Governance, accountability, and leadership within health systems influence healthcare performance, equity, and resilience. Countries in the WHO Eastern Mediterranean Region (EMRO) and South-East Asia Region (SEARO) encounter intricate problems necessitating resilient governance structures, improved accountability systems, and augmented leadership capabilities. These regions, characterized by varied economic environments, political frameworks and health system architectures, provide significant insights into governance strategies that can promote sustainable health advancements. In this article, we provide some examples from both regions.
Enhancing Governance Structures
Health Systems Governance refers to the processes, structures, and institutions that are in place to oversee and manage a country’s healthcare system. Efficient governance frameworks enable evidence-based decision-making, transparent distribution of resources, and responsible healthcare provision.
In 1996, the Ministry of Health in Jordan initiated a governance reform that decentralizes healthcare management while preserving central monitoring of quality standards. This equitable strategy has enhanced responsiveness to local needs while maintaining a focus on national issues. The reform entailed defining explicit roles and duties at various governance levels and setting up transparent reporting methods.
Likewise, since 2008 Thailand’s National Health Assembly has showcased a novel governance framework within the SEARO area. This multi-stakeholder platform unites government agencies, civil society organizations, academic institutions, and private sector representatives to formulate health policies collaboratively. The Assembly has effectively cultivated a political commitment to universal health coverage and enhanced policy consistency across sectors affecting health outcomes.
Governance changes in both regions have illustrated the significance of context-specific methodologies. The governance model of the UAE employs robust centralized planning while permitting operational flexibility at the provider level, facilitating swift adoption of innovation and implementing digital health transformation. In contrast, India’s National Health Mission prioritizes federalism and decentralization in health governance, among others linking central financing to performance-based metrics promoting state-level health outcomes’ accountability.
For governance frameworks to be effective, they must rectify power disparities within health systems and establish procedures for inclusive decision-making that includes underrepresented communities. The Lady Health Worker program in Pakistan exemplifies the capacity of governance to reach the grassroots level via established connections between community health workers and district health systems.
Enhancing Accountability within Health Systems
Accountability mechanisms assess how health systems fulfill their commitments to populations. Underdeveloped social accountability structures restrict communities from holding providers and policymakers accountable in the Middle East. But lately, we’ve been noticing some encouraging innovations in this respect, in spite of sometimes very challenging settings.
In Lebanon, NGOs have been crucial in sustaining health service delivery during the economic crisis and political turmoil. The Lebanese government has created institutional coordination mechanisms for NGOs to engage in health sector planning and implementation oversight. These techniques have enhanced resource allocation and minimized redundancy of efforts during the Syrian refugee crisis.
Digital accountability instruments are also becoming progressively significant in both regions. For example, Tunisia’s citizen feedback program enables patients to evaluate healthcare experiences and report instances of corruption or service deficiencies. This method has generated pressure for enhanced performance and diminished informal payments in public facilities.
In the SEARO region, community scorecards in Bangladesh also improve accountability, enabling communities to assess local health services systematically in accordance with established standards. These assessments initiate discussions between service consumers and providers, thus finetuning action plans. This strategy has enhanced maternal health services in rural regions by tackling cultural obstacles and provider mindsets identified via community input.
For accountability mechanisms to lead to significant change, they must be integrated in decision-making processes that include repercussions for performance. By way of example, the health transformation plan in Iran (implemented since 2014) included public disclosure of hospital performance measures associated with provider compensation and the establishment of financial incentives for accountability outcomes.
Boosting Leadership and Capacity Development
Leadership development has been emphasized in both regions, and for good reason: effective leadership is essential for the successful implementation of health policies and programs.
Egypt’s Leadership Development Program for primary healthcare leaders integrates management competencies with systems thinking methodologies. Participants engage in action-oriented projects that tackle actual healthcare issues within their regions. This initiative has enhanced the capacity of district health teams to manage scarce resources more efficiently.
The National Institute of Health Sciences in Sri Lanka has created a curriculum for crisis leadership focused on disaster planning and emergency response. This approach was beneficial during the COVID-19 pandemic, as health leaders with crisis management training exhibited enhanced adaptability in service restructuring and community participation during lockdowns.
In addition, leadership development should transcend individual competencies to enhance collective leadership capacity. Oman’s collaborative leadership model educates facility management teams collectively rather than concentrating efforts exclusively on senior administrators. This strategy boosted unity and facilitated the execution of infection control protocols during COVID-19.
Distributed leadership strategies have demonstrated potential in precarious environments. In Afghanistan, training mid-level managers in leadership competencies facilitated the preservation of key services amid major security concerns and political shifts. These leaders tailored central policies to local conditions while upholding essential service standards.
Concluding Remarks
The current polycrisis era has raised the bar worldwide: enhancing governance, accountability, and leadership demands continuous investment and political dedication. Effective programs in the EMRO and SEARO regions exhibit common characteristics: contextual relevance, integration with existing frameworks, substantial stakeholder engagement, and processes for translating results into actionable outcomes.
Governance, accountability, and leadership (as well as their interaction) will dictate the resilience and responsiveness of health systems worldwide as they confront escalating challenges from non-communicable diseases, climate change, and emerging or persistent infectious disease threats. The varied experiences from the abovementioned settings illustrate that even in resource-limited and challenging environments, enhancements in governance are achievable if tailored to local conditions and bolstered by suitable capacity-building initiatives.
***Get involved: With the upcoming HSR2026 forum in Dubai, UAE, this is the Survey link for consultation of the themes amongst stakeholders: https://www.surveymonkey.com/r/3ZNBC25