Health system governance for injury care in low- and middle-income countries: a survey of policymakers and policy implementors
Introduction Good health system governance is essential for reducing high mortality and morbidity after injury in low- and middle-income countries (LMICs). Unfortunately, the current state of governance for injury care is not known. This study evaluated governance for injury care in Ghana, Pakistan,...
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BMJ Publishing Group
2025-02-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/10/2/e017890.full |
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| author | Alice Sitch Justine Davies Kathryn Chu Stephen Tabiri Junaid Razzak Lucia D’Ambruoso Alemayehu Amberbir Abebe Bekele Agnieszka Ignatowicz Mohammed Bukari Derbew Fikadu Berhe Barnabas Alayande Pascal Nzasabimana Jean Claude Byiringiro Huba Atiq Komal Abdul Rahim Jane Acquaye Anita Eseenam Agbeko Napoleon Bellua Sam Leila Ghalichi Denys Ndangurura Irene Bagahirwa Dominic Konadu-Yeboah Frederick Sarfo-Antwi Lambert Nzungize Ntombekhaya Tshabalala Richard Osei Tamlyn MacQuene Zaheer Babar Chand Zabin Wajidali Adams Dramani Ebenezer Kwame Amofa Eric Twizeyimana Fazila Sahibjan Ghislaine Umwali Mehreen Mustafa Nadine Mugisha Tariq Jakhro |
| author_facet | Alice Sitch Justine Davies Kathryn Chu Stephen Tabiri Junaid Razzak Lucia D’Ambruoso Alemayehu Amberbir Abebe Bekele Agnieszka Ignatowicz Mohammed Bukari Derbew Fikadu Berhe Barnabas Alayande Pascal Nzasabimana Jean Claude Byiringiro Huba Atiq Komal Abdul Rahim Jane Acquaye Anita Eseenam Agbeko Napoleon Bellua Sam Leila Ghalichi Denys Ndangurura Irene Bagahirwa Dominic Konadu-Yeboah Frederick Sarfo-Antwi Lambert Nzungize Ntombekhaya Tshabalala Richard Osei Tamlyn MacQuene Zaheer Babar Chand Zabin Wajidali Adams Dramani Ebenezer Kwame Amofa Eric Twizeyimana Fazila Sahibjan Ghislaine Umwali Mehreen Mustafa Nadine Mugisha Tariq Jakhro |
| collection | DOAJ |
| description | Introduction Good health system governance is essential for reducing high mortality and morbidity after injury in low- and middle-income countries (LMICs). Unfortunately, the current state of governance for injury care is not known. This study evaluated governance for injury care in Ghana, Pakistan, Rwanda and South Africa, four LMICs with diverse contexts, to allow understanding of similarities or difference in the status of governance systems in different LMICs.Method This cross-sectional study captured the perceptions of 220 respondents (31 policymakers and 189 policy implementers) on injury care governance using the framework for governance in health system developed by Siddiqi. Input was captured in 10 domains: strategic vision; participation and consensus; rule of law; transparency; responsiveness; equity and inclusion; effectiveness and efficiency; accountability; intelligence and information; and ethics.Result The median injury care governance score across all domains and countries was 29% (IQR 17–43). The highest median score was achieved in the rule of law (50, 33–67), and the lowest scores were seen in the transparency (0, 0–33), accountability (0, 0–33), and participation and consensus (0, 0–33) domains. Median scores were higher for policymakers (33, 27–48) than for policy implementers (27, 17–42), but the difference was not statistically significant.Conclusion The four studied countries have developed some of the foundations of good injury care governance, although many governance domains require more attention. The gap in awareness between policymakers and policy implementers might reflect a delayed or partial implementation of policies or lack of communication between sectors. Ensuring equitable access to injury care across LMICs requires investment in all domains of good injury care governance. |
| format | Article |
