A review of health governance: definitions, dimensions and tools to govern

Abstract

Background: The premise that good governance will ultimately lead to better health outcomes has been central to the proliferation of work in this area over the past decade.

Objective: To consolidate and align literature on governance by presenting an overview of efforts to define, describe and operationalize the health governance function.

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 characteristics of the organization of actors in governance arrangements (e.g. hierarchical, networked). (2) Dimensions of governance are defined from different perspectives and in varied combinations, capturing values, sub-functions and/or outcomes of governance. (3) Tools used to 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 recognition 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 accessible understanding of health governance that is both practical at present and actionable for policy-makers.

Keywords: Health governance; Health systems; Stewardship.