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The purpose of this paper is to present the contemporary understanding and emerging structural models of organisational governance of public hospitals in order to provide evidence-based guidance to countries that are reforming their public hospital governance structures in line with best practice.

The paper uses the structural dimension of Cooper, Fusarelli and Randall’s policy model and institutional theory to review the legislative frameworks of four model countries supported by extant literature.

The paper conceptually distinguishes health system governance and organisational governance in the health system. It further visualises the emerging alternative legislative models of organisational governance and a hierarchy of governors applicable to public hospitals.

The paper provides critical knowledge for understanding organisational governance within health system governance framework and develops tools that can be used in reforming institutional mechanism of organisational governance of public hospitals.

Bangladesh is applauded for its achievement in various health and social outcomes though criticized for its failure in properly dealing with governance issues. The purpose of this paper is intends to see how the health outcomes (in case of life expectancy, under-five mortality and adolescent fertility) are impacted by health expenditure (both public and private), per capita income in presence of overall governance and female education. This paper assumes that rapid progress in female education reflects the Bangladeshis’ social responsiveness to change.

This paper uses autoregressive distributed lag technique to estimate the models with data ranges from 1990 to 2016 under two different scenarios.

This study has found that all the explanatory variables exert significant impact on health outcomes. Furthermore, public health expenditure is augmented with a composite governance issue, and this enhances robustness as well as statistical significance of the models. These suggest that the governance issues play a very crucial role to achieve the expected health outcomes. Female secondary enrolment ratio appears with improved coefficients in terms of sign and magnitude for all the health indicators.

This paper contributes to the existing literature showing econometric evidence that highlights the importance of governance and female education in improving health outcomes of Bangladesh apart from health expenditure and per capita gross domestic product.

The purpose of this paper is to examine how and to what extent the design and implementation of universal health coverage (UHC) reforms have been influenced by the governance arrangements of health systems in low- and middle-income countries (LMIC); and how governments in these countries have or have not responded to the challenges of governance for UHC.

Comparative case study analysis of three Asian countries with substantial experience of UHC reforms (Thailand, Vietnam and China) was undertaken using data from published studies and grey literature. Studies included were those which described the modifications and adaptations that occurred during design and implementation of the UHC programme, the actors and institutions involved and how these changes related to the governance of the health system.

Each country adapted the design of their UHC programmes to accommodate their specific institutional arrangements, and then made further modifications in response to issues arising during implementation. The authors found that these modifications were often related to the impacts on governance of the institutional changes inherent in UHC reforms. Governments varied in their response to these governance impacts, with Thailand prepared to adopt new governance modes (which the authors termed as an “adaptive” response), while China and Vietnam have tended to persist with traditional hierarchical governance modes (“reactive” responses).

This study addresses a gap in current knowledge on UHC reform, and finds evidence of a complex interaction between substantive health sector reform and governance reform in the LMIC context in Asia, confirming recent similar observations on health reforms in high-income countries.

Global health challenges and threats could be confronted by collaborative efforts of international community. Governance for global health is a set of formal and informal processes, operating beyond state boundaries, and refers to institutions and mechanisms established at the national, regional and international levels. Nordic countries demonstrated a long-standing commitment to development assistance for health (DAH), and more recently to governance for global health. Governance for global health tools could be used effectively to achieve collective solutions for the maintenance and promotion of health as a common good, could ensure accountability and transparency, and reconcile the interests of different actors on the international and national levels. The aim of this paper is to provide an overview of tools and approaches in support of eight sub-functions of governance for global health applied by the Nordic countries. This will help international audience to compare those mechanisms with similar mechanisms that are available or planned in their countries and regions, and may benefit policy scholars and practitioners.

This study uses qualitative review of research literature, policy documents and information available from institutional websites related to the governance of global health in four Nordic countries. In total, 50 selected publications were analyzed using framework synthesis, mapping all findings to 8 dimensions (sub-functions) of governance for global health and related tools.

Review reveals which tools are available, how they have been applied by the Nordic countries and influenced all domains (sub-functions) of governance for global health at different levels: national governments, agencies and networks; bilateral and multilateral partnerships; inter-governmental institutions and international health-related organizations. Common trends and approaches in governance for global health have been formulated.

This study is unique in relation to the prior literature as it looks at the role of Nordic countries in the governance for global health system through the lens of tools applied in support to its sub-functions.

The purpose of this paper is to determine the status, drivers, and barriers to data governance at the health professional regulatory authorities in Kenya. This study aims to develop a model that can be used to establish a formal data governance program at these regulatory authorities.

This study used data governance decision areas based on the study of Khatri and Brown (2010). Qualitative and quantitative research methods were used in this study to collect data.

This paper identified maintenance of quality of data, achieving customer satisfaction, ensuring data security and control, and achieving operational efficiency as the drivers of data governance at the regulatory authorities. The authorities are faced with lack of data governance awareness, lack of management ownership and support, as well as limited funding and resource allocations as barriers to data governance. This study proposed that for the authorities to increase their data governance, they need to identify their data as an asset, initiate more data quality management mechanism, restrict access to their data, create awareness, and increase management, ownership and support.

A data governance program for healthcare workforce data is necessary for healthcare planning which influences national policy in the healthcare and the overall delivery of health services in a country.

The paper proposes a model that health professional regulators in developing countries that are facing limited resources can be used to establish a formal data governance program.

This paper aims to analyze the relationship between public health spending and health outcome using time series data in Nigeria over the period 1980 to 2017, taking into account the role of governance by assessing how the quality of governance directly affects health status and indirectly as a mediator for the effectiveness of public health spending.

