Key role of governance and accountability to achieve integrated people-centred health services
Models of integrated care continue to evolve globally with the goal to deliver more integrated people-centred health services. These models are characterized by innovative collaborations and partnerships across sectors. One enduring question relates to the best governance structures for these complex, multi-player systems and networks. Governance encompasses all aspects of managing health services delivery to support health system goals, including financing, human resources, and technology, and it is a critical instrument to strengthen public and institutional performance.
The current pandemic is a good reminder that circumstances and environments strongly influence health and well-being. It emphasizes the need to focus on whole-systems health, which cuts across political, economic, and social landscapes. Whole-system health requires governance that is agile and can respond quickly to emerging changes to manage the complex interdependent partnerships in integrated health systems. It further points to the need for diffusion of governance from a state/health services centred model to a collaborative model where a range of actors including state, private industry, the public, media and international organizations across levels co-produce governance by (Kickbusch and Gleicher 2012).
Accountability is an important governance tool. Well-defined accountability structures and high quality monitoring systems are essential for successful governance and to maintain health systems performance. Earlier accountability discussions tend to focus on three levels of accountability and the relationships between different stakeholder groups. Firstly, there is accountability at the level of the state, which may include various ministries (health, finance, social care, education). Secondly, there is accountability at the level of healthcare organizations, regulatory bodies, and service providers. Thirdly, there is accountability to people/citizens (individuals and families, communities, and populations).
However, in parallel to evolving governance structures, accountability tools and mechanisms have to change as cross-sectoral partnerships for health require more flexibility and different accountability relationships. In particular the role of the public needs to be strengthened. There is a key role for people in monitoring system quality and performance. There is also a need for public involvement for the co-creation of health and health services.
There are an increasing number of tools that facilitate the public voice and patient engagement in different aspects of health and health planning. Such tools include public dashboards with health systems performance indicators, searchable public health databases, guidelines and tools for patient engagement, and citizen report cards.
The challenges for governing new models for integrated people-centred health services are significant and there is little evidence about what works in what context. However, there is agreement that governance and accountability matter, and never more so than in times of crisis.
Kickbusch, I & Gleicher, D 2012, Governance for health in the 21st century, WHO Regional Office for Europe, Copenhagen
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