The design and functioning of health systems is not simply a result of technical knowledge and capacities. Health systems are shaped by the choices made by political actors and by how leaders and managers exercise authority. They are a product of decisions about how resources should be raised, allocated and rationed, how public inputs are organized and listened to, and the signals sent to health workers about their roles, orientation and performance. These features of governance and accountability are recognized to be central to the performance of health systems. They have become of even greater importance in recent years with mounting political and leadership challenges.
Alliance for Health Policy and Systems Research Research Issues 3, October 2008, Alliance HPSR, WHO, Geneva, Switzerland, 12 pp.