Many tools and resources focused on developing health system governance and leadership structures have been created over the last decade, particularly from the World Health Organization and through projects funded by the US Agency for International Development (USAID). Below is an interactive resource that provides the most useful documents within the context of our defined scope of PHC policies and leadership, quality management infrastructure, and social accountability.
This Social Development working paper highlights different social accountability initiatives that were led or supported by the World Bank in the first several years of their focus on this type of work. In addition to providing a detailed account of different tools that can be used by citizens and civil society to monitor and assess policies and budgets, expenditures, and service provider performance, the working paper identified several factors that the authors assess as key factors needed for social accountability to be successful.
This practitioner guide provides a detailed overview of how civil society organizations and their partners can design and implement one of the most heavily-utilized social accountability tools – the community scorecard (CSC). Based on CARE’s extensive use of the CSC in different contexts and sectors, the technical guidance is broken down into five key phases (planning and preparation, conducting the scorecard with the community, conducting the scorecard with the providers, interface meeting and action planning, and action implementation and monitoring). The guide also provides samples of different components of the CSC tools that practitioners can readily adapt to their own contexts.
This seminal report highlights how civil society-led accountability efforts can improve the effectiveness, equity, and impact of budget execution, procurement, impact measurement, and audit and legislative oversight. The paper is designed to provide information to civil society organizations about the process associated with each of these governance activities as well as numerous case studies that present successful efforts by practitioners to oversee and improve accountability for these processes in their countries.
Focusing on strategic social accountability rather than traditional tool-based approaches, this paper is divided into two distinct by complementary parts. The first part provides a conceptual framework for key elements to achieving vertical integration in social accountability, highlighting the need for accountability efforts to integrate participation and oversight at all levels of policy processes and implementation (local, subnational, national, and global). The second part provides a detailed case study of one such effort to employ vertical integration into an education-focused social accountability program in the Philippines.
This helpful annotated bibliography provides an extensive list of resources for different social accountability tools developed for or used in the health sector. The resources range from conceptual and theoretical frameworks for social accountability to address different problems in health to practical guidance for specific tools. Each resource is accompanied with a brief description to help the reader best identify what resources or tools may be most applicable to their needs.
This report documents experiences, challenges, tested solutions, and practical ideas for countries as they strengthen governance, improve quality health services, and pursue UHC. It elaborates on critical components of governance for quality health care, specifically looking at: policy strategies, regulation, non-state actors, political will, reliable data, continuous improvement, knowledge sharing, and financing links. The report provides examples of experiences, challenges, and lessons learned in establishing an institutional architecture for governing for quality service delivery.
The guide is for planners and policymakers. It explores how payers can use health financing levers to drive health sector performance. It contains strategies for payers to leverage power to enhance the quality of care, describes possible institutional arrangements among payers and other actors, and proposes processes to establish or improve institutional arrangements in a country.
These country case studies explore how Ethiopia, Mexico, Uganda, Ghana, the Philippines, Malaysia, and Tanzania have progressed toward prioritizing and governing to improve quality health service delivery. There are key lessons on quality reforms – including successes and challenges in promoting quality of care – and descriptions of key inputs and processes to governing quality of care including regulation, law and policies, leadership and management, and planning.
This handbook provides approaches for developing national health policies, strategies, and plans. It explores key elements of national health planning, drawing on country experience, existing work, and literature reviews. It can be looked at as a whole or as independent chapters, which include priority setting, strategic and operational planning, budgeting, monitoring and evaluation, and cross-cutting themes such as law and regulation and intersectoral planning.
This framework discusses the policy and operational levers that represent key elements of health systems and that can be used to accelerate progress on primary health care. It provides resources for countries to use, actions that can be taken, and indicators to track progress. The goal of the framework is to assist countries in efforts towards improving PHC through governance at the national and subnational level, by individuals, and global partners.
The WHO Global Learning Laboratory (GLL) for Quality UHC provides a platform for users to engage one another through webinars, learning pods, and other approaches to discuss critical areas in quality, including through national quality policies and strategies. The GLL includes a national quality policy and strategy area for “consideration of focused policies and strategies to facilitate quality integration across all levels of the health system.”
Covering key aspects of PHC systems, the PRIMASYS case studies explore policy development and implementation, financing, integration of PHC into comprehensive health systems, scope, quality and coverage of care, governance and organization, and monitoring and evaluation of system performance. The knowledge generated through these case studies can be translated into the development and implementation of national PHC policies, programs, and health systems reforms.
This handbook describes eight essential elements to be considered by teams developing national quality policy and strategy, including national health goals and priorities; local definition of quality; stakeholder mapping and engagement; situational analysis; governance and organizational structure, among others. The handbook explores arguments for developing national policy and strategy on quality of health care, the process required to do so, and tools to support the process.
HiAP is a systematic approach to taking health implications into account for decisions across sectors, in an effort to improve population health and health equity. This framework is the founding statement and “starter’s kit” on health in all policies (HiAP), including guidance on six key components to its implementation and suggestions on the roles and responsibilities of government structures and health authorities. The framework provides examples of HiAP in practice in different country contexts as well as implementation recommendations.