| id | doaj-art-65b45fe8312740ae8c0c966bf4ba1478 |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-65b45fe8312740ae8c0c966bf4ba14782025-02-11T09:45:14ZengBMJ Publishing GroupBMJ Global Health2059-79082025-02-0110210.1136/bmjgh-2024-017890Health system governance for injury care in low- and middle-income countries: a survey of policymakers and policy implementors 0Alice SitchJustine DaviesKathryn ChuStephen TabiriJunaid RazzakLucia D’AmbruosoAlemayehu AmberbirAbebe BekeleAgnieszka IgnatowiczMohammed BukariDerbew Fikadu BerheBarnabas AlayandePascal NzasabimanaJean Claude ByiringiroHuba AtiqKomal Abdul RahimJane AcquayeAnita Eseenam AgbekoNapoleon Bellua SamLeila GhalichiDenys NdangururaIrene BagahirwaDominic Konadu-YeboahFrederick Sarfo-AntwiLambert NzungizeNtombekhaya TshabalalaRichard OseiTamlyn MacQueneZaheer Babar ChandZabin WajidaliAdams DramaniEbenezer Kwame AmofaEric TwizeyimanaFazila SahibjanGhislaine UmwaliMehreen MustafaNadine MugishaTariq JakhroKenya National Bureau of Statistics, Nairobi, Nairobi, KenyaIntroduction Good health system governance is essential for reducing high mortality and morbidity after injury in low- and middle-income countries (LMICs). Unfortunately, the current state of governance for injury care is not known. This study evaluated governance for injury care in Ghana, Pakistan, Rwanda and South Africa, four LMICs with diverse contexts, to allow understanding of similarities or difference in the status of governance systems in different LMICs.Method This cross-sectional study captured the perceptions of 220 respondents (31 policymakers and 189 policy implementers) on injury care governance using the framework for governance in health system developed by Siddiqi. Input was captured in 10 domains: strategic vision; participation and consensus; rule of law; transparency; responsiveness; equity and inclusion; effectiveness and efficiency; accountability; intelligence and information; and ethics.Result The median injury care governance score across all domains and countries was 29% (IQR 17–43). The highest median score was achieved in the rule of law (50, 33–67), and the lowest scores were seen in the transparency (0, 0–33), accountability (0, 0–33), and participation and consensus (0, 0–33) domains. Median scores were higher for policymakers (33, 27–48) than for policy implementers (27, 17–42), but the difference was not statistically significant.Conclusion The four studied countries have developed some of the foundations of good injury care governance, although many governance domains require more attention. The gap in awareness between policymakers and policy implementers might reflect a delayed or partial implementation of policies or lack of communication between sectors. Ensuring equitable access to injury care across LMICs requires investment in all domains of good injury care governance.https://gh.bmj.com/content/10/2/e017890.full |
| spellingShingle | Alice Sitch Justine Davies Kathryn Chu Stephen Tabiri Junaid Razzak Lucia D’Ambruoso Alemayehu Amberbir Abebe Bekele Agnieszka Ignatowicz Mohammed Bukari Derbew Fikadu Berhe Barnabas Alayande Pascal Nzasabimana Jean Claude Byiringiro Huba Atiq Komal Abdul Rahim Jane Acquaye Anita Eseenam Agbeko Napoleon Bellua Sam Leila Ghalichi Denys Ndangurura Irene Bagahirwa Dominic Konadu-Yeboah Frederick Sarfo-Antwi Lambert Nzungize Ntombekhaya Tshabalala Richard Osei Tamlyn MacQuene Zaheer Babar Chand Zabin Wajidali Adams Dramani Ebenezer Kwame Amofa Eric Twizeyimana Fazila Sahibjan Ghislaine Umwali Mehreen Mustafa Nadine Mugisha Tariq Jakhro Health system governance for injury care in low- and middle-income countries: a survey of policymakers and policy implementors BMJ Global Health |
| title | Health system governance for injury care in low- and middle-income countries: a survey of policymakers and policy implementors |
| title_full | Health system governance for injury care in low- and middle-income countries: a survey of policymakers and policy implementors |
| title_fullStr | Health system governance for injury care in low- and middle-income countries: a survey of policymakers and policy implementors |
| title_full_unstemmed | Health system governance for injury care in low- and middle-income countries: a survey of policymakers and policy implementors |
| title_short | Health system governance for injury care in low- and middle-income countries: a survey of policymakers and policy implementors |
| title_sort | health system governance for injury care in low and middle income countries a survey of policymakers and policy implementors |
| url | https://gh.bmj.com/content/10/2/e017890.full |
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