Frameworks to assess health systems governance: a systematic review

Abstract

Governance of the health system is a relatively new concept and there are gaps in understanding what health system governance is and how it could be assessed. We conducted a systematic review of the literature to describe the concept of governance and the theories underpinning as applied to health systems; and to identify which frameworks are available and have been applied to assess health systems governance. Frameworks were reviewed to understand how the principles of governance might be operationalized at different levels of a health system. Electronic databases and web portals of international institutions concerned with governance were searched for publications in English for the period January 1994 to February 2016. Sixteen frameworks developed to assess governance in the health system were identified and are described. Of these, six frameworks were developed based on theories from new institutional economics; three are primarily informed by political science and public management disciplines; three arise from the development literature and four use multidisciplinary approaches. Only five of the identified frameworks have been applied. These used the principal–agent theory, theory of common pool resources, North’s institutional analysis and the cybernetics theory. Governance is a practice, dependent on arrangements set at political or national level, but which needs to be operationalized by individuals at lower levels in the health system; multi-level frameworks acknowledge this. Three frameworks were used to assess governance at all levels of the health system. Health system governance is complex and difficult to assess; the concept of governance originates from different disciplines and is multidimensional. There is a need to validate and apply existing frameworks and share lessons learnt regarding which frameworks work well in which settings. A comprehensive assessment of governance could enable policy makers to prioritize solutions for problems identified as well as replicate and scale-up examples of good practice.

Implementation of the free maternity services policy and its implications for health system governance in Kenya

“…14 Other examples of institutional analysis can be found in our recent systematic review of frameworks for assessing health system governance. 15 Previous reports and publications on introduction of FMS in Kenya describe either the implementation (including the perspectives of health workers) or health system outcomes (provision of free maternal health services or increased use of the service) without highlighting governance. 7 16-18 In this study, we report an institutional analysis of the implementation of FMS policy in Kenya.…”

Impact of organisational change for leaders in mental health

“…What is known is that such uncertainty can adversely affect accountability due to role confusion (Brennan and Flynn, 2013), create a disconnect between policy makers and those charged with implementation (Pyone et al, 2017) as well as creating a loss of buy-in amongst some executive executives (Rai, 2016). Boyle (2005) clearly states that sophisticated monitoring and evaluation processes are a key attribute of a well developed governance system.…”

Arranjos regionais de governança do Sistema Único de Saúde: diversidade de prestadores e desigualdade espacial na provisão de serviços

“…In studies on health policies, we can observe different connotations and uses of governance 10,11,12 . The concept's dissemination took place starting in the 1990s, when movements in favor of reforming public health systems were intensifying and variations in the exercise of State authority started being observed 13,14 .…”