Table 1 Major characteristics/domains of health system governance principles covered by the HP-GGT

Types of participants

Components of accountability

Criteria for transparency

Generation, publication and dissemination of useful information

Elements of responsiveness

 State actors

Answerability

Quality of data

Types of information

Respect for dignity

 Health service providers

Sanctions

Speed of publishing data

Evidence based

Autonomy to participate in decisions

 Public

Rewards

Ease of access

Financial resources

Confidentiality

 Others

Enforcement

Mechanisms of transparency

Laws

Prompt attention

Representativeness

Types of accountability

Law to disclose

Values

Adequate basic health services

 Organisations

Financial accountability

E-transparency

Factors affecting use of information

Communication

 Themselves

Performance accountability

Freedom of press

External factors

Benefits of responsiveness

Benefits of participation

Political accountability

Written standard operating procedures and meeting minutes

Context

Human rights

 Ownership

Benefits of accountability

Documentation of policies

Type of evidence

Improve wellbeing

 Human rights

Control misuse and abuse

Benefits of transparency

Stakeholders and their relationship

Goal of health system performance

 Knowledgeable people

Efficient use of resources

Increase public accountability

Benefits of generation and use of information

Direct outcome of governance

 Democracy

Appropriate procedures

Increase public trust

Government encouragement and commitment for linking evidence to policy

Mechanisms to improve responsiveness

Negative impact of participation

Improved service delivery

Effective management

Making data generated at the service delivery level accessible to researchers

Institutional change

 Time consuming

Actors in accountability

Reform component

Need for a mechanism to check funding sources of research to be used in policy-making

Enable participation (inclusion, voice and influence)

 Conflict of interest

Policy-makers

Empower citizens

How research findings are adapted to local context

Media outlets (active and independent)

 Costly

Private sector

Prerequisite for donors

Public polls, surveys

Barriers/facilitators of participation

Civil societies

Strategies to enhance transparency

Need measures of public preferences

 Political will

Public

Institutional capacities and means to enhance it

Fair representation of all

 Legal framework for participants to be involved in decision-making

Who is accountable to whom?

Publishing public service reports

Health policy should be assessed to ensure it meets population needs

 Power struggle Financial resources

Mechanisms to foster accountability

Financial monitoring

 Context

Information system

Release of governments decisions

Criteria for effective participation

Dissemination of information

Decisions related to priority-setting and financial allocation should be made public

 Consensus orientation

Watchdog organisations

Conflict of interest declaration by all stakeholders

 Transparency

Whistleblowing mechanisms

Information should be released in a predictable manner

 Available information

Types of sanctions

 Standard operating procedures

Legal sanctions

Mechanisms to enhance participation

Regulatory sanctions

 Public inquires

Negative publicity

 Policy dialogue

Soft sanctions

 Citizen juries

Need to sign a contract/memorandum of understanding with stakeholders

 Assessments

Inform stakeholders that they will be held accountable before engaging them

 Roundtables

Public role in holding stakeholders accountable

 Contracts

 Committees

Institutional, technical capacity and leadership to facilitate the participation process

Gender consideration among participants

Presence of dedicated resources to enable participation

Using mechanisms to engage vulnerable groups

Presence of a participatory body to oversee the implementation of policy