Leadership, Management, and Governance Evidence Compendium

The compendium is designed to contribute to the evidence base and advocate for continued investment in L+M+G activities. The L+M+G Project, funded by the U.S. Agency for International Development (USAID), aimed to strengthen health systems by developing inspired leaders, sound management systems, and transparent governance practices. The project achieved its objectives by promoting performance improvement processes, using participatory approaches, building evidence-based approaches, and leveraging partnerships. A health system encompasses the organizations, people, and actions that promote, restore, and maintain communities' and individuals' health. The World Health Organization (WHO) categorizes the interrelated aspects of health system functioning into six building blocks: service delivery, health workforce, information, medical products, vaccines, and technologies, financing, and leadership and governance. In strong health systems, all six building blocks work together to provide timely, affordable, high-quality services. The WHO's description of the leadership and governance building block highlights the important role of leadership, management, and governance in laying the foundation for health systems' overall performance. Leadership and governance involve ensuring strategic policy frameworks exist and are combined with effective oversight, coalition building, regulation, attention to system-design, and accountability. The compendium focuses on L+M+G practices rather than theoretical functions or forms, allowing the results to inform intervention designs and implementation practices. Key L+M+G practices include scanning, focusing, aligning and mobilizing, inspiring, planning, organizing, implementing, monitoring and evaluating, cultivating accountability, engaging stakeholders, setting a shared direction, and stewarding resources. A recent publication from the WHO's Alliance for Health Policy and Research asserts that discussions of leadership in the context of health systems have largely focused on high-income country experiences. There is a similar lack of research related to health system governance, with minimal discussion of its influence on the building blocks or on overall health system performance. The compendium draws on existing evidence documented in peer-reviewed and grey literature to describe the mechanisms through which change occurs within the health system. It examines the links between L+M+G capacity-strengthening efforts and health system performance within each of the other building blocks through five chapters that discuss the evidence that illustrates L+M+G's role in the health system and the mechanisms through which L+M+G influences health system functioning. The literature search was guided by a rapid assessment methodology and took place over approximately nine months. The resulting compendium is not meant to be a systematic nor exhaustive review of the literature, but rather a formative evaluation of the state of the evidence to engender discussion and inform further research and study. The compendium uses standardized definitions from various sources, including the WHO and Management Sciences for Health (MSH). The definitions include health system, building blocks, building block functions and characteristics, leadership, management, and governance practices and functions, and evidence. The compendium includes information from implementation documentation and peer-reviewed research, and uses a working definition of leadership as mobilizing and inspiring others to achieve a shared vision. The compendium aims to contribute to the evidence base and advocate for continued investment in L+M+G activities, ultimately strengthening health system performance in LMIC.