PT  - JOURNAL ARTICLE
AU  - Asha George
AU  - Amnesty Elizabeth LeFevre
AU  - Tanya Jacobs
AU  - Mary Kinney
AU  - Kent Buse
AU  - Mickey Chopra
AU  - Bernadette Daelmans
AU  - Annie Haakenstad
AU  - Luis Huicho
AU  - Rajat Khosla
AU  - Kumanan Rasanathan
AU  - David Sanders
AU  - Neha S Singh
AU  - Nicki Tiffin
AU  - Rajani Ved
AU  - Shehla Abbas Zaidi
AU  - Helen Schneider
TI  - Lenses and levels: the why, what and how of measuring health system drivers of women’s, children’s and adolescents’ health with a governance focus
AID  - 10.1136/bmjgh-2018-001316
DP  - 2019 May 01
TA  - BMJ Global Health
PG  - e001316
VI  - 4
IP  - Suppl 4
4099  - http://gh.bmj.com/content/4/Suppl_4/e001316.short
4100  - http://gh.bmj.com/content/4/Suppl_4/e001316.full
SO  - BMJ Global Health2019 May 01; 4
AB  - Health systems are critical for health outcomes as they underpin intervention coverage and quality, promote users’ rights and intervene on the social determinants of health. Governance is essential for health system endeavours as it mobilises and coordinates a multiplicity of actors and interests to realise common goals. The inherently social, political and contextualised nature of governance, and health systems more broadly, has implications for measurement, including how the health of women, children and adolescents health is viewed and assessed, and for whom. Three common lenses, each with their own views of power dynamics in policy and programme implementation, include a service delivery lens aimed at scaling effective interventions, a societal lens oriented to empowering people with rights to effect change and a systems lens concerned with creating enabling environments for adaptive learning. We illustrate the implications of each lens for the why, what and how of measuring health system drivers across micro, meso and macro health systems levels, through three examples (digital health, maternal and perinatal death surveillance and review, and multisectoral action for adolescent health). Appreciating these underpinnings of measuring health systems and governance drivers of the health of women, children and adolescents is essential for a holistic learning and action agenda that engages a wider range of stakeholders, which includes, but also goes beyond, indicator-based measurement. Without a broadening of approaches to measurement and the types of research partnerships involved, continued investments in the health of women, children and adolescents will fall short.