Governance

Question 1

Change in governance actors

Answer 1

• State Government is increasingly one of many actors making decisions on health policies affecting citizenry
– Shift from ‘command and control’ to ‘steering, influence and negotiation’
– Need to align incentives to desired outcomes
• Changing governance typically involves consideration of:
– Roles and responsibilities of the State;
– Influence of different actors on decision making;
– Roles of different actors on service provision;
– Changing expectations of various actors: individual citizens, civil society, private sector, etc.

Question 2

Good governance

Answer 2

• What is the ‘right way’ to set priorities, choose goals, and establish responsibility?
– A normative (value) issue
• Easy to identify what it is ‘bad governance’:, e.g.
– Corruption
– Abuse of power
– Patrimonialism /clientalism
• Definitions of ‘good’ governance vary. Typically seen to include:
– Fairness
– Representation of ‘the people’
– Accountability
– Transparency

Question 3

WHO

Answer 3

• World Health Assembly – Supreme decision making body
– Delegations from 194 member states
– Appoints Director General
• Funded through:
– Assessed contributions – from member states based on means (20%)
– Voluntary contributions – from states and non state actors (80%)
– Gates foundation the 2nd largest donor, after US government – paying more than Brazil, Russia, India and China combined

Question 4

Summary

Answer 4

• In the past, national Government did the business of governing.
• Have seen in most countries:
– Reduced responsibility for health provision by states;
– Increased number of actors at local and global levels;
– Increased importance of global decisions on health decisions, funding, and outcomes.
• Leads to explicit concern with ‘governance’. Two common conceptualisations:
A. The shift away from directive (command and control) government to more of a steering
role;
B. Governance as the organisation of decision making. The national Government plays a
role within a system of governance.
• In both cases, raises questions about how things should get done: good governance (a normative issue)
• Key issues in particular include:
– Representation – whose interests are represented in decision making?
– Accountability – how are those interests represented?
– Responsibility – what body takes ultimate responsibility for outcomes?