A Model for Good Governance of Healthcare Technology Management in the Public Sector: Learning from Evidence-Informed Policy Development and Implementation in Benin

Abstract

Good governance (GG) is an important concept that has evolved as a set of normative principles for low- and middle-income countries (LMICs) to strengthen the functional capacity of their public bodies, and as a conditional prerequisite to receive donor funding. Although much is written on good governance, very little is known on how to implement it. This paper documents the process of developing a strategy to implement a GG model for Health Technology Management (HTM) in the public health sector, based on lessons learned from twenty years of experience in policy development and implementation in Benin. The model comprises six phases: (i) preparatory analysis, assessing the effects of previous policies and characterizing the HTM system; (ii) stakeholder identification and problem analysis, making explicit the perceptions of problems by a diverse range of actors, and assessing their ability to solve these problems; (iii) shared analysis and visioning, delineating the root causes of problems and hypothesizing solutions; (iv) development of policy instruments for pilot testing, based on quick-win solutions to understand the system’s responses to change; (v) policy development and validation, translating the consensus solutions identified by stakeholders into a policy; and (vi) policy implementation and evaluation, implementing the policy through a cycle of planning, action, observation and reflection. The policy development process can be characterized as bottom-up, with a central focus on the participation of diverse stakeholders groups. Interactive and analytical tools of action research were used to integrate knowledge amongst actor groups, identify consensus solutions and develop the policy in a way that satisfies criteria of GG. This model could be useful for other LMICs where resources are constrained and the majority of healthcare technologies are imported.

An Analysis of Good Governance in the Health System

“…As some authors have pointed out and according to the United Nations national development plan document, the goal of good governance is to achieve sustainable human development that focuses on reducing poverty, creating jobs and sustainable prosperity, protecting the environmental and restoring the environment, and women's growth and development. In fact, it is assumed that all these things will be achieved through good governance (4).…”

“…Of course, realizing this issue requires high-level monitoring and supervision, which requires proportional institutional capacity. Political wish is considered from the perspective that the subject of decentralization is considered as one of the main foundations of good governance in health (4). Brinkerhoff (2014) has evaluated the role of good governance in strengthening health systems and pointed to three gaps in health and governance problems.…”

Promoting the use of evidence in health policymaking in the ECOWAS region: the development and contextualization of an evidence-based policymaking guidance

“…There is evidence to suggest that stakeholder engagement is the key in both implementation and translational sciences which includes tailoring best evidence for policy and practices for specific populations [60]. In Benin, Houngbo et al [61], assessed governance of healthcare technology management and noted that interactive and analytical tools of action research can be used to integrate knowledge amongst actor groups, and that the policy development process was characterized as bottom-up, with a central focus on the participation of diverse stakeholders groups. In another study from Benin, Lee et al [62] while assessing vaccine policy, observed that the enabling change required identifying in-country "champions," and orchestration of a coordinated set of steps that heavily involve key stakeholders.…”

Promoting the use of evidence in health policymaking in the ECOWAS region: the development and contextualization of an evidence-based policymaking guidance

“…There is evidence to suggest that stakeholder engagement is the key in both implementation and translational sciences which includes tailoring best evidence for policy and practices for speci c populations [61]. In Benin, Houngbo et al [62], assessed governance of healthcare technology management and noted that interactive and analytical tools of action research can be used to integrate knowledge amongst actor groups, and that the policy development process was characterized as bottom-up, with a central focus on the participation of diverse stakeholders groups. In another study from Benin, Lee et al [63] while assessing vaccine policy, observed that the enabling change required identifying in-country "champions," and orchestration of a coordinated set of steps that heavily involve key stakeholders.…”