Table 2 Health system governance functions and the specific attributes of each domain [8, 12, 18]
From: Governance function analysis of the Patriotic Health Movement in China
Governance domain | Content of each domain | Specific questions guiding the review and data analysis |
|---|---|---|
Policy guidance and vision | Formulating sector strategies and also specific technical policies; defining goals, directions and spending priorities across services; identifying the roles of public, private and voluntary actors and the role of civil society. | Any long term health plans /development goals/ any documents? Role of “Health” in overall country development? Any other technical plans or strategies for this policy? Are goals and priorities clearly defined in the policy strategies? Are the policy strategies and designs comprehensive? Who initiated the policy (e.g. central government, departments and level, individual, or media)? Why initiated the policy (e.g. problems targeted, or high level will)? |
System design | Ensuring a fit between strategy and structure and reducing duplication and fragmentation. | Is the specific health policy related to overall health or national development plan? To what extent does the system structure respond to what needs to happen in this policy? Design of interventions and policies to deliver services Are the duplication and fragmentation reduced? |
Regulation and management capacity | Designing regulations and incentives and ensuring they are fairly enforced. | How is the policy operationalized (e.g. regulation, contract or legal)? How can the different levels of government accountable to the policy aims (e.g. supervision, promotion of leader) be ensured? How is the administrative structure organized and how does it contribute to the enforcement of policy (e.g. duties allocation, reporting to higher authority) What regulations or incentives ensure its implementation? How can the management capacity of different levels of governments be ensured (e.g. selection, training, supervision) |
Accountable and transparent | Ensuring all health system actors are held publicly accountable. Transparency is required to achieve real accountability. | How can the health policy be responsive to current health priorities? How can the different levels of governments adopt policies based on the needs of local residents? Is the performance of health authorities or health providers transparent to the public? Are the financial situation of health authorities or health providers or health insurance funds transparent to the public? |
Intelligence and oversight | Ensuring generation, analysis and use of intelligence on trends and differentials in inputs, service access, coverage, safety; on responsiveness, financial protection and health outcomes; on the effects of policies and reforms; on the political environment and opportunities for action; and on policy options. | What is the basis for policy design and content? Does evidence underpin policy design? How are pilots evaluated? How are the local experience and lessons formulated and disseminated? What monitoring and evaluation systems are in place? How do the monitoring and evaluation contribute to policy? |
Collaboration and coalition building | Across sectors in government and with actors outside government, including civil society, to influence action on key determinants of health and access to health services; to generate support for public policies, and to keep the different parts connected - so called ‘joined up government. | How do the actors work across different sectors on design and implementation of policy? How are different actors mobilized to contribute to health activities? What is the level of collaboration with civil society organizations or other (outside the formal health sector)? How are the different levels of government collaborating? |