Governance for Health: A Critical, but Poorly Understood, Health System Component

The paper by Bernal-Sundiang et al.1 in this issue of Acta Medica Philippina provides one the more extensive and in-depth empirical discussion governance health sector. Utilizing data collected over a one-year period as part Philippine Primary Care Studies urban, rural, remote settings, authors reported on challenges their team encountered project implementation it relates to leadership governance. One strength is that situates system keystone links all other components infrastructure supply chains, information system, workforce, financing, stakeholder engagement, monitoring evaluation. This harks back framework posited World Health Report 20002, highlighting interaction between elements.Despite critical role governance, however, has been characterized being poorly understood, often difficult operationalize, not least because poor capacities different institutions actors bring fore good agenda.3 For instance, suggested regardless sector, “accountable, transparent, responsive, equitable inclusive, effective efficient, participatory, consensus-oriented follows rule law.”4This characterization assumes existence traditions places common front center, something which may be present, if willfully disregarded, many jurisdictions. Another set related buzzwords for entails “whole-of-government” “whole-of-society” approaches, means mobilization public agencies,on hand, private sector civil society organizations, other, towards realization shared goals.5 Aside from need conceptual operational clarity these two terms, reality token participation siloed working environments remain barriers achieving true multisectoral approaches areas.Relatedly, I wish insight our case study tuberculosis program implementation.6 In research, we identified facilitating hindering factors successful prevention control cities municipalities, were rooted source health. We further extended argument stating focusing local chief executive responsible entityfor myopic view only covers levels can labelled “broader environment” “public policies.”7 fine-grained institutional or sectoral within ambit officer, while what propose refer “program-level” realm coordinator. scope specificity exercised across levels, consequent access precise information, differ, highlights responsibility three principal at level so far exercise concerned.Good an aspirational goal decades, was important constituent quest better sustainable development. recommendations outlined provide starting point how gradually improve come closer ambition. However, embedding large will sustaining such gains moving forward.
 Carl Abelardo T. Antonio, MD, MPHDepartment Policy AdministrationCollege Public HealthUniversity Philippines Manila
 
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