Assessing the governance of the health policymaking process using a new governance tool: the case of Lebanon

Emma Carmel, Rasha Hamra, Sameen Siddiqui, Walid Ammar

Research output: Contribution to journalArticle


Background: In the international agenda, it has become common to assert that the assessment of health system governance using a practical tool is crucial. This approach can help us better understand how health systems are being steered and identify gaps in decision-making process and their causes. The authors developed a new assessment tool, health policymaking governance guidance tool (HP-GGT), that was designed to be conceptually sound and practical. This tool enables policymakers and stakeholders to systematically review and assess health system governance at policymaking level. This article presents first use of HP-GGT in Lebanon, together with generated results, recommendations, and discusses how these results improve governance practices when initiating new health policy formulation processes.
Methods: HP-GGT, which is a multidimensional structured tool, was used retrospectively to assess and review the process used to develop a new mental health strategy; this process was compared against consensus-based good governance principles, focusing on participation, transparency, accountability, information and responsiveness. The assessment was conducted through face-to-face interviews with 11 key informants who were involved in the development of the strategy.
Results: HP-GGT enabled policymakers to reflect on their governance practices when developing mental health strategy and was able to identify key areas of strengths and weaknesses using good governance practice checklists given by the questions. The insights generated from the assessment equipped the national policymakers with a better understanding of the practice and meaning of policymaking governance. Identifying weaknesses to be addressed in future attempts to develop other national health policies helped in this regard. Using the tool also increased awareness of alternative good practices among policymakers and stakeholders.
Conclusions: Assessing health policy formulation process from a governance perspective is essential for improved policymaking. HP-GGT was able to provide a general overview and an in-depth assessment of policy formulation process related to governance issues according to international good practices that should be applied while formulating health policies in any field. HP-GGT was found to be a practical tool that was useful for policymakers when used in Lebanon and awaits applications in other low- and middle-income countries to further show its validity and utility.
Original languageEnglish
Article number66
JournalHealth Research Policy and Systems
Publication statusPublished - 15 Jun 2020


  • governance
  • health systems
  • governance assessment tool
  • Low and middle-income countries
  • health policy
  • public policy

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