Framework for assessing governance of the health system in developing countries: Gateway to good governance
Framework for assessing governance of the health system in developing countries: Gateway to good governance
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DOI：
10.1016/j.healthpol.2008.08.005
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发表时间：
2009-04-01
期刊：
影响因子：
3.3
通讯作者：
Jama, Mohamed A.
中科院分区：
文献类型：
--
作者：
Siddiqi, Sameen;Masud, Tayyeb I.;Jama, Mohamed A.
治理被认为是低收入和中等收入国家经济增长、社会进步和整体发展以及实现千年发展目标的关键决定因素。卫生系统的治理是卫生系统中最不为人所知的方面。提出了评估国家和国家以下各级卫生系统治理 (HSG) 的框架，该框架已在东地中海国家得到应用。在制定 HSG 框架时，考虑的关键问题包括国家与市场的作用：卫生部与其他国家部委的作用；行为者在治理中的作用；静态与动态卫生系统；卫生改革与基于人权的卫生方法。考虑了四个现有框架：世界卫生组织（WHO）的管理领域：泛美卫生组织（PAHO）的基本公共卫生职能：世界银行治理的六个基本方面；和联合国开发计划署（UNDP）善治原则。拟议的 HSG 评估框架包括以下 10 项原则：战略愿景、参与和共识导向、法治、透明度、响应性、公平和包容性、有效性和效率、问责制、情报和信息以及道德规范。该框架允许在政策和操作层面对 HSG 的弊病进行“诊断”，并指出改进的干预措施。就应用该框架的巴基斯坦而言，一个积极的方面是利益相关者之间日益增长的参与和共识导向，同时在战略愿景、问责制、透明度、有效性和效率以及法治方面也发现了弱点。在使用HSG框架时，需要认识到这些原则是价值驱动的，而不是规范性的，并且应该在社会和政治背景下看待：该框架依赖于定性方法，不遵循评分或排名系统。它并不直接讨论援助有效性，而是提供了对利用外部资源的能力的见解，并且随着主题本身得到更好的具体化，有能力将全球卫生治理对国家 HSG 的影响纳入其中。卫生部和州卫生部门绩效的改善是该框架的核心。该框架有助于提高政策制定者对 HSG 重要性的认识。卫生领域良好治理的道路是漫长而崎岖的。评估 HSG 只是第一步；仍然存在的挑战是在截然不同的体制背景下进行有效的治理。 (C) 2008 Elsevier Ireland Ltd. 保留所有权利。
Governance is thought to be a key determinant of economic growth, social advancement and overall development, as well as for the attainment of the MDGs in low- and middle-income countries. Governance of the health system is the least well-understood aspect of health systems. A framework for assessing health system governance (HSG) at national and sub-national levels is presented, which has been applied in countries of the Eastern Mediterranean.In developing the HSG framework key issues considered included the role of the state vs. the market: role of the ministries of health vs. other state ministries; role of actors in governance; static vs. dynamic health systems; and health reform vs. human rights-based approach to health. Four existing frameworks were considered: World Health Organization's (WHO) domains of stewardship: Pan American Health Organization's (PAHO) essential public health functions: World Bank's six basic aspects of governance; and United Nations Development Programme (UNDP) principles of good governance. The proposed HSG assessment framework includes the following 10 principles-strategic vision, participation and consensus orientation, rule of law, transparency, responsiveness, equity and inclusiveness, effectiveness and efficiency, accountability, intelligence and information, and ethics.The framework permits 'diagnoses of the ills' in HSG at the policy and operational levels and points to interventions for its improvement. In the case of Pakistan, where the framework was applied, a positive aspect was the growing participation and consensus orientation among stakeholders, while weaknesses were identified in relation to strategic vision, accountability, transparency, effectiveness and efficiency and rule of law.In using the HSG framework it needs to be recognized that the principles are value driven and not normative and are to be seen in the social and political context: and the framework relies on a qualitative approach and does not follow a scoring or ranking system. It does not directly address aid effectiveness but provides insight on the ability to utilize external resources and has the ability to include the effect of global health governance on national HSG as the subject itself gets better crystallized.The improved performance of the ministries of health and state health departments is at the heart of this framework. The framework helps raise the level of awareness among policymakers of the importance of HSG. The road to good governance in health is long and uneven. Assessing HSG is only the first step; the challenge that remains is to carry out effective governance in vastly different institutional contexts. (C) 2008 Elsevier Ireland Ltd. All rights reserved.