Health system governance assessment in protracted crisis settings: Northwest Syria
Abstract Background Since the withdrawal of government forces from Northwest Syria due to the conflict, several national initiatives have aimed to create alternative governance approaches to replace the central governmental system. One of the recent initiatives was the formulation of so-called ‘Cent...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | Health Research Policy and Systems |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12961-023-01042-1 |
| _version_ | 1797555600506224640 |
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| author | Maher Alaref Orwa Al-Abdulla Zedoun Al Zoubi Munzer Al Khalil Abdulkarim Ekzayez |
| author_facet | Maher Alaref Orwa Al-Abdulla Zedoun Al Zoubi Munzer Al Khalil Abdulkarim Ekzayez |
| author_sort | Maher Alaref |
| collection | DOAJ |
| description | Abstract Background Since the withdrawal of government forces from Northwest Syria due to the conflict, several national initiatives have aimed to create alternative governance approaches to replace the central governmental system. One of the recent initiatives was the formulation of so-called ‘Central Bodies’ as institutional governance structures responsible for thematic planning and service provision; for example, the referral unit is responsible for planning and delivering medical referral services. However, the governance and administrative rules of procedures of these bodies could be immature or unsystematic. Assessing the governance of this approach cannot be condoned, especially with the urgent need for a methodical approach to strategic planning, achieving strategic humanitarian objectives, and efficiently utilizing available resources. Multiple governance assessment frameworks have been developed. However, none were created to be applied in protracted humanitarian settings. This research aims to assess the extent to which the existing health governance structure (central bodies) was capable of performing the governance functions in the absence of a legitimate government in Northwest Syria. Methods and materials A governance assessment framework was adopted after an extensive literature review and group discussions. Four principles for the governance assessment framework were identified; legitimacy, accountability and transparency, effectiveness and efficiency, and strategic vision. Focus Group Discussions were held to assess the levels of the selected principles on the governance thermometer scale. Qualitative and quantitative data were analyzed using NVivo 12 and SPSS 22 software programs, respectively. Results The level of the four principles on the governance thermometer scale was between the lowest and middle quintiles; ‘very poor or inactive’ and ‘fair and requires improvement’, respectively. The results indicate that the governance approach of Central Bodies in NWS is underdeveloped and summons comprehensive systematic development. The poor internal mechanisms, poor planning and coordination, and the absence of strategic vision were among the most frequent challenges to developing the approach. Conclusion Humanitarian actors and donors should pay more attention to health governance approaches and tools in protracted crises. The central bodies must improve coordination with the stakeholders and, most importantly, strategic planning. Establishing or utilizing an independent planning committee, with financial and administrative independence, is crucial to maintain and improving contextual governance mechanisms in Northwest Syria. |
| first_indexed | 2024-03-10T16:50:46Z |
| format | Article |
| id | doaj.art-62af0f12499d4817802018ac1a92d329 |
| institution | Directory Open Access Journal |
| issn | 1478-4505 |
| language | English |
| last_indexed | 2024-03-10T16:50:46Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Health Research Policy and Systems |
| spelling | doaj.art-62af0f12499d4817802018ac1a92d3292023-11-20T11:19:52ZengBMCHealth Research Policy and Systems1478-45052023-08-0121111310.1186/s12961-023-01042-1Health system governance assessment in protracted crisis settings: Northwest SyriaMaher Alaref0Orwa Al-Abdulla1Zedoun Al Zoubi2Munzer Al Khalil3Abdulkarim Ekzayez4Research for Health System Strengthening in Northern Syria (R4HSSS), Union for Medical and Relief Organizations, Incili Pinar MAHStrategic Research Center (ÖZ SRC)Research for Health System Strengthening in Northern Syria (R4HSSS), Union for Medical and Relief Organizations, Incili Pinar MAHResearch for Health System Strengthening in Northern Syria (R4HSSS), Union for Medical and Relief Organizations, Incili Pinar MAHSyria Public Health NetworkAbstract Background Since the withdrawal of government forces from Northwest Syria due to the conflict, several national initiatives have aimed to create alternative governance approaches to replace the central governmental system. One of the recent initiatives was the formulation of so-called ‘Central Bodies’ as institutional governance structures responsible for thematic planning and service provision; for example, the referral unit is responsible for planning and delivering medical referral services. However, the governance and administrative rules of procedures of these bodies could be immature or unsystematic. Assessing the governance of this approach cannot be condoned, especially with the urgent need for a methodical approach to strategic planning, achieving strategic humanitarian objectives, and efficiently utilizing available resources. Multiple governance assessment frameworks have been developed. However, none were created to be applied in protracted humanitarian settings. This research aims to assess the extent to which the existing health governance structure (central bodies) was capable of performing the governance functions in the absence of a legitimate government in Northwest Syria. Methods and materials A governance assessment framework was adopted after an extensive literature review and group discussions. Four principles for the governance assessment framework were identified; legitimacy, accountability and transparency, effectiveness and efficiency, and strategic vision. Focus Group Discussions were held to assess the levels of the selected principles on the governance thermometer scale. Qualitative and quantitative data were analyzed using NVivo 12 and SPSS 22 software programs, respectively. Results The level of the four principles on the governance thermometer scale was between the lowest and middle quintiles; ‘very poor or inactive’ and ‘fair and requires improvement’, respectively. The results indicate that the governance approach of Central Bodies in NWS is underdeveloped and summons comprehensive systematic development. The poor internal mechanisms, poor planning and coordination, and the absence of strategic vision were among the most frequent challenges to developing the approach. Conclusion Humanitarian actors and donors should pay more attention to health governance approaches and tools in protracted crises. The central bodies must improve coordination with the stakeholders and, most importantly, strategic planning. Establishing or utilizing an independent planning committee, with financial and administrative independence, is crucial to maintain and improving contextual governance mechanisms in Northwest Syria.https://doi.org/10.1186/s12961-023-01042-1Central bodiesConflictCrisisGovernanceHealth systemSyria |
| spellingShingle | Maher Alaref Orwa Al-Abdulla Zedoun Al Zoubi Munzer Al Khalil Abdulkarim Ekzayez Health system governance assessment in protracted crisis settings: Northwest Syria Health Research Policy and Systems Central bodies Conflict Crisis Governance Health system Syria |
| title | Health system governance assessment in protracted crisis settings: Northwest Syria |
| title_full | Health system governance assessment in protracted crisis settings: Northwest Syria |
| title_fullStr | Health system governance assessment in protracted crisis settings: Northwest Syria |
| title_full_unstemmed | Health system governance assessment in protracted crisis settings: Northwest Syria |
| title_short | Health system governance assessment in protracted crisis settings: Northwest Syria |
| title_sort | health system governance assessment in protracted crisis settings northwest syria |
| topic | Central bodies Conflict Crisis Governance Health system Syria |
| url | https://doi.org/10.1186/s12961-023-01042-1 |
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