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Governance in the Health Sector : A Strategy for Measuring Determinants and PerformanceMany different strategies have been proposed to improve the delivery of health care services, from capacity building to establishing new payment mechanisms. Recent attention has also asked whether improvements in the way health care services are governed could make a difference. These approaches ask which factors -- such as rules and institutions -- influence the behavior of the system in ways that are associated with better performance and outcomes. This paper reviews the concept of governance as it is used in the literature on private firms, public administration, international development and health. It distinguishes between indicators that measure governance determinants from those that measure governance performance in order to propose a framework that is analytically coherent and empirically useful. The framework shows how these indicators can be used to test hypotheses about which governance forms are more useful for improving health system performance. The paper concludes by proposing specific measures of governance determinants and performance and describes the instruments available to collect and interpret them.
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Reprioritizing Government Spending on Health : Pushing an Elephant Up the Stairs?Countries vary widely with respect to
 the share of government spending on health, a metric that
 can serve as a proxy for the extent to which health is
 prioritized by governments. World Health Organization (WHO)
 data estimate that, in 2011, health's share of
 aggregate government expenditure in the 170 countries for
 which data were available averaged 12 percent. However,
 country differences were striking: ranging from a low of 1
 percent in Myanmar to a high of 28 percent in Costa Rica.
 Some of the observed differences in health's share of
 government spending across countries are unsurprisingly
 related to differences in national income. However,
 significant variations exist in health's share of
 government spending even after controlling for national
 income. This paper provides a global overview of
 health's share of government spending and summarizes
 key theoretical and empirical perspectives on allocation of
 public resources to health vis-a-vis other sectors from the
 perspective of reprioritization, one of the modalities for
 realizing fiscal space for health. Theory and cross-country
 empirical analyses do not provide clear, cut explanations
 for the observed variations in government prioritization of
 health. Standard economic theory arguments that are often
 used to justify public financing for health are equally
 applicable to many other sectors including defense,
 education, and infrastructure. To date, empirical work on
 prioritization has been sparse: available cross-country
 econometric analyses suggests that factors such as
 democratization, lower levels of corruption, ethnolinguistic
 homogeneity, and more women in public office are correlated
 with higher shares of public spending on health; however,
 these findings are not robust and are sensitive to model
 specification. Evidence from case studies suggests that
 country-specific political economy considerations are key,
 and that results-focused reform efforts, in particular
 efforts to explicitly expand the breadth and depth of health
 coverage as opposed to efforts focused only on government
 budgetary targets, are more likely to result in sustained
 and politically-feasible prioritization of health from a
 fiscal space perspective.
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Bangladesh Governance in the Health SectorThe purpose of this systematic review is to inform the World Bank, development partners and other stakeholders on the state of governance in the health sector of Bangladesh. With billions2 of Bangladeshi Taka invested in the government-run health sector every year, financed by domestic and international sources, there have been numerous efforts to better understand the governance challenges in the sector. This report reviews sixty such reports and studies written by NGOs, academics, government entities, research institutions, consultants and development partners, in the last fourteen years. However, translating that research into policy dialogue and improvement has been challenged due to poor knowledge management, a lack of a systematic approach to research (building on earlier studies findings), and limited efforts to place the work in the public domain and discourse. This paper takes a systematic approach to the literature review, bringing the key findings together and evaluating the weight of evidence on the governance problems in the sector, as well as the gaps that should be addressed by future research efforts. This review furthermore emphasizes the need to understand the factors, and political economy factors in particular, that explain the current state of affairs. The review is structured to systematically assess this literature, leading to several broad conclusions. First, it identifies the structure and method of the review and outlines the categorization of the governance issues reviewed, and provides a background to the health sector. It then methodically summarizes the relevant literature for each governance issue, highlighting the lessons and identifying the gaps and weaknesses. The review ends by highlighting these gaps in research, with a view to improve its scope and impact.