1.1 Improved access to quality essential health services

1.1.4 Countries’ health governance capacity strengthened for improved transparency, accountability, responsiveness and empowerment of communities

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The discussion of the scorecard by the output delivery team was helpful for understanding both the challenges faced and the rich variety of responses from the Organization. Significant differences were found, however, among the major WHO offices in approaches to scoring the dimensions of the scorecard, and there was consensus that median scores should be used instead of mean scores to mitigate any skewing.

Scorecard

The discussion of the scorecard by the output delivery team was helpful for understanding both the challenges faced and the rich variety of responses from the Organization. Significant differences were found, however, among the major WHO offices in approaches to scoring the dimensions of the scorecard, and there was consensus that median scores should be used instead of mean scores to mitigate any skewing. While the pandemic has delayed some regular programme activities, the vulnerability exposed has catalysed strengthening of systems governance by WHO and its Member States. The repurposing of staff and resources during the early response to COVID-19 will be followed by an increased focus on effective technical support, equity and efficiency to ensure value for money. While more strategic information is required to meet priorities in gender, equity and rights, significant progress has been made, especially in the Region of the Americas 

Achievements and challenges

COVID-19 brought to the fore the importance of strong governance and empowered communities, two of the goals of this output, which are essential in the pandemic response. The pandemic shows the importance of elements of good governance, such as accountability, responsiveness and inclusiveness to strengthen health institutions, laws and regulations, including institutional approaches to increasing participation in health systems policy.

Although the pandemic left limited time for programme work, which was either cancelled or adapted, with some repurposing of staff, it also provided information relevant to this output, and some achievements were made, despite the challenges.

In the Region of the Americas, the pandemic response included improving public health functions, such as emergency preparedness and response. In December 2020, the Regional Office launched the renewal of essential public health functions, with input from 10 countries and more than 20 regional public health institutes and universities. The Region has shown that, even with the constraints imposed by the pandemic, gender, equity and rights can be integrated as core aspects of health systems governance. By the end of 2020, nearly all the countries (32 of 35) in the Region had national plans for preparedness and response to COVID-19. The pandemic also raised awareness about the importance of research and reports on access and coverage. Research and epidemiological surveillance were enhanced, with more studies, analyses and reports on barriers to access. COVID-19 has amplified such barriers, particularly for vulnerable communities. The Region therefore improved articulation of its policies in health, social and other sectors to address social determinants and the needs of vulnerable communities.

In the Eastern Mediterranean Region, the pandemic catalysed promotion of the principles of good governance and the roles of governance and leadership. An assessment of essential public health functions has been initiated in collaboration with Public Health England, and relevant health legislation is to be reviewed.

In the European Region, the pandemic also demonstrated the importance of good governance in the functioning of health systems, particularly in response to emergencies, and the importance of a strategic vision to support strengthening of governance. Health systems governance was thus systematically embedded in the pandemic response and in documents requested by Member States, and the response was aligned with universal health coverage. The Regional Office, in consultation with partners. provided authoritative, evidence-based guidance to countries on mental health and psychosocial support in the pandemic and also worked on a new mental health initiative.

In both the South-East Asia and Western Pacific regions, the response to the pandemic strengthened the whole-of-government approach in countries. In the Western Pacific, governance of interagency financing and legislative frameworks for the public health response was strengthened. The Region also used lessons from COVID-19 to raise awareness of the importance of health in the economic context. Strengthening legal frameworks is central to ensuring that vulnerable and marginalized people receive good-quality health services. The aim of the Region’s draft framework Reaching the unreached is to promote transparent, effective, appropriate governance.

At WHO headquarters, despite the disruptions caused by the pandemic, the highest possible quality of technical support was provided; partnerships were leveraged and strengthened and many successful events were conducted, including advocacy with donors. Rigorous analytical approaches are used in WHO and elsewhere in systems governance, and progress was made in strengthening the evidence base and providing normative documents for countries on systems governance, which include:

 

 

 

 

Learn more about the output scorecard

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