Smart Governance for Health: Why G4H Matters

Smart Governance for Health: Why G4H Matters

{Photo credit: MSH.}Photo credit: MSH.

Policy makers and health sector leaders in low- and middle-income countries are recognizing the value of smart governance for significant and sustained gains in health status outcomes. The new USAID Leadership, Management and Governance (LMG) project, led by MSH with a consortium of partners, is actively engaged in building the capacity and competencies of those expected to accomplish smart governance.

To explore smart governance, LMG convened a Roundtable on Governance for Health in low- and middle-income countries May 18, 2012, at The Brookings Institution in Washington DC.

What is smart governance?

Dodgson, Lee, and Drager define governance --- what LMG calls smart governance --- as “the cost effective actions and means adopted by a society or organization to promote collective action and deliver collective solutions in pursuit of common goals.”

Governance for health --- also known as health governance or "G4H" --- “concerns the actions and means adopted by a society to organize itself in the promotion and protection of the health of its people.”

Dodgson and colleagues say:

The rules defining such organization, and its functioning, can again be formal (e.g. Public Health Act, International Health Regulations) or informal (e.g. Hippocratic oath) to prescribe and proscribe behavior.  The governance mechanism, in turn, can be situated at the local/subnational (e.g. district health authority), national (e.g. Ministry of Health), regional (e.g. Pan American Health Organization), international (e.g. World Health Organization) and … the global level.  Furthermore, health governance can be public (e.g. national health service), private (e.g. International Federation of Pharmaceutical Manufacturers Association), or a combination of the two (e.g. Malaria for Medicines Venture).

Why does smart governance for health matter?

The value of effective governance standing alone is modest. Its impact flourishes when integrated with smart management and leadership.

Governance for health is valuable from a stakeholder engagement perspective, and from its potential to facilitate the work of those who manage and those who lead within a community’s or country’s health sector. Engagement brings legitimacy as well as enhanced ownership by those being governed or receiving services from the organization.

Sustainable gains in governance for health effectiveness must embrace not only those who govern, but also those who are governed.

Smart governance must encompass strategies, infrastructure and systems for stakeholder engagement and a sense of meaningful participation in the governance processes. Sustainable health gains are a function of sustainable governance process gains.

Governance for health's value is a function of its capacity to engage and to enable. From villages to parliaments, smart governance for health engages all stakeholders and enables leaders to more successfully develop policies and plans that improve health outcomes and save lives.

James (Jim) A. Rice, PhD, is project director of USAID's Leadership, Management, & Governance (LMG) project. Jim is Vice Chairman of The Governance Institute and holds faculty positions at the Judge School of Business, Cambridge University England, and the School of Public Health, University of Minnesota.

Future blogs will provide examples of smart governance practices and strategies to develop the competencies, confidence and capacity of those who govern.


Why does smart governance for health matter? Add your comments below.


This is eminently true. What is of interest is: 1. Efforts in health should probably center much more in governance (which means, maybe there is room for other professions to get involved, a welcome change) 2. Governance should be a sine-qua-non for health projects. There is no point spending precious resources in improving infrastructure or systems if the sector will continue its practises and 3. Governance at the Global level needs tackling. Having been among the original staff of the Global Fund I can vouch how difficult it is to move away from the traditional, and, judging from current status, how easy it is to revert to them when change starts to bother some. A good topic to be continued
James A. Rice, PhD
Thank you, Hernan. In the LMG Project we agree that more formal and effective governance strategies and systems will be essential to ensure health sector gains, especially in low and middle income countries (LMICs). Good governance practices will help create a culture and operating environment that fosters stakeholder engagement in and ownership of policies to enable: <ul> <li>more responsive health providers in both communicable and non-communicable diseases;</li> <li>bolder health system strategies that drive for improved outcomes via access, affordability, transparency and accountability of frontline health workers and parliament level politicians; and</li> <li>smarter stewardship use of scarce human, technological and financial resources.</li> </ul> Thank you for encouraging this conversation moving forward among health sector leaders across the globe.

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