Governance in the Health Sector: A Strategy for Measuring Determinants and Performance

The role of rules and institutions in influencing the behaviour of health systems is increasingly acknowledged. This paper reviews the concept of governance as it is used in the literature on private firms, public administration, international development and health. The paper argues that governance should be understood as the combination of political, social, economic and institutional factors that affect the behaviour of organisations and individuals and influence their performance.
Applying this understanding to applied research in the health sector requires specifying which organisations are the subject of analysis, and how their performance is measured. It also requires distinguishing between governance determinants such as ownership or decentralisation, and governance performance (e.g. whether formal procedures are implemented or workers fulfil their responsibilities).
Measures of governance performance can be gathered through facility and population surveys. Measures of governance determinants are more difficult to collect and are highly variable across contexts. While it is possible to measure governance determinants in the health sector and create a large cross-country database, these determinants can be more effectively researched through case studies supplemented with synthetic reviews.