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Health Governance: Concepts, Issues, and Programming Options

Health Systems 20/20 held a one-day workshop on Health Governance: Concepts, Issues, and Programming Options on June 13, 2007 in Washington, DC to:

  • Develop understanding of health governance concepts and practices within a framework that links the state, providers, and service users
  • Share experiences about health governance challenges, issues, and practices
  • Make recommendations for health systems programming in health and democratic governance

Derick Brinkerhoff
Derick Brinkerhoff, team leader for health governance and chair of the Health Governance Workshop, summarized the event saying:
"The workshop was an important step toward sharing perspectives between the health and democratic governance communities, and gaining recognition of the importance of integrating governance into efforts to strengthen health systems to improve the delivery of essential health services."
The workshop gathered experts in health and governance from the U.S. Agency for International Development, nonprofit organizations, and cooperating agencies for a day of presentations, discussion, and dialogue.

Among the issues debated was, “what is, and what is not, health governance?” Some participants felt that the key is efficient management, while others considered civil society’s interaction with the state, plus the political and policy arenas, as more central. Consensus emerged that health governance incorporates all these elements, and can usefully be thought of as a nested phenomenon, encompassing the whole health system, down to individual organizations. This nested, systems perspective is more helpful than trying to classify what is or is not health governance. Depending on the intervention, health governance is either a target for reform and assistance, or the context within which reform and assistance take place.

Other points highlighted during the day included the core role of accountability as the primary governance relationship among state actors, providers, and citizen/service users; and how exercising that role depends upon information availability and transparency. Participants recognized the inter-penetration of the politics and technical aspects of health governance and the connections among good health governance, sustainable health systems, and health outcomes. The group agreed that the ultimate success metric of health governance is health outcomes, but we need governance-specific indicators too.

From a programming perspective, the multiple entry points in health governance relationships allow for a variety of options that can be tailored to resource levels, existing capacity, and objectives. One health governance example for programming is reform of procurement systems to increase transparency, reduce opportunities for corruption, and provide a basis for more efficient management of health resources. Another example is including capacity-building for community groups to provide input on service quality as part of pay-for-performance schemes; such programs can increase provider responsiveness and accountability and give service users greater voice in expressing their health preferences and needs.

The workshop began with introductory remarks from the Senior Deputy Assistant Administrator of USAID’s Bureau for Global Health, Gloria Steele, and the Chief of the Bureau’s Health Systems Division, Bob Emrey. Following an opening session presenting the health governance framework and concepts, participants drew on their experience to identify selected challenges and issues. 

Subsequent panels addressed accountability and transparency, and decentralization and local-level health governance. Maureen Lewis, from the World Bank, delivered the lunchtime keynote talk on health care corruption and governance, highlighting current best practices and the issue of indicators. The afternoon panel discussed institutional roles and reform for health governance. Panelists examined social insurance legal reform in Ghana, integrating health governance into the policy process, and the implications for health governance of donor approaches to restoring health services in post-conflict states. The last sessions of the workshop were dedicated to small group discussion and presentation of programming options followed by general debate of the proposals, potential next steps, and the lessons learned during the day’s deliberations.

The workshop was an important step toward shared perspectives between the health and democratic governance communities, and recognition of the importance of integrating governance into efforts to strengthen health systems and improve the delivery of essential health services.

To view the workshop agenda, click here.

To view presenter bios, click here.

Presentations