The Value of Integrating Governance and Sector Programs: Evidence from Senegal

Abstract

As the global community works toward the Sustainable Development Goals, closer integration between governance and sectoral interventions offers a promising, yet unproven avenue for improving health service delivery. We interrogate what value an integrated governance approach, intentionally combining governance and sectoral investments in strategic collaboration, adds to health service readiness and delivery using data from a study in Senegal. Our quasi-experimental research design compared treatment and control communes to determine the value added of an integrated governance approach in Senegal compared to health interventions alone. Our analysis shows that integrated governance is associated with improvements in some health service delivery dimensions, specifically, in aspects of health facility access and quality. These findings—that health facilities are more open, with higher quality infrastructure and staff more frequently following correct procedures after integrated governance treatment—suggests a higher level of service readiness. We suggest that capacity building of governance structures and an emphasis on social accountability could explain the added value of integrating governance and health programming. These elements may help overcome a critical bottleneck between citizens and local government often seen with narrower sector or governance-only approaches. We discuss implications for health services in Senegal, international development program design, and further research.

Integrated Governance: Achieving Governance Results and Contributing to Sector Outcomes

“…For our purposes, we follow the framework in USAID's 2013 DRG strategy and define governance as institutions, structures, and processes that enable broad participation and inclusion, facilitate transparency and availability of information, and support accountability of public officials to the rule of law and citizens. 20 the Democratic Republic of the Congo, 23 and Uganda 24 on the effects of integrated governance on health service outcomes and in Malawi on integration at the USAID mission level. 25 However, the operational impediments to capitalizing on the governance integration noted here remain real.…”