Sunday, November 10, 2013

Health as an indicator of good governance

It suddenly dawned on me this morning (jet lagged) that health is a direct reflection of good governance. An indicator that governments are functioning in a manner that is protective of the people they are governing. Online searching has revealed some interesting work by the Center for Global Development/Global Health Policy. I found an article from 2006 titled "Measuring Commitment to Health" (link:,final.pdf), which describes the CGD's efforts to inform better measurment of government performance in the health sector. It's extremely well done both theoretically and delivery. The authors of this report discuss the Millenium Challenge Account, and how it measures government performance in the health sector, which is interesting:
At the forefront of the movement to link aid allocation to evidence of good governance is the Millennium Challenge Account (MCA), a bilateral U.S. development assistance program intended to promote poverty reduction and growth in countries with good governance and development policies.The MCA, managed by the independent agency the Millennium Challenge Corporation (MCC), uses a set of 16 indicators to measure various aspects of governance and commitment to sound policies in low- and lower-middle-income countries. Countries that perform well relative to their peers on indicators in three categories – labeled “ruling justly,” “economic freedom” and “investing in people” – are rewarded with access to the agency’s nearly $5 billion pool of aid money. For countries that do not pass this eligibility filter, the agency anticipates that the promise of aid in exchange for results will serve as an incentive to improve their performance, and recent research has supported this hypothesis
But what is "Good Governance"? Here is how the authors define it:
The most critical consideration in the serach for a proxy for good governance in the health sector is the definition of good government behavior. For the purposes of this analysis, the working Group poased four questions related to a government's commitment to the health of its citizents: i. Is the government placing appropriate priority on health, relative to its means? ii. Is the government focusing its resources on public goods and essential public health functions? iii. Is the government employing cost-effective health interventions so that limited health resources go furthest toward improved health outcomes? iv. Is the government protecting the poor and other vulnerable populations from catastrophic losses? In concept, then an ideal suite of indicators would relfect all of these elements of a government's health policies. Of these, however, questions (ii) and (iii) are easiest to measure objectively and are the focus of the Working Group's efforts.
Open access to health services of a reasonable standard...I think that's a succint (and not nuanced) summary of what the working group was thinking.

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