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


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


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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    References listed on IDEAS

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    6. Martina Björkman & Jakob Svensson, 2009. "Power to the People: Evidence from a Randomized Field Experiment on Community-Based Monitoring in Uganda," The Quarterly Journal of Economics, Oxford University Press, vol. 124(2), pages 735-769.
    7. Veenstra, Gerry, 2002. "Social capital and health (plus wealth, income inequality and regional health governance)," Social Science & Medicine, Elsevier, vol. 54(6), pages 849-868, March.
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    11. Lewis, Maureen & Pettersson, Gunilla, 2009. "Governance in health care delivery : raising performance," Policy Research Working Paper Series 5074, The World Bank.
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    1. repec:eee:socmed:v:206:y:2018:i:c:p:67-74 is not listed on IDEAS
    2. Krueger, Patrick M. & Dovel, Kathryn & Denney, Justin T., 2015. "Democracy and self-rated health across 67 countries: A multilevel analysis," Social Science & Medicine, Elsevier, vol. 143(C), pages 137-144.
    3. Daniel Cobos Muñoz & Paloma Merino Amador & Laura Monzon Llamas & David Martinez Hernandez & Juana Maria Santos Sancho, 2017. "Decentralization of health systems in low and middle income countries: a systematic review," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 62(2), pages 219-229, March.


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