Role of governance in healthcare system functioning

According to WHO Europe's study, governance  for  health  is  defined  as  the  attempts  of  governments  or  other actors  to steer  communities,  countries  or groups  of countries  in  the pursuit  of health  as integral to  well-being  through  both  whole-of-government  and  whole-of-society  approaches. 

For a smooth functioning of health system,  a  synergistic approach integrating all the building blocks of health is required. This will happen by diffusion  of  governance,  from  a  state-centred  model  to  a  collaborative one,  in  which  governance  is co-produced  by a wide range of  actors  at the level of  the  state,  society, media, foundations and so on.

So, what is expected out of a good governance in health system functioning? UNDP (1997) came up with some points to ponder.

1. Accountability

Accountability entails the procedures and progressions by which one stakeholder justifies and takes responsibility for its action. When NHP-2017, keeps it as a keyword; Grievance redressal and feedback in India started the “Mera Aspatal” initiative" in ten central and later expanded to other hospitals and health facilities is a good example of putting accountability in action. Meanwhile, NRHM document recognized the lack of community ownership of public health programs and impacts the levels of efficiency, accountability, and effectiveness. Making public health a shared value across the various sectors is a politically challenging but such collective action is crucial. In order to ensure that the benefits of social security measures reach the intended sections of the society, enumeration of BPL families and other eligible sections is vital.

2. Transparency

Transparency is about striving for cost reduction, improving quality and satisfaction of beneficiaries. We have a transparency index which focus on 6 key elements, studies based on which have put India as 31st out of 32 countries studied, the huge sent being caused by the quality of health care and communication of health care data. Thus, launch of the ambitious Ayushman Bharat programme can be considered as a damage control measure to improve the transparency.

3. Responsiveness

Responsiveness measures the extent to which legitimate, non health expectations of people from health system are met. Hence it is a good indicator of performance of health system. World Health Organisation proposed eight elements (autonomy, confidentiality, communication, choice of providers, dignity, prompt attention, social support, basic amenities) to measure responsiveness. Sood et al in 2017, pointed out on a study that element Confidentiality has got the highest mean score whereas Quality of amenities has got the least mean thereby implying expectations of people in terms of confidentiality are met to a higher degree than their expectations in terms of Quality of amenities. It is observed here that almost all the elements are perceived to be extremely important or very important; though more work on the area would certainly be useful to comment upon further.

Though the above mentioned needs some elaboration, rest of the points are reasonably self-explanatory to the readers and a clear cut evidence backed comment on each of them will be a cumbersome task, but will be covered in the subsequent sessions.

4. Equitability and inclusiveness

5. Effectiveness and efficiency

6. Following the rules of law

7. Participatory

8. Consensus oriented