Why is governance relevant in health systems?

When we talk about health system governance, we move away from the proverbial traditional ‘box’ in which health care institutions are located. This implies that in the analysis of health system governance, in addition to taking into account the role of traditional actors in the provision of medical services and in the conduct of health policies, we also study the influence of local governments, organized civil society groups - be they community-based organizations, trade unions, and others - as well as academic institutions and economic agents - such as the pharmaceutical and medical technology industries, etc. We can say that our analysis of governance applied to health systems:

• It contributes to identify strategic spaces for political advocacy, social participation and strengthening of citizenship in health. All this is done from the perspective of governance. We also see that social participation goes beyond collaborating in the implementation of medical programs and services and should be a process of building dialogue in the definition and implementation of public policies.
• It contributes to a better understanding of the conflicts of power and interests among the actors, as well as the level of influence that each of them exerts. This influence is reflected in the priorities and policies implemented in health systems.
• It requires the application of strategic thinking that makes it possible to identify the prevailing factors in specific contexts. This can bring important benefits to health systems because a better strategic reading of the elements involved -actors, policies and resources- will make it possible to identify and implement interventions that are both technically feasible and politically viable.
• What is health systems governance?

The World Health Organization (WHO) defined health systems governance as ‘The participation of stakeholders concerned with defining and implementing policies, programs and practices that promote equitable and sustainable health systems’. The WHO definition is limited because it associates governance only with stakeholder participation. Research work by our members (Flores 2010) defines governance in health systems as: The processes for decision making that directly or indirectly affect the health system. In these processes, strategic actors and organizations that apply the rules of the game and other formal and informal procedures interact. Strategic actors use power resources to influence decision-making.