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Health sector governance: should we be investing more?
  1. Robert Fryatt1,
  2. Sara Bennett2,
  3. Agnes Soucat3
  1. 1 International Health Division, ABT Associates Inc, International Health, Bethesda, Maryland, USA
  2. 2 Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3 Department of Health Systems Governance and Financing, World Health Organisation, Geneva, Switzerland
  1. Correspondence to Dr Robert Fryatt; Bob_Fryatt{at}


Governance is central to improving health sector performance and achieving Universal Health Coverage (UHC). However, the growing body of research on governance and health has not yet led to a global consensus on the need for more investment in governance interventions to improve health. This paper aims to summarise the latest evidence on the influence of governance on health, examines how we can assess governance interventions and considers what might constitute good investments in health sector governance in resource constrained settings. The paper concludes that agendas for improving governance need to be realistic and build on promising in-country innovation and the growing evidence base of what works in different settings. For UHC to be achieved, governance will require new partnerships and opportunities for dialogue, between state and non-state actors. Countries will require stronger platforms for effective intersectoral actions and more capacity for applied policy research and evaluation. Improved governance will also come from collective action across countries in research, norms and standards, and communicable disease control.

  • health policy
  • health systems
  • governance

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  • Contributors RF and SB contributed to sections of the final draft article and AS provide comments on final drafts prior to completion and submission. All read comments from reviewers and contributed to the amended version. For final draft, RF made changes and coauthors read and agreed to changes.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.