11/19/2022 0 Comments The system lens![]() 5–8Ī governance perspective encourages taking a step back to understand how the health of women, children and adolescents is viewed before focusing on the micro-details of specific measurement metrics for health systems drivers. At its core, governance entails the mediation of power between diverse actors to influence the design and implementation of policies and services, although multiple definitions and frameworks for governance exist and continue to evolve, signalling its multidisciplinary origins. Governance involves the formal and informal rules and mechanisms that influence decision-making between citizens, providers, and the state in the public interest or not ( figure 1). ![]() 5 It is the force which binds or repels actors, relationships and resources across all levels of the health system to collectively realise health goals. 2–4 Governance is therefore not an additional building block of ancillary input in health systems, but the overarching frame within which the people, organisations, institutions and resources that make up health systems work. These governance features, while less easily observable and often referred to as the underlying or ‘software’ of health systems, are key to understanding health systems performance and variation within and across jurisdictions. This requires attention to people and how their relationships govern health systems across diverse contexts over time. ![]() In addition to coordinating these inputs, health policy implementation and programme scale-up hinges on mobilising a multiplicity of actors for collective action to realise common goals within health programmes and across other sectors. Key health systems inputs include human resources, financing, commodities, infrastructure and information systems to ensure high-quality health services. Health systems consist of all the organisations, institutions, resources and people whose primary purpose is to promote and improve health. Health systems play a critical role in improving and sustaining the health of women, children and adolescents by supporting intervention coverage and quality, promoting the rights of end users and intervening on the social determinants of health. 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. The system lens drivers#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. 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). 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. 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. Governance is essential for health system endeavours as it mobilises and coordinates a multiplicity of actors and interests to realise common goals. 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. ![]()
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