Governance Roles and Capacities of Ministries of Health: A Multidimensional Framework

Document Type : Perspective


1 Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland

2 University of Chicago, Chicago, IL, USA

3 World Health Organization, Geneva, Switzerland

4 Health Systems Governance Collaborative, Geneva, Switzerland


The lack of capacity for governance of Ministries of Health (MoHs) is frequently advanced as an explanation for health systems failures in low- and middle-income countries (LMICs). But do we understand what governance capacities MoHs should have? Existing frameworks have not fully captured the dynamic and contextually determined role of MoHs, and there are few frameworks that specifically define capacities for governance. We propose a multidimensional framework of capacities for governance by MoHs that encompasses both the “hard” (de jure, explicit and functional) and “soft” (de facto, tacit, and relational) dimensions of governance, and reflects the diversification of their mandates in the context of the Sustainable Development Goals (SDGs). Four case studies illustrate different aspects of the framework. We hope that the framework will have multiple potential benefits including benchmarking MoH governance capacities, identifying and helping analyze capacity gaps, and guiding strategies to strengthen capacity.


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  • Receive Date: 14 December 2019
  • Revise Date: 02 March 2020
  • Accept Date: 05 March 2020
  • First Publish Date: 01 May 2021