2017, Health Systems Planning, Health Systems Governance

The Health Systems Planning & Governance Platform

HSGP blog

Thinking about health systems governance and how it can be used to improve population health

Is “health systems governance” becoming the new buzzword in global health? While an increasing number of academic papers are being published on this theme, each trying to lay down the theoretical and foundational elements of what health systems governance is and what it can possibly mean in practice, ideas such as “good governance” or “governance for UHC” are seemingly entrenching themselves and developing roots in the global health discourse.

But what exactly is governance? In the field of international development, the concept is not new. It has been with us since the late 1980s, when the World Bank first coined it in what they called the “crisis of governance” in many Sub-Saharan African countries. But as many critics would point out, governance is an elusive concept; it can be used to mean everything and nothing.

In effect, various definitions of governance have been proposed, depending on disciplinary backgrounds and approaches (political science, economics, international development etc.). Yet we seem to lack an overarching definition or consensus on what the concept stands for or what it is composed of, irrespective of one’s discipline. Can the concept of governance stand by itself? The fog surrounding the concept may have operational or practical implications. How do you practice governance? If indeed the concept of governance is elusive, then by extension the concept of health systems governance itself is elusive.

Whether the current heightened interest in understanding and defining the scope of health systems governance will lead to continuous learning and cautious policy experimentation with the potential of significantly improving the performance of health systems remains to be seen. However, as public health professionals and researchers, we are at the beginning of a long journey in deciphering the various contours of health systems governance; what it is and what it is not, how it is (or should be) manifested in practice, and most importantly how we can use it to deliberately strengthen our health systems.

With this in mind, the Health Systems Planning and Governance Platform (HSPGP), launched in April 2017, was established with the aim of engaging with this concept. It was launched by a few health professionals and active members of a previous community of practice on health systems planning & budgeting who wanted to create a technological space where interested health researchers and practitioners in Africa could collaboratively join the search for knowledge and understanding on health systems governance.

The platform contains web pages with learning resources. On these pages, existing knowledge on various aspects of health systems governance in general and in some African countries can be easily found and accessed. This includes knowledge on district-level management and leadership in Ghana, priority setting and resource allocation processes in county hospitals in Kenya, primary healthcare governance in Nigeria, and theoretical underpinnings of health systems governance. These pages provide a constantly updated collection of existing conceptual and empirical knowledge on health systems governance approaches, mechanisms, processes and practices in African countries.

In the quest to make conceptual and practical sense of governance, the platform is also home to a bilingual community of practice of Anglophone and Francophone health professionals interested in learning and sharing in a collaborative way their reflections, knowledge, and understanding of this theme and how it is manifested within their respective health systems. Currently consisting of about 96 members (from 21 African and 12 other countries), the bilingual nature of the community of practice means that both English and French speaking members can participate equally in discussions and reflections and, as such, learn from each other’s diverse perspectives and operational contexts. This is possible through the work of a bilingual facilitator and a bilingual group of core members.

A few months ago, members of the community of practice engaged in a discussion of the various definitions of health systems governance and what it means in practical terms within the context of their health systems. While we have not yet adopted one working definition of the concept (as we are focusing first on examining and reflecting on the various definitions proposed in the literature), I see much value in the definition of governance proposed by Ansell & Torfing (2016) who define it as “the process of steering society and the economy through collective action and in accordance with common goals”.

Health systems governance could then be “the process of steering the health system through collective action and in accordance with common goals”. This generic definition does well in stating how this “art”, “way of doing” or “practice” should be conducted (through collective action; so involving many or representatives of all stakeholders) and why (in accordance with common goals; so in accordance with what has been agreed by all, i.e. an agreed vision, or a purpose). It is now left to us, public health practitioners and researchers, to experiment and unpack its practical underpinnings.

The platform therefore provides a response to the need for, or rather an opportunity to build, an interpretive community of African health professionals and researchers who collaboratively and openly reflect, discuss and make sense of the concept of governance. It provides a virtual space where they can keep abreast of knowledge, as well as reflect on and debate various academic and practical perspectives around this theme, thus improving their capacities to effect positive change within their health systems.

Looking ahead and moving forward, the platform will continue to engage in more depth with some key questions including:

  1. What is governance and what is health systems governance?
  2. How can health systems governance be measured?
  3. What are the internal (health systems) and external (environmental) factors that determine or influence health systems governance practices?
  4. How can health systems governance be used to strengthen health systems and improve population health?

Our vision is that members will collaboratively contribute to building the field and practice of health systems governance. If you are interested in joining the community of practice or simply supporting this vision and work, in any capacity, then get in touch with us here.

Nadege Ade, facilitator of the Community of Practice on Health Systems Planning & Governance

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