Anna Elisabet Olafsdottir|Daniel D. Reidpath|Subhash Pokhrel|Pascale Allotey
Health systems performance in sub-Saharan Africa: governance, outcome and equity
Brunel University London|Monash University Malaysia|Brunel University London|Monash University Malaysia
literature health systems focuses largely performance healthcare systems operationalised around indicators hospital beds maternity care immunisation coverage broader definition health systems however needs include wider determinants health including possibly governance relationship health health equity aim study examine relationship health systems outcomes equity governance part process extend range indicators used assess health systems performanceusing cross sectional data 46 countries african region world health organization ecological analysis conducted examine relationship governance health systems performance data analysed using multiple linear regression standard progressive modelling procedure underfive mortality rate u5mr used health outcome measure ratio u5mr wealthiest poorest quintiles used measure health equity governance measured using two contextually relevant indices developed mo ibrahim foundationgovernance strongly associated u5mr moderately associated u5mr quintile ratio controlling possible confounding healthcare finance education water sanitation governance remained significantly associated u5mr governance however significantly associated equity u5mr outcomesthis study suggests quality governance may important structural determinant health systems performance could indicator monitored association suggests might causal relationship however crosssectional design level missing data small sample size forces tentative conclusions research needed assess causal relationship generalizability beyond u5mr health outcome measure well geographical generalizability results