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Governance

Challenge

Governance problems that confront health systems are often vaguely defined and poorly understood. Because rules and institutions exist from the global to the local level, governance issues are interconnected and complex. For example, corruption may derive from a combination of international financing mechanisms and local financial management practices. Weak engagement of citizens in health policy dialogue can result from lack of capacity of civil society and limited incentives or capacity of ministries of health (MOHs) to share information and engage stakeholders.

Approach

Health Systems 20/20 seeks first to clarify the governance component of health system performance issues. Second, our approach is to work with USAID Missions and their country counterparts to diagnose governance problems and develop solutions. Experience demonstrates that most solutions need to tackle both the demand and supply sides of governance. On the demand side, work with citizens and oversight entities inside and outside of government enhances capacity to exercise voice and accountability. Complementing such efforts are interventions to strengthen the MOH’s and other health sector actors’ ability to share information, incorporate external input, and create performance incentives: the supply side of governance. Because of the prime importance of sound financial resource allocation and budgeting to effective stewardship, our approach pays particular attention to these governance challenges. Third, our approach capitalizes on the recognized enabling effects of institutional arrangements such as decentralization, public-private partnerships, and checks and balances among health sector executive agencies, legislators, and accountability actors (auditors, courts, citizens’ groups).

Health Systems 20/20 and Governance Brief