Abstract

The impacts of health care investments in developing and transition countries are typically measured by inputs and general health outcomes. Missing from the health agenda are measures of performance that reflect whether health systems are meeting their objectives; public resources are being used appropriately; and the priorities of governments are being implemented. This paper suggests that good governance is central to raising performance in health care delivery. Crucial to high performance are standards, information, incentives and accountability. This paper provides a definition of good governance in health and a framework for thinking about governance issues as a way of improving performance in the health sector. Performance indicators that offer the potential for tracking relative health performance are proposed, and provide the context for the discussion of good governance in health service delivery in the areas of budget and resource management, individual provider performance, health facility performance, informal payments, and corruption perceptions. What we do and do not know about effective solutions to advance good governance and performance in health is presented for each area, drawing on existing research and documented experiences.

Introduction

The impacts of investments in health care delivery in developing and transition countries are typically measured by inputs and outcomes. Individual programs sometimes track specific intermediary outputs such as immunization coverage or percentage of HIV/AIDS patients under treatment but these examine specific programs rather than the overall health care delivery system. Focusing on inputs, while critical, does not capture whether resources are actually deployed or how they are used. Relying on outcomes (typically life expectancy or infant and maternal mortality) to measure the effectiveness of service delivery is hampered by the fact that these events only occur once and are often determined by factors beyond the control of service providers.

Missing from the health agenda are measures of performance that reflect how well the health care delivery system is operating, and whether services are being provided effectively. This is difficult to measure but it is critical to do so if health systems are to achieve their objectives and ensure reasonable returns to public investments. This paper suggests that using good governance as an entry point can help to focus on performance in health care delivery, and in turn, provide policymakers and program managers with a basis upon which to raise performance.