ArticleBMC public health2011
Health systems performance in sub-Saharan Africa: governance, outcome and equity.
Article in BMC public health, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The Astronomy of Africa's Health Systems Literature During the MDG Era: Where Are the Systems Clusters?Global health, science and practice · 2015Pooled it
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- Health system governance in strengthening International Health Regulations (IHR) compliance in Myanmar.BMJ global health · 2020Review
- Monitoring Sustainable Development Goals 3: Assessing the Readiness of Low- and Middle-Income Countries.International journal of health policy and management · 2020Article
- Governing access to emergency care in Africa.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2020Review
- 'I have no love for such people, because they leave us to suffer': a qualitative study of health workers' responses and institutional adaptations to absenteeism in rural Uganda.BMJ global health · 2019Article
- Health sector governance: should we be investing more?BMJ global health · 2017Review
- Trends in Between-Country Health Equity in Sub-Saharan Africa from 1990 to 2011: Improvement, Convergence and Reversal.International journal of environmental research and public health · 2016Article
- Factors associated with declining under-five mortality rates from 2000 to 2013: an ecological analysis of 46 African countries.BMJ open · 2016Article
- Effect of Governance Indicators on Under-Five Mortality in OECD Nations: Generalized Method of Moments.Electronic physician · 2016Article
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- Implementing people-centred health systems governance in 3 provinces and 11 districts of Afghanistan: a case study.Conflict and health · 2015Article
- Health systems performance assessment in low-income countries: learning from international experiences.Globalization and health · 2014Review
- [Performance of a zonal hospital in Benin: an example of evaluation model].The Pan African medical journal · 2014Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe literature on health systems focuses largely on the performance of healthcare systems operationalised around indicators such as hospital beds, maternity care and immunisation coverage. A broader definition of health systems however, needs to include the wider determinants of health including, possibly, governance and its relationship to health and health equity. The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance.
methodsUsing cross sectional data from 46 countries in the African region of the World Health Organization, an ecological analysis was conducted to examine the relationship between governance and health systems performance. The data were analysed using multiple linear regression and a standard progressive modelling procedure. The under-five mortality rate (U5MR) was used as the health outcome measure and the ratio of U5MR in the wealthiest and poorest quintiles was used as the measure of health equity. Governance was measured using two contextually relevant indices developed by the Mo Ibrahim Foundation.
resultsGovernance was strongly associated with U5MR and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes.
conclusionThis study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the causal relationship, and its generalizability beyond U5MR as a health outcome measure, as well as the geographical generalizability of the results.
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