Health system governance: welcoming the reboot

Meessen, Bruno

doi:10.1136/bmjgh-2020-002404

Cited by 14 publications

(11 citation statements)

References 20 publications

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“…Consequently, the process of governing is closely linked to context and actors and may change over time as societies, health systems, and CHW programmes evolve. Our approach to governing in this paper is congruent with other recent conceptual thinking that takes a less “government-centred” view and focuses more on the roles of a wider range of actors, and the rules that shape their collective action to make decisions [ 22 , 23 ]. Within the health sector, these actors may include citizens and citizen organizations, labour unions, nongovernmental organizations (NGOs), multilateral and bilateral organizations, and donors, sometimes working together through coalitions to influence decisions [ 24 ].…”

Section: What Is Meant By “Governing” In the Context Of Health Systems?mentioning

confidence: 61%

Community health workers at the dawn of a new era: 3. Programme governance

Lewin

Lehmann

Perry

2021

Health Res Policy Sys

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Background Community health workers (CHWs) can play a critical role in primary healthcare and are seen widely as important to achieving the health-related Sustainable Development Goals (SDGs). The COVID-19 pandemic has emphasized the key role of CHWs. Improving how CHW programmes are governed is increasingly recognized as important for achieving universal access to healthcare and other health-related goals. This paper, the third in a series on “Community Health Workers at the Dawn of a New Era”, aims to raise critical questions that decision-makers need to consider for governing CHW programmes, illustrate the options for governance using examples of national CHW programmes, and set out a research agenda for understanding how CHW programmes are governed and how this can be improved. Methods We draw from a review of the literature as well as from the knowledge and experience of those involved in the planning and management of CHW programmes. Results Governing comprises the processes and structures through which individuals, groups, programmes, and organizations exercise rights, resolve differences, and express interests. Because CHW programmes are located between the formal health system and communities, and because they involve a wide range of stakeholders, their governance is complex. In addition, these programmes frequently fall outside of the governance structures of the formal health system or are poorly integrated with it, making governing these programmes more challenging. We discuss the following important questions that decision-makers need to consider in relation to governing CHW programmes: (1) How and where within political structures are policies made for CHW programmes? (2) Who implements decisions regarding CHW programmes and at what levels of government? (3) What laws and regulations are needed to support the programme? (4) How should the programme be adapted across different settings or groups within the country or region? Conclusion The most appropriate and acceptable models for governing CHW programmes depend on communities, on local health systems, and on the political system in which the programme is located. Stakeholders in each setting need to consider what systems are currently in place and how they might be adapted to local needs and systems.

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Section: What Is Meant By “Governing” In the Context Of Health Systems?mentioning

confidence: 61%

Community health workers at the dawn of a new era: 3. Programme governance

Lewin

Lehmann

Perry

2021

Health Res Policy Sys

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“…7 In a recent focused edition of this journal, Bruno Meessen found that while the literature on health system governance is growing, the empirical agenda is progressing only slowly. 8 Health system governance can be defined as the structures and institutions that determine the roles and responsibilities of, and relationships between, various health system actors in taking and enacting policy decisions. Experiences around the world as health systems were faced with the COVID-19 pandemic brought to light the essential nature of four sets of relationships at the core of health system governance that have proven key to resilience and performance.…”

Section: Uhc As a Global Health Policy Paradigmmentioning

confidence: 99%

Health system governance and the UHC agenda: key learnings from the COVID-19 pandemic

Schneider

2021

BMJ Glob Health

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“…The Organisation for Economic Co‐operation and Development (OECD) consortium's “S” priorities for optimal health system capacity in response to COVID‐19 included space, staff and supplies (OECD, 2020 ). Correlating governance and health system capacity and resilience has subsequently garnered the pace for reviewing normalised forms of identifying health system priorities (Meessen, 2020 ). Lal et al.…”

Section: Introductionmentioning

confidence: 99%

Optimising health system capacity: A case study of community care staff’s role transition in response to the coronavirus pandemic

Martin

Hatzidimitriadou

2021

Health Social Care Comm

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The coronavirus disease (COVID‐19) increased the demand for critical care spaces and the task for individual countries was to optimise the capacity of their health systems. Correlating governance and health system capacity to respond to global crises has subsequently garnered the pace in reviewing normalised forms of identifying health priorities. Aligning global health security and universal health security enhances the capacity and resilience of a health system. However, weak methods of governance hinder the alignment necessary for controlling infection spread and coping with the increase in demand for hospital critical care. A range of qualitative studies has explored staff experiences of providing care in hospitals amidst the COVID‐19 pandemic. Nonetheless, limited understanding of the influence of governance on health and social care staff experiences in response to the COVID‐19 pandemic exists. This case study aimed to explore the influence of health system governance on community care staff experiences of role transition in response to the COVID‐19 pandemic in England. We used criterion sampling to include community care staff initially recruited to deliver a community integrated model of dementia care at two facilities repurposed in March 2020 to optimise hospital critical care space. Six community care staff participated in the narrative correspondence inquiry. A lack of control over resources, limitations in collective action in decision making and lack of a voice underpinned staff experiences of role transition in contexts of current crisis preparedness, transition shock and moral dilemmas. Health system governance influenced the disposition of community care staff's role transition in response to the COVID‐19 pandemic. Staff's mere coping clouds the glass of wider issues in health system governance and capacity. The normative dominance that the control over resources and centrally determined health system priorities ordain require reviewing to enable optimal health and social care cross systems' capacity and resilience.

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Health system governance: welcoming the reboot

Cited by 14 publications

References 20 publications

Community health workers at the dawn of a new era: 3. Programme governance

Community health workers at the dawn of a new era: 3. Programme governance

Health system governance and the UHC agenda: key learnings from the COVID-19 pandemic

Optimising health system capacity: A case study of community care staff’s role transition in response to the coronavirus pandemic

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