Healthcare governance practices and their determinants among public hospital managers in South Wollo zone, Northeast Ethiopia.

Healthcare governance is essential for ensuring quality service delivery, accountability, and transparency within health systems. However, challenges such as resource limitations, political interference, and inexperienced management hinder effective governance in many regions, including the South Wollo Zone of Northeast Ethiopia. Therefore, this study assessed the healthcare governance practices and their determinants among public hospital managers in South Wollo Zone, Northeast Ethiopia, in 2024. A facility-based cross-sectional study using a mixed-method approach was conducted. Quantitative data were collected from 182 randomly selected hospital managers using simple random sampling. For the qualitative component, purposive sampling was employed to select 10 key informants for in-depth interviews. In this study, good governance was defined as the ability of hospital managers to uphold accountability, transparency, participation, responsiveness, and rule of law in their managerial roles, based on principles adapted from the World Health Organization's (WHO) health system governance framework. The WHO framework and the UNDP governance principles were used as reference frameworks to guide measurement and analysis of good governance among healthcare managers. For the quantitative analysis, good governance was treated as a single dependent variable, classified dichotomously as good governance or poor governance based on a predefined scoring system. Variables with a p-value < 0.2 in the bivariable logistic regression were considered candidates for multivariable logistic regression, and those with a p-value < 0.05 were considered statistically significant. Quantitative analysis revealed that only 41.20% of the managers demonstrated good healthcare governance practices. Key factors significantly associated with good governance included having governance-related training, access to structured feedback systems, opportunities for peer learning, and freedom from political interference. The qualitative findings supported these results, emphasizing the role of training, feedback, collaboration, and managerial autonomy in strengthening governance practices. To improve governance in public hospitals, strengthening managerial training programs, establishing regular feedback mechanisms, promoting peer-learning opportunities, and minimizing political interference are recommended.