladesh and Ukraine.
See the LMG Project’s Five Smart Strategies to Govern Decentralized Health Systems
Read a Summary Report on LMG’s Governance for Health in Low- and Middle-Income Countries Round Table
Download LMG’s Findings on Governing in Decentralized Health Systems
Björkman M, Svensson J. 2009. Power to the People: Evidence from a Randomized Field Experiment on Community-Based Monitoring in Uganda. The Quarterly Journal of Economics, 124 (2), pp. 735-769.