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Linking governance mechanisms to health outcomes: A review of the literature in low- and middle-income countries

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  • Ciccone, Dana Karen
  • Vian, Taryn
  • Maurer, Lydia
  • Bradley, Elizabeth H.

Abstract

We conducted a synthesis of peer-reviewed literature to shed light on links between governance mechanisms and health outcomes in low- and middle-income countries. Our review yielded 30 studies, highlighting four key governance mechanisms by which governance may influence health outcomes in these settings: Health system decentralization that enables responsiveness to local needs and values; health policymaking that aligns and empowers diverse stakeholders; enhanced community engagement; and strengthened social capital. Most, but not all, studies found a positive association between governance and health. Additionally, the nature of the association between governance mechanisms and health differed across studies. In some studies (N = 9), the governance effect was direct and positive, while in others (N = 5), the effect was indirect or modified by contextual factors. In still other studies (N = 4), governance was found to have a moderating effect, indicating that governance mechanisms influenced other system processes or structures that improved health. The remaining studies reported mixed findings about the association between governance and health (N = 6), no association between governance and health (N = 4), or had inconclusive results (N = 2). Further exploration is needed to fully understand the relationship between governance and health and to inform the design and delivery of evidence-based, effective governance interventions around the world.

Suggested Citation

  • Ciccone, Dana Karen & Vian, Taryn & Maurer, Lydia & Bradley, Elizabeth H., 2014. "Linking governance mechanisms to health outcomes: A review of the literature in low- and middle-income countries," Social Science & Medicine, Elsevier, vol. 117(C), pages 86-95.
    • Handle: RePEc:eee:socmed:v:117:y:2014:i:c:p:86-95
    DOI: 10.1016/j.socscimed.2014.07.010
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