Governance shortcomings put Global South patients at risk

Remarkable opportunities in the governance of injury care across Ghana, Pakistan, Rwanda, and South Africa highlight an urgent need for investments and strategies to address the high burden of injury-related deaths and disabilities in these countries.

Researchers discovered a significant gap exists between policymaking and policy implementation in these countries. That these gaps were similar in all countries, despite vastly different contexts, suggests weak policy implementation and engagement with those delivering services exists in many other in Low- or Middle-Income Countries (LMIC) across the Global South.

Good health system governance, whereby oversight and management are done in line with the rule of law and to protect human rights, is central to ensuring good health care. Issues of poor governance in injury care likely contributor to the large numbers of deaths after injury in LMICs – currently standing at 3.8 million per year.

The researchers found that overall governance score was around 30% across all countries indicating substantial room for improvement. Transparency, accountability, and participation & consensus consistently scored the lowest, revealing significant gaps in these essential areas.

Publishing its findings in BMJ Global Health, the international research group led by the University of Birmingham emphasise that addressing governance gaps is crucial for achieving equitable access to injury care and improving patient outcomes in LMICs.

They call for increased investment in all elements of good injury care governance, along with ongoing monitoring and evaluation to ensure that policies are effectively implemented and are reaching those who need them most.

Part of the NIHR-funded Global Health Group on Equitable Access to Quality Health Care for Injured People in Four Low- or Middle-Income Countries: Equi-injury, the study recommends bridging the policy/implementation gap through boosting accountability mechanisms, engaging better with stakeholders and creating clear operational frameworks. Strengthening data systems, capacity building, and continuous feedback between policymakers and implementers are also crucial.

The co-author, Dr Leila Ghalichi, from the University of Birmingham, commented: "Good governance is essential for ensuring access to quality health systems and reducing avoidable death and disability.

“Our findings highlight an urgent need for targeted interventions to improve governance for injury care in LMICs. This includes increasing awareness of existing governance structures, fostering greater transparency and accountability, and promoting inclusive participation in decision-making." Professor Justine Davies, the lead author adds.

The study surveyed 220 policymakers and policy implementers - assessing injury care governance across 10 key domains, including strategic vision, participation & consensus, rule of law, transparency, responsiveness, equity and inclusion, effectiveness and efficiency, accountability, intelligence and information, and ethics.

Injuries are a major contributor to the global burden of disease, with a disproportionate impact on LMICs. This study underscores that inadequate governance structures are hindering efforts to reduce preventable deaths and disabilities resulting from injuries.