Governance in the Health Sector : A Strategy for Measuring Determinants and Performance
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Many different strategies have been
proposed to improve the delivery of health care services,
from capacity building to establishing new payment
mechanisms. Recent attention has also asked whether
improvements in the way health care services are governed
could make a difference. These approaches ask which factors
-- such as rules and institutions -- influence the behavior
of the system in ways that are associated with better
performance and outcomes. This paper reviews the concept of
governance as it is used in the literature on private firms,
public administration, international development and health.
It distinguishes between indicators that measure governance
determinants from those that measure governance performance
in order to propose a framework that is analytically
coherent and empirically useful. The framework shows how
these indicators can be used to test hypotheses about which
governance forms are more useful for improving health system
performance. The paper concludes by proposing specific
measures of governance determinants and performance and
describes the instruments available to collect and interpret them.
Palabras clave
CAPACITY BUILDING, GOVERNANCE, HEALTHCARE SERVICE DELIVERY, HEALTH, HEALTH SYSTEM PERFORMANCE, INTERNATIONAL DEVELOPMENT, NEW PAYMENT MECHANISMS, PRIVATE FIRMS, PUBLIC ADMINISTRATION