Governance in health: A conceptual and analytical approach to research

Abstract

In the Latin American region there is a notable absence of conceptual coherency in the use of the terms governability and governance. This is true for their application to both the social and political sciences and health. Researchers' understanding of governance varies, and the concept is used heterogeneously within academic circles, with ignorance of the term on the part of decision-makers and great confusion and ambiguity in the meanings used by researchers and decision-makers in the health sector. Instead of the prevailing normative use, promoted by most international agencies, a conceptual and analytical framework for governance is proposed here for health systems and services research. Advances in the design of this framework were used to evaluate the public health insurance program in Buenos Aires, Argentina, which allowed the use of the analytical framework to be assessed as a tool for systemizing the social, political, and institutional complexity of the health policy formulation and implementation processes.