2/13/2021 (PDF) A Review of Health governance: definition, dimentions and tools to govern

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A Review of Health governance: definition, dimentions and tools to govern

January 2014 · Health Policy 116(1)

DOI: 10.1016/j.healthpol.2014.01.007
Source · PubMed

Authors:

Erica Barbazza Juan Tello

Academisch Medisch Centrum Universiteit van Amsterdam World Health Organization WHO

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Citations (95) References (76) Figures (1)

Abstract and Figures

The premise that good governance will ultimately lead to better health outcomes has been Discover the world's
central to the proliferation of work in this area over the past decade. To consolidate and research
align literature on governance by presenting an overview of efforts to define, describe and
19+ million
operationalize the health governance function. A targeted review of governance literature.
members
(1) A variety of terms have been assigned to precede health governance definitions. These
terms commonly describe governance ideals (e.g. good, democratic) or characteristics of 135+
the organization of actors in governance arrangements (e.g. hierarchical, networked). (2) million
Dimensions of governance are defined from different perspectives and in varied publications
combinations, capturing values, sub-functions and/or outcomes of governance. (3) Tools 700k+
used to govern remain to be cataloged, however, measures can be aligned according to research
dimensions of governance or their ability to create specific relationships between actors. Join for free
projects
Resolving the conceptual confusion around health governance requires recognition for the
differences in the premise and approaches taken to defining governance, as well as
specifying core dimensions and aligning applicable tools. Despite a growing literature
base, a concerted effort is needed for a more accessible understanding of health
governance that is both practical at present and actionable for policy-makers.

Governance
frameworks…

Figures - uploaded by Erica Barbazza Author content

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Health Policy 116 (2014) 1–11

Contents lists available at ScienceDirect

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2/13/2021 (PDF) A Review of Health governance: definition, dimentions and tools to govern

Health Policy
journal homepage: www.elsevier.com/locate/healthpol

Review

A review of health governance: Definitions, dimensions

and tools to govern
Erica Barbazza ∗ , Juan E. Tello
WHO Regional Office for Europe, Marmorvej 51, DK-2100 Copenhagen, Denmark

a b s t r a c t
a r t i c l e i n f o
Background: The premise that good governance will ultimately lead to better health out-
Article history:
Received 2 July 2013
comes has been central to the proliferation of work in this area over the past decade.
Received in revised form Objective: To consolidate and align literature on governance by presenting an overview of
11 December 2013 efforts to define, describe and operationalize the health governance function.
Accepted 7 January 2014 Methods: A targeted review of governance literature.
Results: (1) A variety of terms have been assigned to precede health governance definitions.
These terms commonly describe governance ideals (e.g. good, democratic) or characteris-
Keywords: tics of the organization of actors in governance arrangements (e.g. hierarchical, networked).
Health governance (2) Dimensions of governance are defined from different perspectives and in varied combi-
Stewardship
nations, capturing values, sub-functions and/or outcomes of governance. (3) Tools used to
Health systems
govern remain to be cataloged, however, measures can be aligned according to dimensions
of governance or their ability to create specific relationships between actors.
Discussion: Resolving the conceptual confusion around health governance requires recog-
nition for the differences in the premise and approaches taken to defining governance, as
well as specifying core dimensions and aligning applicable tools.
Conclusion: Despite a growing literature base, a concerted effort is needed for a more acces-
sible understanding of health governance that is both practical at present and actionable
for policy-makers.
© 2014 Elsevier Ireland Ltd. All rights reserved.

1. Introduction actors in health [6–10] has allowed for the function to

Governance – either in terms of leadership, stew-
ardship, regulation, oversight or governance itself – has
repeatedly been asserted as a core function in theories
and frameworks on health system [1,2]. The World Health
Organization (WHO) first framed the concept as ‘stew-
ardship’ in the World Health Report 2000, defined as “the
careful and responsible management of the well-being
of the population” [3, p. 45]. Later iterations of WHO’s
systems-thinking [4,5] and work from other dominant
mature and evolve, characterized at various stages as ‘stew-
ardship’, ‘leadership’ and/or ‘governance’ [hereafter ‘health
governance’]. Complemented by a continuously growing
literature base, there is now clear and compelling consen-
sus about the importance of the health governance function
and its role in ensuring that priorities for population health
and well-being are realized.1
1 A chronological account of health stewardship and governance has

∗ Corresponding author at: WHO Regional Office for Europe, DSP-HSD,
Marmorvej 51, DK-2100 Copenhagen, Denmark. Tel.: +45 45 33 69 09;
fax: +45 45 33 70 01; mobile: +45 91 67 96 57.
E-mail addresses: est@euro.who.int (E. Barbazza),
jet@euro.who.int (J.E. Tello).
been detailed in other literature (see [1,8]). Pertaining to the WHO, this
includes the endorsement of leadership and governance in its framework
for strengthening health systems in 2007 [4]. In the European Region, this
has also included an affirmed commitment to the stewardship function
in 2008 at a ministerial conference in Tallinn, Estonia. More recently, the
adoption in the European Region of the guiding policy framework, Health
2020, has prioritized improving leadership and participatory governance

0168-8510/$ – see front matter © 2014 Elsevier Ireland Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.healthpol.2014.01.007

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Citations (95) References (76)

... To be effective, policy goals must be aligned with the institutional design and implementation strategies and be
coherent with the concerns and interests of stakeholders. More specifically, high-quality governance in health policy-
making is considered an important factor in shaping the improvement of health systems [1,5], their functioning [6,7],

