Nurse Kai and community mobiliser Jeremiah sometimes need to use a canoe to reach patients in hard-to-reach communities in Bombali District, Sierra Leone.
Health system governance
Health systems governance refers to the processes, structures and institutions that are in place to oversee and manage a country's healthcare system. It manages the relationships between different actors and stakeholders involved in healthcare, including government agencies, healthcare providers, patients and their families, people and communities, civil society organizations and private sector entities.
Health systems governance means ensuring strategic policy frameworks exist and are combined with effective oversight, coalition-building, provision of appropriate regulations and incentives, attention to system design, and accountability.
Effective health systems governance is essential for ensuring that healthcare services are accessible, equitable, efficient, affordable and of high quality for all. This requires efficient and equitable allocation of healthcare resources, the presence of policies and regulations guiding healthcare delivery, and mechanisms for monitoring, evaluating and reviewing the healthcare system’s performance.
Moreover, health systems governance plays a crucial role in promoting equity and social justice in healthcare. It strives to ensure that the healthcare system is responsive to the needs of all members of society, regardless of their socioeconomic status, ethnicity, culture, gender or other factors.
In the context of the Sustainable Development Goals (SDG) agenda, WHO is committed to supporting countries to exercise effective health systems governance, with a specific focus on strengthening the capacity of governments to formulate and implement strategies that will lead to the realization of UHC by 2030.
In line with the Thirteenth General Programme of Work 2019–2023, WHO works collaboratively across its three organizational levels, adopting a horizontal approach to pursue the following key objectives:
- call upon countries to strengthen the governance of their health systems for UHC
- provide guidance on ways to enhance health systems governance
- support regions and countries in strengthening their health systems governance as needed.
WHO’s work on the health systems governance not only supports countries in advancing the UHC agenda but has an impact on reaching the targets beyond SDG 3. Improvements in health systems governance will support achieving results in both health and non-health-related SDGs, such as ending poverty (SDG 1), achieving gender equality (SDG 5), reducing inequalities (SDG 10), building effective, accountable and inclusive institutions (SDG 16), etc.
For WHO, health systems governance involves not only the development of policy tools, techniques and methods but also what policy looks like in practice, including its goals and intentions. Based on this approach, WHO’s work on health systems governance aims to assist Member States in:
- developing strategic policy frameworks that articulate the country’s policy vision (e.g. through national health policies, strategies and plans);
- operationalizing these policy frameworks through relevant policy instruments, including legal instruments (e.g. laws and regulations);
- building coalitions and partnerships with all relevant stakeholders, such as civil society and the private sector, to provide guidance in the development, implementation and review of health policy and programmes;
- shaping the system design and establishing the overall architecture of the health system, tailoring powers and duties to fit the unique context of the country; and
- providing accountability and oversight mechanisms to ensure effective policy implementation and impact, as well as addressing market failures.