Governance involves ensuring that strategic policy frameworks exist and are combined with effective oversight, coalition building, regulation, attention to system-design and accountability [1]

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WHO Definition of Governance

WHO Health System Strengthening Glossary [2]

Governance: (i) the exercise of political, economic and administrative authority in the management of a country's affairs at all levels, comprising the complex mechanisms, processes, relationships and institutions through which citizens and groups articulate their interests, exercise their rights and obligations and mediate their differences.[3] (ii) the traditions and institutions by which authority in a country is exercised for the common good, including the processes by which those in authority are selected, monitored and replaced; the capacity of the government to effectively manage its resources and implement sound policies; and the respect of citizens and the state for the institutions that govern economic and social interactions among them [4]; (iii) the process of creating an organizational vision and mission —what it will be and what it will do- in addition to defining the goals and objectives that should be met to achieve the vision and mission; of articulating the organization, its owners and the policies that derive from these values-policies concerning the options that its members should have in order to achieve the desired outcomes; and adopting the management necessary for achieving those results and a performance evaluation of the managers and the organization as a whole.[5]

WHO Health Systems website [6]

Governance in the health sector refers to a wide range of steering and rule-making related functions carried out by governments/decisions makers as they seek to achieve national health policy objectives that are conducive to universal health coverage. Governance is a political process that involves balancing competing influences and demands. It includes:

  • maintaining the strategic direction of policy development and implementation;
  • detecting and correcting undesirable trends and distortions;
  • articulating the case for health in national development;
  • regulating the behavior of a wide range of actors - from health care financiers to health care providers; and
  • establishing transparent and effective accountability mechanisms.

Beyond the formal health system, governance means collaborating with other sectors, including the private sector and civil society, to promote and maintain population health in a participatory and inclusive manner. In countries that receive significant amounts of external development assistance, governance should also be concerned with managing these resources in ways that promote national leadership, contribute to the achievement of agreed policy goals, and strengthen national health systems. While the scope for exercising governance functions is greatest at the national level, it also covers the steering role of regional and local authorities. [7]

Health policy and systems research reader on human resources for health [8]

Governance entails transferring some decision-making responsibility from individuals to a governing entity, with implementation by one or more institutions, and with accountability mechanisms to monitor and assure progress on decisions made. [9] 

Governance is about the rules that distribute roles and responsibilities among societal actors and that shape the the principal–agent interactions among them. [10]

Other Definitions of Governance

World Bank [11]

Governance is the process through which state and non-state actors interact to design and implement policies within a given set of formal and informal rules that shape and are shaped by power.

OECD [12]

Governance is the exercise of political, economic and administrative authority necessary to manage a nation‘s affairs.

Context: The process by which decisions are made and implemented (or not implemented). Within government, governance is the process by which public institutions conduct public affairs and manage public resources. [13] 

Center for Global Development [14]

"I am going to define governance as a government's ability to make and enforce rules, and to deliver services, regardless of whether that government is democratic or not...there are at least four broad approaches to evaluating the quality of governance: procedural measures, input measures, output measures, and measures of bureaucratic autonomy."

Cordaid's Governance for Human Resources in Health [15]

Several definitions exist for governance, and for this exchange, partners have agreed upon the definition of governance of Brinkerhoff and Bossert (2008) [10]: “Governance is about the rules that distribute roles and responsibilities among government, providers and beneficiaries and that shape the interactions among them. Governance encompasses authority, power, and decision making in the institutional arenas of civil society, politics, policy, and public administration”...To better understand the issues at stake when discussing governance, the concept of governance can be divided into four overarching dimensions (Dieleman and Hilhorst 2008): performance; equity and equality; partnerships and participation; oversight. 

