Development of Health Policymaking Governance Guidance Tool (HP-GGT)

  • Rasha Hamra

Student thesis: Doctoral ThesisDoctor of Health (DHealth)


Assessing and understanding governance at all levels of the health system is crucial to improve the way in which the system is steered and managed and thus might positively affect (among other things) its performance, and ultimately, health outcomes. This association needs to be further explored by more research in order to confirm the type of relationship between governance and health outcomes, but first we need to define it and assess it in a pragmatic way. Previously, several assessments tools for health governance were proposed; but, due to a range of reasons, they are not being widely employed. Thus, there is a need for a new assessment tool to address some of the limitations of the existing ones (one that is specific to the health sector, practical, and capable of assessing change and progress over time) and help fill some of the gaps in knowledge (such as supplementing conceptual depth to the governance principles covered). Additionally, policymakers require a diagnostic tool to identify deficiencies in governance that need to be addressed.This research involved the development of a valid generic tool, suitable for assessing the principles and practices of governance in health policymaking, as well as providing a structured opportunity to policymakers to critically reflect on good practices. The assessment/guidance instrument covers five fundamental principles of good governance (GG) as yet insufficiently explored within the literature on health governance or systematically operationalised. These are participation, transparency, accountability, use of information, and responsiveness. The tool was developed over five steps (three stages). Stage one focused on the conceptualisation of the five selected principles based on a review of the available literature, with the aim to compile concepts/characteristics of GG under each of these principles and operationalise them into a list of questions, which comprised the initial tool. In stage two, the tool was refined by conducting three rounds of online Delphi consultations with 25 experts from 16 countries. These consultations helped attain consensus on the most important characteristics of the governance principles and explored new attributes that were not identified through the literature search. Moreover, the tool was reviewed by seven high-level policymakers from seven different countries, mainly to consider its practical application in the health context. Stage three pertained to pilot testing the refined tool with regard to a new national policy on mental health in Lebanon in order to identify GG practices as well as possible gaps in its formulation. The results of the assessment were presented with recommendations to the relevant policymakers. In conclusion, the end product of this research is a Health Policymaking Governance Guidance Tool (HP-GGT) that can be readily used by policymakers at the Ministry of Health level and/or by health authorities. It offers guidance concerning a list of "good practices" for reflexivity that could lead to enhancements in health policy governance.
Date of Award6 Oct 2018
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorEmma Carmel (Supervisor) & Walid Ammar (Advisor)


  • Health System Governance
  • Assessment Tool
  • Health Policymaking

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