Health Sys tem Governance: A Conceptual Review

Governance is one of the important functions of health system management. Good governance leads to better performance of the health system and ultimately, achieving better health outcomes for the people. Nevertheless, the concept of health system governance is ambiguous and complex. Therefore, the purpose of this study is to explain the concept of health system governance.

This research was conducted using the conceptual review method. All articles related to the health system governance indexed in Medline, EMBASE, ProQuest, Scopus, Cochrane Library and Science Direct databases and Google and Google Scholar search engines were searched, extracted, and assessed. Finally, 95 articles were selected and analyzed by content analysis.

Health system governance is “a system of structures, processes, values, laws, power and authority for effective management of resources, coordination of stakeholders’ behaviors, planning and stewardship of health programs and evaluation of health system performance to promote, restore, and maintain health”. Health policy-making, strategic planning, organizing, stewardship and controlling are the main components of the health system governance. Environmental factors, information systems, appropriate culture, community participation and cooperation, and resource management influence the governance of the health system. Health system governance affects the goals of the health system (i.e. public health, financial protection, and responsiveness). Finally, a model and a checklist were developed to evaluate the health system governance.

Health system governance is a complex and multidimensional concept that is evolving. Strengthening health policy-making, strategic planning, organizing, stewardship and controlling is essential to achieve good health system governance.