We conducted a systematic review of the literature to understand which frameworks for assessing governance in health systems have been developed and how these try to operationalise and/or assess how governance principles at different levels of a health system are implemented.
In total, 16 papers describe frameworks for assessing governance and 10 empirical research studies describe how such frameworks can potentially be used to assess health systems governance. Most of the frameworks originated from the discipline of new institutional economics (NIE), which focuses on the role of institutions (humanly devised constraints) which shape interactions among organisations within the system.
Governance frameworks are dominated by the “principal-agent” theory focusing on information asymmetry between the principal (the patient or the government) and the agent (healthcare providers). Governance needs to be operationalised by individuals at different levels in the health system. Governance is not an “apolitical” process, and there are no absolute principles that define governance; it is a diffuse concept that cuts across disciplines, and borrows from a range of theories. However, whether it is applied to health systems or political science, governance is concerned with how different actors in a given system or organisation function and operate and the reasons for this.