In recent years, the governance of the health system has become a
key issue of discussion for international organisations such as the
WHO, the WB, UNDP, USAID and the EC. Furthermore, they state that
spending on health would not alone achieve the intended results in
health without addressing governance. The study aims to recommend
specific strategies to strengthen governance of the DHA in Bihar.
In doing so, it first identifies and critically analyses the causes
of poor governance. Moreover, it reviews theories and documented
effective examples of strengthening governance in the district
level health systems in low and middle income countries. The study
finally analyses various strategies for strengthening governance
and outlines appropriate governance for the DHA. To undertake this
study, a framework developed by Brinkerhoff et al. (2008) is used,
which covers leadership and management capacity, accountability,
community participation and transparency in decision making. The
methodology primarily involves reviewing secondary data; however, a
number of health and development professionals were contacted to
obtain a number of practical experiences.
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