Governance in health is increasingly regarded as a salient theme on the development agenda. The increased interest in governance has been driven by the need for greater accountability, arising from both increased funding and a growing demand to demonstrate results. An intrinsic aspect of governance, therefore, is accountability. This concerns the management of relationships between various stakeholders in health including individuals, households, communities, firms, governments, non-governmental organizations, private firms, and other entities which have the responsibility to finance, monitor, deliver, and use health services (World Bank 2004).

In particular, accountability involves:

1. delegation or an understanding (either implicit or explicit) of how services will be supplied;
2. financing to ensure that adequate resources are available to deliver services;
3. performance around the actual supply of services; d) receipt of relevant information to evaluate or monitor performance; and,
4. enforcement which concerns the imposition of sanctions or the provision of rewards for performance (World Bank 2004).

Governance in health is a cross-cutting theme, which is intimately connected with issues surrounding accountability. In the context of our discussion on health systems strengthening, it is an integral part of the previous health system components discussed: health information systems, health financing, human resources for health, and health service delivery. Despite consensus on the importance of governance in improving health outcomes, however, it remains inadequately monitored and evaluated.