From frameworks to practices: experiences of sub-national governance in low- and middle-income countries
The health systems governance collaborative - in conjunction with RESYST and CHESAI consortia - hosted a webinar drawing on a recent special series on health system governance in the International Journal for Equity in Health. The unifying theme of the papers in this series is a concern for understanding the everyday practice of governance in low- and middle-income country health systems.
The webinar focused on two case studies of sub-national governance in the series - devolution in Kenya and implementation of policies shaping provider-patient interaction in two South African hospitals. Through these cases the webinar drew attention to:
- Governance as distributed within health systems, and not just the property of national spheres
- Influences on sub-national governance, and the complex interplay of hardware and software
- The notion of ‘everyday governance’ and its role in illuminating the decision-making processes that are central to governance concerns
- The role of embedded research in documenting the ‘hidden dynamics’ of governance within health systems
Rather than seeing governance as a normative health system goal addressed through the architecture and design of accountability and regulatory frameworks, these papers provide insights into the real-world decision-making of health policy and system actors. Their multiple, routine decisions translate policy intentions into practice – and are filtered through relationships, underpinned by values and norms, influenced by organizational structures and resources, and embedded in historical and socio-political contexts.