2.1 Bolstering participatory governance. Robust governance mechanisms are needed in order to achieve a coherent and integrated approach in health care policy, planning and delivery at all levels of the health system. Governments need to take responsibility for protecting and enhancing the welfare of their populations and to build trust and legitimacy with citizens through effective stewardship. The stewardship role of the health ministry is essential for good governance in health, and involves the identification and participation of community stakeholders so that voices are heard and consensus is achieved. It is also needed to ensure that the different goals of donor agencies and vertical programmes tackling specific diseases do not hinder the ability of health systems to focus on community health and well-being for all.

• Community participation in policy formulation and evaluation

• National health policies, strategies and plans promoting integrated people-centred health services

• Harmonization and alignment of donor programmes with national policies, strategies and plans

• Decentralization, where appropriate, to local levels

• Clinical governance

2.2 Enhancing mutual accountability. Essentially, this means answerability of decision-making, and encompasses both the “rendering of the account” (that is, providing information about performance) and the “holding to account” (namely, the provision of rewards and sanctions). Strengthening accountability of health systems requires joint action at all levels to improve services organization and delivery, health policy in health and non-health sectors, public and private sectors, and people, towards a common goal.

• Health rights and entitlement

• Provider report cards

• Patient reported outcomes and balanced scorecard

• Performance based financing and contracting

• Population registration with accountable care provider(s)