title: Linking governance mechanisms to health outcomes: a review of the literature in low- and middle-income countries.
abstract: We conducted a synthesis of peer-reviewed literature to shed light on links between governance mechanisms and health outcomes in low- and middle-income countries. Our review yielded 30 studies, highlighting four key governance mechanisms by which governance may influence health outcomes in these settings: Health system decentralization that enables responsiveness to local needs and values; health policymaking that aligns and empowers diverse stakeholders; enhanced community engagement; and strengthened social capital. Most, but not all, studies found a positive association between governance and health. Additionally, the nature of the association between governance mechanisms and health differed across studies. In some studies (N = 9), the governance effect was direct and positive, while in others (N = 5), the effect was indirect or modified by contextual factors. In still other studies (N = 4), governance was found to have a moderating effect, indicating that governance mechanisms influenced other system processes or structures that improved health. The remaining studies reported mixed findings about the association between governance and health (N = 6), no association between governance and health (N = 4), or had inconclusive results (N = 2). Further exploration is needed to fully understand the relationship between governance and health and to inform the design and delivery of evidence-based, effective governance interventions around the world.
authors: Yale School of Public Health, Department of Health Policy and Management, Yale Global Health Leadership Institute, United States. Electronic address: dana.ciccone@gmail.com.
authors: Dana Karen
authors: DK
authors: Ciccone
authors: Boston University School of Public Health, United States.
authors: Taryn
authors: T
authors: Vian
authors: Stanford University School of Medicine, United States.
authors: Lydia
authors: L
authors: Maurer
authors: Yale School of Public Health, Department of Health Policy and Management, Yale Global Health Leadership Institute, United States. Electronic address: Elizabeth.Bradley@yale.edu.
authors: Elizabeth H
authors: EH
authors: Bradley
mesh_terms: D003906:Developing Countries; D014943:Global Health; D006076:Government; D033161:Government Regulation; D006291:Health Policy; D006801:Humans; D011050:Policy Making
keywords: Accountability; Global health; Governance; Health outcomes; International development