title: Promoting good policy for leadership and governance of health related rehabilitation: a realist synthesis.
abstract: Good governance may result in strengthened performance of a health system. Coherent policies are essential for good health system governance. The overall aim of this research is to provide the best available scientific evidence on principles of good policy related leadership and governance of health related rehabilitation services in less resourced settings. This research was also conducted to support development of the World Health Organization's (WHO) Guidelines on health related rehabilitation.
  
  
  
  An innovative study design was used, comprising two methods: a systematic search and realist synthesis of literature, and a Delphi survey of expert stakeholders to refine and triangulate findings from the realist synthesis. In accordance with Pawson and Tilley's approach to realist synthesis, we identified context mechanism outcome pattern configurations (CMOCs) from the literature. Subsequently, these CMOCs were developed into statements for the Delphi survey, whereby 18 expert stakeholders refined these statements to achieve consensus on recommendations for policy related governance of health related rehabilitation.
  
  
  
  Several broad principles emerged throughout formulation of recommendations: participation of persons with disabilities in policy processes to improve programme responsiveness, efficiency, effectiveness, and sustainability, and to strengthen service-user self-determination and satisfaction; collection of disaggregated disability statistics to support political momentum, decision-making of policymakers, evaluation, accountability, and equitable allocation of resources; explicit promotion in policies of access to services for all subgroups of persons with disabilities and service-users to support equitable and accessible services; robust inter-sectoral coordination to cultivate coherent mandates across governmental departments regarding service provision; and 'institutionalizing' programmes by aligning them with preexisting Ministerial models of healthcare to support programme sustainability.
  
  
  
  Alongside national policymakers, our policy recommendations are relevant for several stakeholders, including service providers and service-users. This research aims to provide broad policy recommendations, rather than a strict formula, in acknowledgement of contextual diversity and complexity. Accordingly, our study proposes general principles regarding optimal policy related governance of health related rehabilitation in less resourced settings, which may be valuable across diverse health systems and contexts.
authors: Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland.|School of Psychology, Trinity College Dublin, College Green, Dublin 2, Ireland.
authors: Joanne
authors: J
authors: McVeigh
authors: Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland. malcolm.maclachlan@tcd.ie.|School of Psychology, Trinity College Dublin, College Green, Dublin 2, Ireland. malcolm.maclachlan@tcd.ie.|Centre for Rehabilitation Studies, Medicine and Health Sciences Faculty, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa. malcolm.maclachlan@tcd.ie.
authors: Malcolm
authors: M
authors: MacLachlan
authors: Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland.
authors: Brynne
authors: B
authors: Gilmore
authors: Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland.
authors: Chiedza
authors: C
authors: McClean
authors: Centre for Rehabilitation Studies, Medicine and Health Sciences Faculty, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa.|SINTEF Technology and Society, P.O. Box 124 Blindern, NO-0314, Oslo, Norway.|Department of Health Science, Norwegian University of Science and Technology, Tungasletta 2, 7047 Trondheim, Norway.
authors: Arne H
authors: AH
authors: Eide
authors: School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland.
authors: Hasheem
authors: H
authors: Mannan
authors: Handicap International Fédération, 138, avenue des Frères Lumière, 69008, Lyon, France.
authors: Priscille
authors: P
authors: Geiser
authors: Handicap International, 8757 Georgia Avenue, Suite 420, Silver Spring, MD 20910, USA.
authors: Antony
authors: A
authors: Duttine
authors: Centre for Rehabilitation Studies, Medicine and Health Sciences Faculty, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa.
authors: Gubela
authors: G
authors: Mji
authors: School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland.
authors: Eilish
authors: E
authors: McAuliffe
authors: Nossal Institute for Global Health, Level 4, Alan Gilbert Building, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia.
authors: Beth
authors: B
authors: Sprunt
authors: Ahfad University for Women, P.O. Box 167, Omdurman, Sudan.
authors: Mutamad
authors: M
authors: Amin
authors: Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland.|Health Policy & Management, Trinity College Dublin, Room 0.21, 3-4 Foster Place, College Green, Dublin 2, Ireland.
authors: Charles
authors: C
authors: Normand
mesh_terms: D006233:Persons with Disabilities / Q000534:rehabilitation; D006078:Government Programs / Q000379:methods / Q000592:standards*; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D007857:Leadership; D012046:Rehabilitation / Q000331:legislation & jurisprudence*
keywords: Delphi study; Governance; Health related rehabilitation; Leadership; Less resourced settings; Policy; Realist synthesis