an approach to addressing governance from a health system framework perspective一个方法来解决治理从卫生系统框架的角度来看.pdfVIP

Mikkelsen-Lopez et al. BMC International Health and Human Rights 2011, 11:13 /1472-698X/11/13 CORRESPONDENCE Open Access An approach to addressing governance from a health system framework perspective Inez Mikkelsen-Lopez1,2*, Kaspar Wyss1,2 and Don de Savigny1,2 Abstract As countries strive to strengthen their health systems in resource constrained contexts, policy makers need to know how best to improve the performance of their health systems. To aid these decisions, health system stewards should have a good understanding of how health systems operate in order to govern them appropriately. While a number of frameworks for assessing governance in the health sector have been proposed, their application is often hindered by unrealistic indicators or they are overly complex resulting in limited empirical work on governance in health systems. This paper reviews contemporary health sector frameworks which have focused on defining and developing indicators to assess governance in the health sector. Based on these, we propose a simplified approach to look at governance within a common health system framework which encourages stewards to take a systematic perspective when assessing governance. Although systems thinking is not unique to health, examples of its application within health systems has been limited. We also provide an example of how this approach could be applied to illuminate areas of governance weaknesses which are potentially addressable by targeted interventions and policies. This approach is built largely on prior literature, but is original in that it is problem-driven and promotes an outward application taking into consideration the major health system building blocks at various levels in order to ensure a more complete assessment of a governance issue rather than a simple input-output approach. Base