ArticleBMJ global health2025
Health system governance for injury care in low- and middle-income countries: a survey of policymakers and policy implementors.
Article in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- 'A race against time': a photovoice study on priorities for quality of injury care with patients, health workers and policymakers in four low- and middle-income countries.BMJ global health · 2026Article
- A systems approach to understanding injury care in LMICs using causal loop diagrams.BMJ global health · 2026Article
- Critical deficits in CBRNE preparedness: A nationwide assessment of Jordanian healthcare providers' knowledge, skills, and training gaps.SAGE open medicine · 2025Article
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2 authors.
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Abstract
introductionGood health system governance is essential for reducing high mortality and morbidity after injury in low- and middle-income countries (LMICs). Unfortunately, the current state of governance for injury care is not known. This study evaluated governance for injury care in Ghana, Pakistan, Rwanda and South Africa, four LMICs with diverse contexts, to allow understanding of similarities or difference in the status of governance systems in different LMICs.
methodThis cross-sectional study captured the perceptions of 220 respondents (31 policymakers and 189 policy implementers) on injury care governance using the framework for governance in health system developed by Siddiqi. Input was captured in 10 domains: strategic vision; participation and consensus; rule of law; transparency; responsiveness; equity and inclusion; effectiveness and efficiency; accountability; intelligence and information; and ethics.
resultThe median injury care governance score across all domains and countries was 29% (IQR 17-43). The highest median score was achieved in the rule of law (50, 33-67), and the lowest scores were seen in the transparency (0, 0-33), accountability (0, 0-33), and participation and consensus (0, 0-33) domains. Median scores were higher for policymakers (33, 27-48) than for policy implementers (27, 17-42), but the difference was not statistically significant.
conclusionThe four studied countries have developed some of the foundations of good injury care governance, although many governance domains require more attention. The gap in awareness between policymakers and policy implementers might reflect a delayed or partial implementation of policies or lack of communication between sectors. Ensuring equitable access to injury care across LMICs requires investment in all domains of good injury care governance.
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