This online repository of WHO tools is designed to assist national and sub-national health authorities in elaborating health policies, strategies, and plans. It contains diagnostic tools for assessment, monitoring, and evaluation, as well as tools to support priority setting, identify effective strategies, costing scenarios, resource planning and budgeting, and programming and implementation. This is useful for a deeper look at tools developed by WHO and other sources for national health planning efforts.
This report makes the case for quality improvement as a core function of PHC, providing perspectives of different levels of the health system on improving PHC quality, and citing a number of principles and interventions that can form part of efforts to achieve such change. This paper includes some interventions for improving quality, and encourages a learning agenda that focuses on questions around what is working, how it is working, and how it can be scaled up.
This handbook focuses on the six core components, or building blocks, of health systems identified by the WHO: service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance. The leadership and governance section includes a policy index and introduces the components and related indicators. It describes possible sources of information and available measurement strategies, and proposes core and supplemental indicators that may be used depending on the country health system attributes and needs.
This document is a detailed guide to Bangladesh’s health sector strategic development plan, but is applicable on a broader scale as an example of a national country strategy. It details strategies and plans that emphasize quality, effective service provision, and equity. It is a useful reference for PHC policy reform efforts, recognizing many of the key steps and pathways described for establishing strong PHC policies.
This document is an example of a national country plan. It includes an assessment of the performance of each building block of the health system, describes the major tasks and solutions moving forward, in addition to financing needs, monitoring and evaluation plan, and the country’s approach for organization implementation of the major tasks. Primary health care is fundamental to this plan; it is a useful reference for a successful plan for strengthening PHC policies.
This is an example of a comprehensive national plan focusing on quality management through a national policy and strategy. It includes a situational assessment reviewing community ownership, health status, and equity. It describes a policy framework accompanied by a strategic assessment, and strategic objectives, and performance measures. This is an ambitious and detailed strategic transformation plan that could be of use for other country stakeholders looking for examples, or benchmarking opportunities for planning.
While this document was developed with a focus on improving quality assurance in Ghana, it is a useful reference as a detailed guide to developing quality management programs. With guidance to the steps for and reasoning behind developing organizational infrastructure and leadership, performance measurement, and involving the community in meaningful ways, it can be used as a toolkit for quality management efforts.
This review describes structures and activities promoting quality in health care used at national and international levels, catalogues examples of quality concepts and tools in use in health care, and analyzes the operation of national health service accreditation programs. It consolidates recommendations from WHO and International Society for Quality in Health Care quality assurance consultations between 1988 and 2000, and includes key questions for consideration for national quality strategy in low- and middle-income countries focusing on policy, organization, methods, and resources.
"The OneHealth Tool is a software tool designed to inform national strategic health planning in low- and middle-income countries. While many costing tools take a narrow disease-specific approach, the OneHealth Tool attempts to link strategic objectives and targets of disease control and prevention programmes to the required investments in health systems. The tool provides planners with a single framework for scenario analysis, costing, health impact analysis, budgeting and financing of strategies for all major diseases and health system components. It is thus primarily intended to inform sector wide national strategic health plans and policies."
"The Data Impact Program partners with governments to enable them to use data to improve public health by prioritizing health issues and identifying populations in need, allocating financial and human resources, enacting laws and regulations, and establishing programs and services. The Data to Policy training course builds capacity among government health staff on using data to advance a policy agenda and support specific policy priorities."
This report collects and analyses a series of case studies detailing successful multisectoral and intersectoral initatives in WHO member. states. It is intended to serve as a compendium of best practices for multisectoral and intersectoral health and well-being policy development and implementation across the European region.
"The volumes in this series focus on key issues for health policy-making in Europe. Each study explores the conceptual background, outcomes and lessons learned about the development of more equitable, more efficient and more effective health systems in Europe. With this focus, the series seeks to contribute to the evolution of a more evidence-based approach to policy formulation in the health sector. These studies will be important to all those involved in formulating or evaluating national health policies and, in particular, will be of use to health policy-makers and advisers, who are under increasing pressure to rationalize the structure and funding of their health system."
"This paper provides tailored guidance for policy makers tasked with developing and implementing health financing policy in fragile and conflict affected situations, as well as those who advise such policy...The intention is to not to prescribe specific processes or health financing arrangement, but to guide policy makers to develop and implement policies in a way which increases resilience in the health system in both the short, medium and long-term. The recommendations are based on a review of evidence from a wide range of fragile and conflict-affected settings, as well as an extensive process of consultation with stakeholders."
This article proposes, "a multidimensional framework of capacities for governance by MoHs that encompasses both the “hard” (de jure, explicit and functional) and “soft” (de facto, tacit, and relational) dimensions of governance, and reflects the diversification of their mandates in the context of the Sustainable Development Goals (SDGs). Four case studies illustrate different aspects of the framework. We hope that the framework will have multiple potential benefits including benchmarking MoH governance capacities, identifying and helping analyze capacity gaps, and guiding strategies to strengthen capacity."
