Webinar – The Trouble with the building blocks

"Governance is a practice in dynamic systems in which various actors map their authority."

“We need to liberate governance and stop shaping it as one of the ‘building blocks’. Governance is cross cutting and dynamic, we need to think of it as “mortar” rather than a block. Governance gives the system strength and the ability to withstand shocks.”

In the first webinar of our series on Health Systems Governance Frameworks and Missing Links, we teamed-up with the Collectivity to organize a great session around the trouble with the current building block thinking in health systems debates.

This webinar featured primary health care practitioner, health systems researcher and global health lecturer, Dr. Seye Abimbola. Building up on his recent paper, “Institutional analysis of Health Systems Governance”, Seye tackled the oversimplification and static nature of the health systems building block approach and the need to build an institutional approach of health systems governance that is both operational and actionable.

More than 75 people shared the experience and engaged in a very animated discussion.

Commentators welcomed the shift from static to dynamic health systems and governance thinking; governance is a practice in dynamic systems in which various actors map their authority. They drew attention to viewing the arenas of negotiation and decision-making as ‘architected spaces’.

Many supported Seye’s plea to see rules as having been constructed not only in economic but also historical contexts. A number of respondents went on to stress the importance of understanding health systems logic as situated between formal and informal articulations, and urged for allowing different actors to arise in the governance debate, pointing out that civil society, for instance, is often underrepresented or ignored in governance environments. They reminded the participants to pay more attention to the study of feedback mechanisms in the health and governance systems.

Many shared the view that a substantial amount of ‘pre-definitional’ investigation still needs to be done to look into the current governance spaces and into the methods that study them. Define who is actually talking and along what lines. Unveil who has the power to make, change and enforce rules, and by what mandate. Or define and quantify much better the effects of weak governance.

The debates were very rich. In conclusion, all participants agreed there is a lot of space for new questions and new methods to be used in health systems governance studies.

This discussion will be part of the ongoing Health Systems Governance Collaborative work.

It is never too late to join, so watch the recording below and leave us your comments.