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Table 1 Health system governance functions and the specific attributes to be analysed for each domain

From: The role of health system governance in strengthening the rural health insurance system in China

Governance domain

Features of good governance [5, 6]

Specific questions

Policy guidance and vision

Formulating sector strategies and also specific technical policies; defining goals, directions and spending priorities across services; identifying the roles of public, private and voluntary actors and the role of civil society.

Any long term health plans/development goals/any documents?

Role of “Health” in overall country development?

Any other technical plans or strategies for this policy?

Are goals and priorities clearly defined in the policy strategies?

Are the policy strategies and designs comprehensive?

Who initiated the policy (e.g. central government, departments and its level, individual, or media)?

Why initiated the policy (e.g. problems targeted, or high level will)?

System design

Ensuring a fit between strategy and structure and reducing duplication and fragmentation.

Is the specific health policy related to overall health or national development plan?

To what extend the system structure responds to what needs to happen in this policy?

Design of interventions and policies to deliver services

Are the duplication and fragmentation reduced?

Regulation and management capacity

Designing regulations and incentives and ensuring they are fairly enforced.

How the policy is operationalized (e.g. regulation, contract or legal)?

How to ensure the different levels of government accountable to the policy aims (e.g. supervision, promotion of leader)?

How administrative structure is organized and contribute to the enforcement of policy (e.g. duties allocation, reporting to higher authority)

What regulations or incentive to ensure the implementation?

How to ensure the management capacity of different levels of governments (e.g. selection, training, supervision)

Accountable and transparent

Ensuring all health system actors are held publicly accountable. Transparency is required to achieve real accountability.

How to ensure the health policy be responsive the priority of health problems at that time?

How the different levels of governments adopt policies based on the needs of local residents?

Is the performance of health authorities or health providers transparent to the public?

Is the finance situation of health authorities or health providers or health insurance fund transparent to the public?

Intelligence and oversight

Ensuring generation, analysis and use of intelligence on trends and differentials in inputs, service access, coverage, safety; on responsiveness, financial protection and health outcomes; on the effects of policies and reforms; on the political environment and opportunities for action; and on policy options.

What is the basis for policy design and contents? Is evidence underpinning policy design?

How are pilots evaluated? How are the local experience and lessons formulated and disseminated?

What monitoring and evaluation systems are in place?

How the monitoring and evaluation contribute to policy?

Collaboration and coalition building

Across sectors in government and with actors outside government, including civil society, to influence action on key determinants of health and access to health services; to generate support for public policies, and to keep the different parts connected - so called ‘joined up government.

How actors work across different sectors on design and implementation of policy?

How are different actors mobilized to contribute to health activities?

How is the collaboration with civil society organizations or other (outside the formal health sector)?

How are the different levels of government collaborating?