Additional Notes on Governance

Save the Children's Protect my future: The links between child protection and good governance [16]

"What is governance?”: There is no singular definition of governance as the dimensions and interpretations of governance vary across intergovernmental and donor organisations. However, governance is commonly defined as the traditions, mechanisms, and institutions by which authorities exercise and manage their affairs, resources, and policies in conjunction with the interests of their constituents. An important element across many definitions is that governance does not only encompass the responsibilities of government and state authorities but also the functions of private and social actors (UNDP 1997; World Bank 2013a; Save the Children et al. 2011; Kaufmann and Kraay, 2008). There are fundamental differences in models of government within and across regions globally, which includes how authority is structured and exercised, the ability of society and individuals to exercise their voices, the role of religion and traditions in defining how power is exercised, and the role of private interests. Accordingly, there are different models affecting how governments develop legislation, manage or affect economic affairs, and allocate public resources. Good governance, in turn, is defined in terms of the mechanisms and processes needed to promote effective governance and achieve the goals of development (World Bank, 2013b). Good governance rests on the following key characteristics: participation, accountability, transparency, responsiveness, effectiveness, efficiency, equity and inclusivity (Kaufmann and Kraay 2008; OECD 2013; World Bank 2013a; Save the Children et al. 2011). In order to have functioning governance systems and, accordingly, an equitable and functioning society, there is need for: the rule of law, effective and accountable public institutions, equitable services, adequate human and financial resources, political leadership, civic participation, and inclusion of strong civil society to mobilise citizens to hold governments accountable (Kaufmann and Kraay 2008; OECD 2013; World Bank 2013a; Save the Children et al. 2011; Save the Children 2010a).

Gisselquist (2012) [17]

Points to variations of governance definitions between and within IOs, instead offers seven disaggregated components of good governance that are common across definitions:  (1) democracy and representation, (2) human rights, (3) the rule of law, (4) effective and efficient public management, (5) transparency and accountability, (6) developmentalist objectives, and (7) a varying range of particular political and economic policies, programmes, and institutions (e.g., elections, a legislature, a free press, secure property rights)

Daly (2002) [18]

Offers four dimensions of governance based on common themes: (1) analysis of the state and the 'public' sphere more broadly; (2) practice of policy-making; (3) policy implementation; (4) prescriptions for the organization of society. All based on UK Labour Party.

Williams (2004) [19]

"This article argues that changing governance modes in the European Union (EU), including territorial multi-level governance and the dispersion of decision-making authority in policy networks, along with the separation of functions at all governance levels, is often characterised by fragmentation in the policy process. This causes difficulties for policy makers in identifying and avoiding unintended ex post policy outcomes, including 'trade-offs' between economic, social and environmental objectives that, in the context of sustainability, are sub-optimal."

[1] WHO. Everybody's business: strengthening health systems to improve health outcomes: WHO's framework for action. Geneva, Switzerland: World Health Organization, 2007.

[2] Health Systems Strengthening Glossary

[3] Governance for sustainable human development. A UNDP policy document. New York, United Nations Development Programme, 1997.

[4] Governance matters 2008: worldwide governance indicators 19962007. Washington, D.C., World Bank Institute, 2008. Available at:

[5] Sinclair D, Rochon M, Leatt P. Riding the third rail: the story of Ontario’s health services restructuring commission. 1996–2000. Montreal, Institute for Research on Public Policy, 2005, 65–6.


[7] WHO Alliance HPSR Loewenson R. Neglected Health Systems Research: Governance and Accountability. Research Issues. 2008;3:2-11.

[8] George A, Scott K, Govender V, World Health Organization. A health policy and systems research reader on human resources for health. World Health Organization; 2017.

[9] Fryatt R, Bennett S, Soucat A. Health sector governance: should we be investing more? BMJ Global Health 2017;2:e000343.

[10] Derick W Brinkerhoff, Thomas J Bossert, Health governance: principal–agent linkages and health system strengthening, Health Policy and Planning, Volume 29, Issue 6, September 2014, Pages 685–693,

[11] World Bank's 2017 World Development Report on Governance and the Law

[12] OECD, 2006, DAC Guidelines and Reference Series Applying Strategic Environmental Assessment: Good Practice Guidance for Development Co-operation, OECD, Paris

[13] IMF, 2007, Manual on Fiscal Transparency, IMF, Washington DC, Glossary




[17] Gisselquist, R. M. (2012). Good governance as a concept, and why this matters for development policy World Institute for Development Economics Research, United Nations University. 

[18] Daly, M. (2003). Governance and social policy. Journal of Social Policy, 32, 113-128. doi:

[19] Williams A. Governance and sustainability: an investigation of the role of policy mediators in the European Union policy process. Policy & Politics. 2004 Jan 1;32(1):95-110.