"This series of ReBUILD briefing papers addresses key questions on health systems strengthening in settings affected by conflict or crisis. The purpose of these briefing papers is to bring together current knowledge and research in order to inform decision-makers, implementers, researchers and other stakeholders in this area."
"Read full profiles of international health systems describing the role of government, how systems are organized and financed, who and what is covered, and what is being done to ensure quality of care, reduce disparities, and promote care coordination."
"The Knowledge Action Portal (KAP) is a flagship online community-driven platform launched by the WHO Global Coordination Mechanism on the Prevention and Control of Noncommunicable Diseases (WHO GCM/NCD). The KAP presents users with an innovative way to enhance global understanding, interaction, and engagement across sectors for the purpose of fulfilling existing - and initiating new - commitments to noncommunicable disease (NCD) prevention and control."
"In this WHO Working Paper, we seek to understand and illustrate this interplay between governance and capacity in Ministries of Health across the world, and offer a range of practical examples and recommendations."
"The strategy outlines six governance behaviors critical to private sector health service delivery governance. 1. Build understanding; 2. Foster relations; 3. Enable stakeholders; 4. Align structures; 5. Nurture trust; 6. Deliver strategy. This strategy serves as a guide for WHO and member states at various levels of engagement to promote a new way of doing business with the private sector. The proposed strategy builds upon WHO’s mandate and normative work on health systems strengthening, governance and financing."
This paper is intended to strike a discourse on and study of health system governance in global health. The author draws from country experiences and evidence to explain the 'triangle of rules' in health system governance and 'missing links'.
This paper uses the World Development Report's governance framework to " to further explore both formal and informal relations between stakeholders in the governance triangle and identify, as we reflect on our past investments in health system governance, a number of gaps or ‘missing links’. Exploring the missing links described in this paper will help us better understand governance mechanisms in health system and design and implement more effective health policies and interventions."
"The Cluster Approach is a way of organizing coordination and cooperation among humanitarian actors to facilitate joint strategic planning. At country level, it: establishes a clear system of leadership and account-ability for international response in each sector, under the overall leadership of the humanitarian coordinator; and provides a framework for effective partnerships among international and national humanitarian actors in each sector."
Here, stakeholders can access various articles and workshops brief related to the development, application, and goals and objectives of the Health Systems Performance Assessment framework for Universal Health Coverage (HSPA Framework for UHC) in practice. This framework allows stakeholders to evaluate health system performance, largely by drawing on the information available in the existing tools or through global data collection initiatives.
"The UHC Data Portal aims to provide a single interface to get an overview of the state of UHC commitments in every country and access UHC and Health System data sets and data visualizations from SDG official statistics and UHC2030 partners."
"This compendium collates current tools and resources on quality improvement developed by the WHO Service Delivery and Safety Department and provides examples of how the tools and resources have been applied in country settings. The target audience for this document are ministries of health, facility quality improvement teams, researchers and development agencies. WHO technical programmes, regional and country offices can also use the document in their technical cooperation work with the identified audience. Those working to improve the quality of health service delivery can also make good use of this resource."
"This report documents the current state of quality measurement in complex care; Identifies key challenges associated with complex care; and Details current complex care research and measurement development efforts. It also contains eight recommendations for next steps the field can take to develop a standard set of quality measures, including a proposed set of measurement domains and subdomains to structure future measure sets."
"This “compendium” of case studies and country examples is intended as a reference guide to practitioners and civil society organizations working to shape their country’s approach to anti-corruption. It builds on the existing body of literature, the experiences of World Bank staff around the globe, and the initiatives undertaken in international fora. The report is not intended to be read from cover to cover and has been structured in a manner that allows the reader to easily identify and focus on a thematic area of interest."
This article explores governance arrangements between and within different sectors using the transparency, accountability, participation, integrity, and capacity (TAPIC) framework for governance. Specifically, it provides theoretical and practical insights about the ways to address governance in a way that promotes health more effectively across government and society, thus turning ambulances into fences.
"The draft roadmap aims to serve as a guide for WHO’s member states at various levels of engagement with the private sector and promote a new way of doing business for both WHO internally and the member states. Following the publication of this roadmap, WHO will evaluate different approaches to support this new vision and the implementation of the roadmap. This is an important piece of work to strengthen the enabling environment that is needed for private sector to contribute effectively to UHC."
This case study series highlights global efforts to promote citizen monitoring and health care in countries like Peru. Learnings from the case studies and concepts featured in this series, such as the actors involved and stages and processes of citizen monitoring, are intended to support health practioners to implement such practices in their own communities, and improve health outcomes and equity of care.
This policy brief introduces the Transparency, Accountability, Participation, Integrity, and Capacity (TAPIC) framework, a simple, unified approach to health system governance. It is intended to provide policymakers with a roadmap for the practical analysis of governance issues and ultimately, a way to improve policymaking, policy, and services.
This article outlines various challenges to and options for strengthening PHC systems based on an analysis of PHC systems in 20 LMICs. Here, readers can unpack determinants of PHC performance in LMICs and explore lessons for implementation, policymaking, and systems reform to help drive improvements in their PHC systems.