Using the Hausman statistical tests to check for the existence of endogeneity, the proper method for estimating the model for this study is the two-stage least square regression model. The two-stage least squares regression model addresses the problem of endogeneity using instrumental variables. The mediating role of governance on the effectiveness of public health spending on health was considered by an interaction of governance indicators with public health spending.

The results showed that public health spending had no significant effect on health outcome except when interacted with governance quality. The interaction of government health spending with governance effectiveness as well as that for control of corruption improved health by inducing a fall in maternal deaths, whereas government health expenditure interacted with rule of law raised maternal mortality. Public health spending interacted with regulatory quality improved life expectancy while that for political stability with public health spending induced a fall in life expectancy, poor maternal and infant health. Political stability and the control of corruption had direct influence on maternal health.

Given the predominance of public health spending in promoting access to health care and population health status for developing economies, the effectiveness of such spending should be top priority in policy makers’ agenda. This again is important because for developing economies, government revenue is generated from a small tax base due to their highly informal nature. To improve health status from public intervention in the health sector, there is indeed need for improvement in the overall state of governance in Nigeria.

This paper is one of the few country case studies which uses time series data to examine the role of governance on the efficacy of public health spending with extension of findings to maternal health and covering more measures of governance quality. The results fundamentally illuminate the importance of governance in fostering development in health and consequently enhancing economic development and growth.

Risk governance is being successfully inserted into scientific and political agendas as a way to understand and address complex problems, such as health problems that have both social and ecological dimensions. However, to date, the debate on risk governance has remained rather conceptual. This chapter addresses these lacunae through describing research that was conducted on the Flemish environmental health governance arrangement and draws on this empirical case study to suggest ways that risk governance can be put into practice.

The case study analysis was conducted through a mixed methods study that combined document analysis and data gathered through 22 in-depth interviews with environmental and health scientists as well as policymakers.

This research shows that the Flemish environmental health risk governance arrangement has succeeded in increasing the exchange of information between: (1) governments at a variety of levels; (2) scientists, policymakers and the general public and (3) environmental and public health civil servants. The analysis also provides insights into some shortcomings and makes recommendations for ameliorating this arrangement: (1) the integration of environmental health objectives into all relevant policy domains, (2) the need for additional research into environmental health indicators and (3) the facilitation of the co-production of knowledge and multi-actor governance.

Empirical contributions and analysis about risk governance and policy formation processes are not often conducted. The added value of this Flemish case study is that it presents an example of good practice from which lessons for future risk governance arrangements can be drawn.

The purpose of this paper is to present a description of the Irish national clinical governance development initiative and an evaluation of the initiative with the purpose of sharing the learning and proposing actions to activate structures and processes for quality and safety. The Quality and Patient Safety Division of the Health Service Executive established the initiative to counterbalance a possible focus on finances during the economic crisis in Ireland and bring attention to the quality of clinical care.

A clinical governance framework for quality in healthcare in Ireland was developed to clearly articulate the fundamentals of clinical governance. The project plan involved three overlapping phases. The first was designing resources for practice; the second testing the implementation of the national resources in practice; and the third phase focused on gathering feedback and learning.

Staff responded positively to the clinical governance framework. At a time when there are a lot of demands (measurement and scrutiny) the health services leads and responds well to focused support as they improve the quality and safety of services. Promoting the use of the term “governance for quality and safety” assisted in gaining an understanding of the more traditional term “clinical governance”. The experience and outcome of the initiative informed the identification of 12 key learning points and a series of recommendations

The initial evaluation was conducted at 24 months so at this stage it is not possible to assess the broader impact of the clinical governance framework beyond the action project hospitals.

The single most important obligation for any health system is patient safety and improving the quality of care. The easily accessible, practical resources assisted project teams to lead changes in structures and processes within their services. This paper describes the fundamentals of the clinical governance framework which might serve as a guide for more integrative research endeavours on governance for quality and safety.

Experience was gained in both the development of national guidance and their practical use in targeted action projects activating structures and processes that are a prerequisite to delivering safe quality services.

While there is established research that explores individual innovations across countries or developments in a specific health area, there is less work that attempts to match national innovations to specific systems of health governance to uncover themes across nations.

We used a cross-comparison design that employed content analysis of health governance models and innovation patterns in eight OECD nations (Australia, Britain, Canada, France, Germany, the Netherlands, Switzerland, and the United States).

Country-level model of health governance may impact the focus of health innovation within the eight jurisdictions studied. Innovation across all governance models has targeted consumer engagement in health systems, the integration of health services across the continuum of care, access to care in the community, and financial models that drive competition.

Improving our understanding of the linkage between health governance and innovation in health systems may heighten awareness of potential enablers and barriers to innovation success.

Networked forms of organizing in health care are increasingly viewed as an effective means of addressing “wicked”, multifaceted health and societal challenges. This is because networks attempt to address these challenges via collaborative approaches in which diverse stakeholders together define the problem(s) and implement solutions. Consequently, there has been a sharp increase in the number and types of networks used in health care. Despite this growth, our understanding of how these networks are governed has not kept pace. The purpose of this chapter is to chart a research agenda for scholars who are interested in studying health care network governance (i.e., the systems of rules and decision-making within networks), which is of particular importance in deliberate networks between organizations. We do so based on our knowledge of the literature and interviews with subject matter experts, both of which are used to identify core network governance concepts that represent gaps in our current knowledge. Our analysis identified various conceptualizations of networks and of their governance, as well as four primary knowledge gaps: “bread and butter” studies of network governance in health care, the role of single organizations in managing health care networks, governance through the life-cycle stages of health care networks, and governing across the multiple levels of health care networks. We first seek to provide some conceptual clarity around networks and network governance. Subsequently, we describe some of the challenges that researchers may confront while addressing the associated knowledge gaps and potential ways to overcome these challenges.