Table 5 Summary of studies exploring different dimensions of ‘Governance’ (n = 18)
Author, year (country) | Type of study | Settings | Themes/sub-themes covered | Findings |
|---|---|---|---|---|
Rose J et al., 2014 [43] | Systematic review | Bangladesh health sector since 2000 | Transparency /accountability: public sector | • Some pertinent governance issues included corruption of inventory management, high rate of absenteeism of health care service providers and problems of human resource management • There is limited transparency in government regarding basic data e.g., procurement procedures at the national level • public doctors unnecessarily refer patients to private clinics or practices. |
Nurunnabi M and Islam SK, 2011 [44] | Survey and Secondary research | 533 patients from 45 hospitals in Dhaka city of Bangladesh were surveyed using questionnaire | Transparency/ accountability: private sector | • In the private health care sector, four factors were found to be significantly associated with accountability, in order of influence: professionals, administration and management, legal enforcement and ethics, and government |
Ghimire, J et al.; 2013 [45] | Qualitative study | 90 health facilities in Siraha, Bardiya and Doti districts in Nepal | Transparency /accountability: display of information | • Only 49 (54%) of the health facilities have properly displayed signboard, 42 (47%) citizen charter, 36 (40%) free health services and Information on Aama program in 25 (28%) health facilities. • 72 out of 90 health facilities have not displayed social audit reports, and 80 (89%) of the health facilities have not maintained complaint box. |
Dieleman, M et al.; 2011 [46] | Review of case studies | A literature review of HRH management in LMICs; case studies identified through Scopus, PubMed, Embase | Transparency /accountability: managing HRH | • The review covered four dimensions of governance: performance, equity and equality, partnership, and oversight • In ‘oversight,’ local-level corruption affects accountability and local-level trust in governance • Experiences with accountability mechanisms for HRH policy development and implementation were lacking. |
Kamal S et al.; 2014 [47] | Qualitative study using In-depth interviews, KII group discussion and secondary data | Public and private health care institutions in Bangladesh | Transparency /accountability: HRH | • 20% of total sanctioned post is vacant. Doctors do not have to be accountable for not attending the office on time. • The procedures of promotion, selection grade, and regularizing ‘In Charge’ positions are quite lengthy in the health sector. • Political pressures and influences are very prevalent when medical certificates on death and injuries are badly needed for filing police cases. |
Garimella, S and Sheikh, K; 2016 [48] | Case studies on posting and transfer | Primary health care center in Tamil Nadu, India | Transparency /accountability: HRH | • Posting and transfer emerge as a complex phenomenon, shaped partially by the laws of the state and partially as a parallel system of norms and incentives requiring consideration and coordination of the interests of different groups. • Beyond a functional perspective of PT, it also reflects justice and fairness as it plays out in the health system. |
Cleary, S et al.; 2013 [49] | Descriptive literature review | Review of PubMed literature in LMICs | Accountability: citizen participation | • Bureaucratic accountability mechanisms often constrain the functioning of external accountability mechanisms. • Citizen participation: community members are behaving like “watchdogs;” external supervision by community people can play a role for functioning external accountability mechanism. |
Papp, S et al.; 2013 [50] | Case study | Civil society organizations in Orissa, India | Accountability: citizen participation | • Public hearings as a social accountability tool facilitate: (1) demand generation for better services, (2) leveraging intermediaries to legitimize demands of poor and marginalized women, and (3) sensitizing leaders and health care providers to women’s needs • The process involves raising critical consciousness among marginalized women and giving space to voice their concerns and demands to people in power and also, receptivity of the latter to hear their grievances and act on these |
Roalkvam, S; 2014 [51] | Review | India | Accountability: citizen participation | • Rights of citizens are not solely contingent upon the existence of legally guaranteed rights but also significantly on the social conditions that make their effective exercise possible. |
Lodenstein, E et al.; 2017 [52] | Review | 37 social accountability initiatives in LMICs identified through a literature search | Accountability: citizen participation | • Perspectives of providers to citizen’s expectations and demands for better health care is essential for improving the quality of primary health care in different settings • Providers’ ‘receptivity’ to such demands expectations and their ‘relation’ to citizens for tapping personal and professional support for improved responsiveness can be understood and acted upon following a Context-Mechanism-Outcome theory of change |
Islam MS and Ullah MW; 2009 [53] | Mixed method using case study approach | Muradnagarupazila health complex, Comilla, Bangladesh | Accountability: citizen participation | • Peoples’ have no involvement in decision making process in the health sector • Lack of proper economic management is hampering the participation of people in health services. |
Regmi, K et al.; 2010 [54] | Review | Medline, PubMed, Embase, CINAHL, DARE literature review from Nepal | Decentralization | • Decentralization of health sector implies increased accessibility of the public to health services by increasing transparency and accountability • The restructuring of the district health care services from decentralization was considered the highest achievement for meeting the needs of the local community. • Decentralization is diverting the attention of the public away from central bureaucratic rules and gained popularity by installing local governments at the lower level. |
Panda, B, and Thakur, H; 2016 [55] | Review | Focused literature review from India using PubMed and Google Scholar | Decentralization | • For exploring effects of decentralization, one needs to examine and assess the role and functions of local decision-making institutions and results thereof at institutions, systems, and individual levels • Decentralization of local self-governance in public health sector has multiple dimensions in conceptualization, measurement complexities, and byproducts for consideration. |
Gurung, G, and Tuladhar, S; 2013 (Nepal) [56] | Quantitative study | 28 districts | Decentralization | • Local health facility management committee ensured community engagement, mobilization of local resources, improved responsiveness and accountability to the community, and provision of inclusive health services • Availability of technical staff, supervision, and monitoring, and display of citizen charter improved accountability. |
Rauniyar G et al., 2013 [57] | Performance Evaluation report | Indonesia; evaluation of ADB funded decentralized health services project | Decentralization | • Improved access to health care services, especially in remote and rural areas; the poor benefitted the most • Service delivery constrained by limited funding with a major proportion spent on administration • Continuous monitoring is essential for identifying current trends of decentralization |
Millington KA and Bhardwaj M; 2017 [58] | Report | LMICs including India, Bangladesh | Good governance | • To address corruption in pharmaceutical procurement, drug pricing transparency is mandatory for good governance through drug pricing information from a govt. online database. |
Roncarati, M; 2010 [59] | Review of examples | LMICs | Good governance | • Weak institutional capacities hinder good governance and better health outcome. • Generate awareness among stakeholders, supportive institutional structures, incentives and payment schemes enhance good governance |
Huss, R et al.; 2010 (India) [60] | Qualitative study/ 44 semi-structured interviews | Government hospitals in urban and rural areas of Karnataka; | Good governance | • Good governance is the responsibility of all citizens for a responsive and inclusive health systems with fair outcomes • To combat corruption effectively, committed and powerful leadership, adequate resource and capacity to investigate senior government officials, and institutional reforms are needed • Concerted efforts from political and justice systems, media and awareness-building among the population is essential to succeed in anti-corruption actions |