Paper - Health system governance: welcoming the reboot

A paper by Bruno Meessen published in the BMJ Global Health

Summary

► The literature on health system governance is growing. Alternative frameworks have been proposed, but none has really imposed itself so far. The empirical agenda is progressing slowly.

► There is a turning point among recent publications: a move away from a government-centred perspective of governance to a broader understanding of governance as the people’s organisation of their collective action.

► In this paper, we argue that what matters is the choice set of actions that groups of individuals can undertake, that is, their collective agency.

► The focus on collective agency broadens the perspective for action: the governance of the health system is not only about the ministry of health doing well certain things, it is about groups of individuals being able to organise their collective action, through the state, but also through other mechanisms.

► The collective agency approach opens avenues for research. For example, governance is both an explanatory and an outcome variable. A governance intervention (explanatory variable) may be effective to improve some health outcomes, but also disempower collective action for some groups of the population (outcome variable).