Table 2 Siddiqi et al. [21] governance framework principles (Adapted from Siddiqi et al. [21])

Strategic vision

 Leaders have a broad and long-term perspective on health and human development, along with a sense of strategic directions for such development. There is also an understanding of the historical, cultural and social complexities in which that perspective is grounded

Long-term vision; comprehensive development strategy including health

Participation and consensus orientation

 All men and women should have a voice in decision-making for health, either directly or through legitimate intermediate institutions that represent their interests. Such broad participation is built on freedom of association and speech, as well as capacities to participate constructively. Good governance of the health system mediates differing interests to reach a broad consensus on what is in the best interests of the group and, where possible, on health policies and procedures

Participation in decision-making process; stakeholder identification and voice

Rule of law

 Legal frameworks pertaining to health should be fair and enforced impartially, particularly the laws on human rights related to health

Legislative process; interpretation of legislation to regulation and policy; enforcement of laws and regulations

Transparency

 Transparency is built on the free flow of information for all health matters. Processes, institutions and information should be directly accessible to those concerned with them, and enough information is provided to understand and monitor health matters

Transparency in decision-making; transparency in allocation of resources

Responsiveness

 Institutions and processes should try to serve all stakeholders to ensure that the policies and programs are responsive to the health and non-health needs of its users

Response to population health needs; response to regional local health needs

Equity

 All men and women should have opportunities to improve or maintain their health and well-being

Equity in access to care; fair financing of health care; disparities in health

Effectiveness and efficiency

 Processes and institutions should produce results that meet population needs and influence health outcomes while making the best use of resources capacity for implementation

Quality of human resources; communication processes

Accountability

 Decision-makers in government, the private sector and civil society organizations involved in health are accountable to the public, as well as to institutional stakeholders. This accountability differs depending on the organization and whether the decision is internal or external to an organization

Accountability: internal; accountability: external

Intelligence and information

 Intelligence and information are essential for a good understanding of health system, without which it is not possible to provide evidence for informed decisions that influences the behaviour of different interest groups that support, or at least do not conflict with, the strategic vision for health

Information: generation, collection, analysis, dissemination

Ethics

 The commonly accepted principles of health care ethics include respect for autonomy, nonmaleficence, beneficence and justice. Health care ethics, which includes ethics in health research, is important to safeguard the interest and the rights of the patients

Principles of bioethics; health care and research ethics