Why is it important to talk about health system governance?

When we speak of health system governance, we are going outside the box where public health institutions are there to render traditional health services. It is necessary to look and analyze the way the health system operates and to take into account the role that all stakeholders play when providing care and developing and implementing public policies. We must also study the influence that local governments have, as well as that of civil society organizations whether they are community organizations, workers’ unions or others. Additionally, we must include academic and economic stakeholders like the pharmaceutical industry.

Our analysis of health system governance:

  • Contributes to the identification of strategic spaces for political incidence, of social participation and the strengthening of citizenry in health. All of this is carried out using a governance lens. For us, social participation goes beyond volunteering in the implementation of interventions and should be a process where public policy is designed and implemented.


  •  Contributes to a deeper understanding of conflicts of power and interest between stakeholders, as well as the level of influence that each of them exerts. This is reflected in the priorities and policies that are implemented within the health system.


  • Requires the application of strategic thinking in order to identify the factors that play a large role in specific contexts. This may bring about important benefits to health systems because a better reading of these issues –stakeholder participation, policies and power resources- allows us to identify and implement interventions that are technically and politically viable.

But, what is health system governance?

According to the World Health Organization (WHO), health system governance is ‘the participation of stakeholders that are involved in the definition and implementation of public policy, programs and practices that promote equitable and sustainable health systems’. This WHO definition is limited because it associates governance only with stakeholder participation. Research carried out by our members (Flores, 2010) define governance in health systems as ‘the processes through which decisions that have a direct of indirect effect in the health system are taken. These interact with strategic actors and organizations, which apply specific game rules and other formal and informal procedures, along with their power resources to influence decision-making.