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Please use this identifier to cite or link to this item: http://bura.brunel.ac.uk/handle/2438/6612

Title: Governance and health systems performance: Exploring the association and pathways
Authors: Olafsdottir, Anne
Advisors: Allotey, P
Reidpath, DD
Pokhrel, S
Keywords: Health policy
Eonomic crisis
Health system financing
Publication Date: 2012
Publisher: Brunel University School of Health Sciences and Social Care PhD Theses
Abstract: There has been an increase in empirical evidence indicating an association between governance and health systems, suggesting that better governed countries tend to have healthier populations with better performing health systems. This is an important finding, as it could point to structural public health interventions having a greater impact on health systems performance than individually targeted interventions. This doctoral thesis in public health (DrPH) from Brunel University is a compilation of three independent research projects undertaken under different settings, converging in the examination of the relationship between governance and health systems. The first project was a study conducted in the African region of the World Health Organization with the aim of understanding how and to what extent measures of governance are statistically correlated with performance of health systems as measured by a key health outcome: the under-five child mortality. The second project was a case study from a high income country in Europe during the period in which it went through an economic meltdown, the focus being a qualitative analysis of the extent to which the response to economic crisis influenced public health policy making and short term performance of the health system. The third project was a policy analysis carried out in an upper middle income country in Asia and the focus was to examine how the long history of health financing reform has influenced the performance of the health system. All research projects indicate an association between governance and health systems and the case studies provide empirical evidence of how health systems are affected by governance quality. The African study shows a statistically positive relationship between governance indicators and health outcomes, suggesting better governed countries to have lower child mortality. The European and the Asian cases suggest accountability, responsiveness, transparency and fair partnership to be important governance qualities for successful policy making and reforms. This evidence could be of use to current and future policy makers and others with the authority to configure and implement new public health policies. It indicates the importance of comprehensive analytical work prior to policy making with easy access to documents and fair participation with all stakeholders to increase the probability of reaching consensus oriented policy proposals followed by successful implementations. The main contribution of this thesis is to provide evidence through robust statistical/ qualitative analysis around the association between governance and health systems in countries at all income levels. The originality is located in the breadth (three different settings) as well as depth (three distinct, robust methods) of this kind of research. The congruence of findings regardless of study locations, the outcome measures used or types of methods applied have added to the growing evidence that there is a strong correlation between governance and health systems performance. This increased knowledge provides policy makers with additional evidence which can be applied to develop and improve governance with the aim of allocating public resources more efficiently and equitably. However, further research is required on governance and its link to health systems, inter alia how health equity is affected by selective partnership in the decision making processes and how political ideologies influence governance practices.
Description: This thesis was submitted for the degree of Doctor of Public Health and awarded by Brunel University.
URI: http://bura.brunel.ac.uk/handle/2438/6612
Appears in Collections:Community Health and Public Health
Dept of Clinical Sciences Theses

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