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legitimacy [8] and outcomes [7, 9, 10]. With the agenda to provide universal health care in all countries [11], the
development of effective and robust health policy-making processes is a particularly urgent and important challenge. ...
... Policy-makers have a stake in improving governance at all levels to better steer and manage the health sector to meet
their policy goals [18]. However, making highquality health governance "actionable" [9] remains a challenge, given the
abstract character of the principles. In low-and middle-income countries (LMICs), this challenge is exacerbated by
conditions of resource scarcity and multiple urgent competing priorities for political and policy action, including
conflicting development and donor agendas [19]. ...
... For reasons of practicality, the authors decided to focus on an 'acceptable' number of principleswhich was
determined to be five-to generate a practical tool given the in-depth assessment it intended to offer; this number of
principles was in line with other studies that have reported an average number of principles investigated of five
[9, 16,19]. The HP-GGT was organised around five of the ten components of Siddiqi's framework, including participation,
transparency, accountability, use of information and responsiveness given their particular importance in policy
formulation. ...

Assessing the governance of the health policy-making process using a new governance tool: the case of Lebanon
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Rasha Hamra · Sameen Siddiqi · Emma Carmel · Walid Ammar

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... Findings are modelled after Barbazza and Tello's previous work in conceptualising and bringing applicability of
governance to a health system setting [13] . As governance is fundamentally a systems-based process of which core
characteristics can be determined, we will focus our findings on the definition of governance (an objective description),
and the dimensions of governance (an operational characterisation) as they apply to the health workforce. ...
... Within health literature, there is already extensive writing on the conceptualisation and definition of governance with
broad consensus that governance represents the efforts and processes [13] through which priorities are achieved.
'Stewardship' further adopts the additional element of direction, i.e. in defining an overarching vision, goal and 'playing
field' . ...
... As for health workforce literature, Table 1 outlines the scope of definitions for governance. Most sources make
reference to established definitions in health literature with Barbazza and Tello's [13] and Brinkerhoff and Bossert's [40]
definitions being the most popular. This characterisation of governance is process-oriented: it seeks to describe a set of
processes through which rules and responsibilities are distributed amongst different actors to achieve goals. ...

Governance in health workforce: how do we improve on the concept? A network-based, stakeholder-driven approach
Article Full-text available
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Max Ying Hao Lim · Vivian Lin

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... Good health governance has gained importance as health funds increase and donors demand greater accountability,
responsibility and transparency from recipients (Lewis, 2006;Lewis & Pettersson, 2009;Ramiro et al., 2001;Vian,
2008;Vian, Savedoff, & Mathisen, 2010). In addition, good governance in health has discussed across various
dimensions, including global governance, corporate governance, governance in development, and how the private sector
can govern in providing public services (Barbazza & Tello, 2014) . However, when it comes to health outcomes, much of
the literature on good governance is more theoretical and less conducive to the practices and Several studies have
discussed the effects of different areas of governance and selected aspects of good governance on health outcomes,
for example, Brinkerhoff Most literature on good governance and health outcomes has focused on the dimensions of
good governance, such as the degree of government effectiveness, the degree of corruption, and the participation of
community in development. ...
... The scale to measure Accountability was adapted from the study of Cleare (2011). The measurement of Equity and
Responsiveness were adapted from WHO report (2000) while the measure for transparency was adapted from the study
of Rawlins (2008) and Barbazza & Tello (2014) as given in Table 3. ...

Good Governance Model for the Healthcare Administration: A Case Study of Public Hospitals in Pakistan
Article Full-text available
Nov 2020
Dawood Nawaz · Ahmad Martadha

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... 38 Although SA agencies work collaboratively to control fraud and abuse, the absence of health governance in
providing a strategic policy framework and system design is attributed mainly to health policy weaknesses. 4,33, 39, 40
Adopting an effective HIS was a concern in both qualitative and quantitative analyses from the executives' perspectives,
especially when sending-receiving medical claims. 21 Having a unified health policy was not seen as a solution in
rendering smooth contract management and unjustified rejection, as good will plays a role in balancing trustworthiness
between health insurance companies and health providers. ...

Fraud and Abuse in the Saudi Healthcare System: A Triangulation Analysis

Article Full-text available
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Wadi Alonazi

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... Most discussions on health systems are around the first five blocks, with relatively much less said, written and
analysed about governance of health systems. Partly this is because governance is difficult to define, quantify and
measure, and there are quite a few alternative approaches to assess governance (Barbazza and Tello 2014) . This is
especially true of India, where published articles on governance are substantially fewer in number than those that
discuss, for example, service delivery and health financing. ...

Relying on serendipity is not enough: Building a resilient health sector in India

Article
Aug 2020 · Indian Econ Rev
Indrani Gupta

View Show abstract

... To deliver the African countries, Nigeria inclusive, from high burden of disease, alternative health care financing
through community health partnership is an important prerequisite and imperative. This must begin with an overview of
Nigeria's health care financing, having found that "financial and social risk protection" is one of the outcomes of health
governance (Barbazza & Tello, 2014) . ...

Advancing alternative health care financing through effective community partnership: A necessity for universal health
coverage in Nigeria
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Jun 2020
Isaac Oyekola · John Ojediran · Oludele Ajani · Rasak Bamidele

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... To deliver the African countries, Nigeria inclusive, from high burden of disease, alternative health care financing
through community health partnership is an important prerequisite and imperative. This must begin with an overview of
Nigeria's health care financing, having found that "financial and social risk protection" is one of the outcomes of health
governance (Barbazza & Tello, 2014) . ...

Advancing alternative health care financing through effective community partnership: A necessity for universal health
coverage in Nigeria Advancing alternative health care financing through effective community partnership: A necessity for…
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Isaac Oyekola · John Ojediran · Albert Ajani · Oyeyipo Eyitayo

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