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Governance

Challenge

A variety of problems that confront health systems relate to governance. These include, for example, financial management practices that permit corruption; unavailable information on planning, operations, and financing, thereby reducing accountability; lack of capacity of civil society and elected officials to hold health sector actors accountable; and failures of MOHs and local governments to engage stakeholders in health decision-making and priority setting.

Approach

The Health Systems 20/20 approach tackles both the demand and supply sides of governance. On the demand side, work with citizens and oversight entities inside and outside of government enhances capacity to exercise voice and accountability. These practices go hand-in-hand with strengthening the MOH and other health sector actors: the supply-side of governance improvement. Health Systems 20/20 promotes institutional arrangements that enhance the likelihood of positive results. Examples of such arrangements include decentralization, public-private partnerships, and checks and balances among health sector executive agencies, legislators, and accountability actors (auditors, courts, citizens’ groups).