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Analytical summary - Leadership and governance

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Leadership and governance involves the responsibility of providing oversight across all national institutions through policy-making and health planning, organization and management, and regulation of health services. In all 46 countries of the WHO African Region, the ministries of health are mandated to provide this oversight function. Some country health policies contain additional mandates in respect of population and social welfare. Increasingly, in order to address upstream social and environmental key determinants of health, ministries of health work in close collaboration with other government sectors responsible for agriculture, water supply and sanitation, other environmental issues, education, and women’s empowerment.

The overall goal of health policy-making and health planning is to improve the performance of health systems, and the health status and trends of African populations, through application of primary health care principles. The process of creating health policy is becoming more evidence based and participatory over time, and therefore more responsive to differing population needs. National health policy will also take account of major international development agreements, goals or movements, aligning health and development policy to the extent possible in the interest of a unified governance approach. Further initiatives to acquire and use high-quality data for policy-creation purposes are desirable, and debates concerning the respective roles of international, national and subnational level data continue.

Many African countries are moving towards decentralized organizational models, bringing funding and services closer to the populations served. This circumvents many problems associated with the centralized approach, but places demands on district or local level services that current levels of local capacity may find challenging. Capacity to update and maintain the necessary regulatory and legislative measures in the area of health policy is also restricted, and monitoring and evaluation systems in the area of health governance are in very early stages of development.

However, what all health policies and strategies have in common is:

  • the need to address themselves to the most commonly occurring causes of disease and to the most vulnerable sectors of the population;
  • to ensure that all components of the health system function at their highest capacity.

Biannual reviews have become a commonly accepted governance method of monitoring and adjusting health policy and strategy. However, a major obstacle revealed through this process is an often conflicting series of health and related sector policies that hamper effective health leadership and reduce clarity of vision.