The governance of basic health coverage: A systematic review

Abstract

Background: Governance is a concept with multiple meanings. In health coverage systems around the world, there is always an interest in studying governance and measuring its impact on the performance of existing systems and proposing evaluation tools.

Objectives: This study aimed to assess the application of governance in health medical coverage systems across the globe by conducting a systematic literature review. Specifically, it looked at whether we can define a standard model of health coverage governance and assess the governance of a country’s medical coverage.

Methods: A systematic review of the literature was conducted using Google Scholar in July 2019. We searched studies, published from 2002 to July 2019, on the governance of basic health coverage that were published in English and French. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was followed to conduct systematic reviews.

Results: We identified 27 studies that met our inclusion criteria. The governance of basic health coverage is analyzed in all publications that focused on health systems in a particular country or more that one country or looked at the phenomenon globally. A few of the included studies carried out specifications of governance in a health medical coverage context. The World Bank proposes an evaluation framework of the governance of health medical coverage using five main dimensions: coherent decision-making structures, stakeholder participation, transparency and information, supervision and regulation, and consistency and stability.

Conclusions: Our systematic review of the governance of basic health coverage showed that few studies have focused on this topic. The difficulty lies in the interaction that exists between basic health coverage and other systems: health and social protection systems. Our study also concluded that one study, that of the World Bank, evaluated the governance of basic health coverage. This reflection will be useful for all decision-makers who want to assess the governance of their health care system, provided that it is adapted to the country context. [Ethiop. J. Health Dev. 2020; 34(3): 217-225]

Key words: Governance, social security, health insurance, basic health coverage