Health governance is becoming more and more recognized as a key issue on the development agenda. When creating a health system, leadership and governance entail making sure that strategic policy frameworks are in place and that they are paired with efficient oversight, coalition building, regulation, system design considerations, and accountability. More financing as well as an increasing requirement to show results are driving the need for more accountability.
Therefore, accountability is a fundamental component of governance, which deals with the management of relationships between different health stakeholders, such as people, families, communities, businesses, governments, nongovernmental organizations, and other organizations tasked with funding, supervising, providing, and utilizing health services. Accountability entails, specifically:
- delegation or a knowledge (implicit or explicit) of the provision of services;
- funding to guarantee that sufficient resources are available to provide basic services; performance concerning the provision of services;
- obtaining pertinent data for performance assessment or monitoring;
- enforcement, including the application of penalties or the offering of incentives for good work.
Health governance is a multidisciplinary topic that is closely related to accountability-related concerns. It is an essential component of the health system components that were previously mentioned in the context of improving health systems. Even while leadership and governance are widely acknowledged to be crucial for enhancing health outcomes, they are nevertheless insufficiently observed and assessed.
Indicators for measuring health system governance
Two types of indicators have been proposed for measuring governance: rules-based and outcome-based.
Countries’ adoption of relevant policies, strategies, and codified methodologies for health system governance is gauged by rules-based indicators. These indicators in the context of health systems include things like the existence of a national program for the control of malaria or a national list of necessary medications. They belong to a broader category of indicators known as governance determinants. The determinants of health-care-provision governance encompass four major areas, namely ownership arrangements, decentralization, stakeholder participation, and contextual factors, in addition to the existence of regulations, also referred to as “formal procedures.” Governance performance and drivers of governance are compared in this approach.
The effectiveness of rules and procedures’ implementation or enforcement is measured by outcome-based indicators, which take into account the relevant stakeholders’ experience. Examples for health systems could be the absence of medical personnel or the availability of necessary medications in medical facilities. Only the rules-based indicators for monitoring health system governance are covered in this part, as the outcome-based indicators are directly related to the operation of other health system “building blocks.”
The utility and relevance of the metrics chosen should be highly valued when gauging health governance. However, it is possible that even the best governance indicators will fall short of accurately predicting whether or not changes in a nation’s or industry’s governance is to blame for certain occurrences. Therefore, in general, when developing policy responses to problems with the performance of the health system, governance indicators shouldn’t be employed in isolation.
Sources of information on health system governance
In most situations, expert analysis of publicly available sources, such as administrative records (including legal and regulatory papers) and expert assessments of national health policies, would be used to measure rules-based health system governance indicators. Administrative records, which include legal and regulatory documents, national health strategies, budget documents, and rules and guidelines pertaining to the management, organization, and financing of the health sector, are the crucial primary data sources for rules-based indicators of governance.
Government publications, legal and administrative document departments, and official websites are the places to find administrative records. Other sections of this guide include the generation of the outcome-based governance indicators, which are derived from a variety of data sources such as facility surveys, public expenditure evaluations, or client assessments.
Core indicators
Ten rules-based indicators covering health policies for various disease interventions and features of the health system make up the composite governance policy index that is given. An overview of governance quality from a rules-based perspective is given by the index. The indicators do not attempt to evaluate enforcement; rather, they evaluate whether a country has strategies, policies, or rules in place to support excellent leadership and governance in the health sector. If there is no acceptable policy in place or cannot be evaluated, each indication receives a score of 0; if there is an adequate policy accessible, it receives a score of 1. Thus, ten is the maximum score for the policy index.
These indicators include:
- Existence of an up-to-date national health strategy linked to national needs and priorities.
- Existence and year of last update of a published national medicines policy.
- Existence of policies on medicines procurement that specify the most cost-effective medicines in the right quantities; open, competitive bidding of suppliers of quality products.
- Tuberculosis—existence of a national strategic plan for tuberculosis that reflects the six principal components of the Stop-TB strategy as outlined in the Global Plan to Stop TB 2006–2015.
- Malaria—existence of a national malaria strategy or policy that includes drug efficacy monitoring, vector control and insecticide resistance monitoring.
- HIV/AIDS—completion of the UNGASS (United Nations General Assembly Special Session) National Composite Policy Index questionnaire for HIV/AIDS.
- Maternal health—existence of a comprehensive reproductive health policy consistent with the ICPD (International Conference on Population and Development) action plan.
- Child health—existence of an updated comprehensive, multi-year plan for childhood immunization.
- Existence of key health sector documents that are disseminated regularly (such as budget documents, annual performance reviews and health indicators).
- Existence of mechanisms, such as surveys, for obtaining opportune client input on appropriate, timely and effective access to health services
Source:
World Health Organisation. https://cdn.who.int/media/docs/default-source/service-availability-and-readinessassessment(sara)/related-links-(sara)/who_mbhss_2010_section6_web.pdf?sfvrsn=71928980_3