Governance is how societies make and implement decisions

Governance is vitally important to health policy and implementation, but harder to pin down than almost any other core concept of health policy analysis. It refers to how decisions are made and implemented – everything from the ability of policy-makers to take evidence-based and relevant decisions to their ability to implement policies and create alignment between different actors. While conflicts, contradictions and burdens – as well as flat-out mistakes – will always be common in human affairs, focused and practical thinking about governance can reduce them.

Governance can be broken into five key domains: Transparency, Accountability, Participation, Integrity and policy Capacity

Frameworks for governance analysis are everywhere, confusing, diverse and often of uncertain applicability. Many of them fall into a checklist, or cookbook, literature which lists policies that look like “good governance”, regardless of whether the policies are relevant to a given country or the particular policy area.

However, a review of the large literature on governance reveals that almost every aspect of governance, good or bad, and almost every recommendation for the improvement of governance fall into one of five domains. We call these five domains the TAPIC framework and use it to highlight the places to look for potential or real governance problems and the policies that can redress them:

• T is for Transparency – making clear decisions, their grounds and the decision-makers.
• A is for Accountability – ensuring that anybody who acts must account for their actions to appropriate other actors who can reward or punish them.
• P is for Participation – ensuring that people who are affected by a decision can express their views about it in a way that ensures they are at least heard.
• I is for Integrity – a system in which organizations and jobs have clear definitions, and procedures such as hiring and contracting are regularized and clear.
• C is for policy Capacity – employing the necessary expertise to assist policy-makers in avoiding, diagnosing and remedying policy failures and unintended consequences.

A governance problem may mean too little or too much of something

While each of these domains has a positive connotation, they are parts of governance, not a cookbook for some mythical “good governance”. Thus, the problem of accountability might not be insufficient accountability, but too much accountability (wasting time on excess bureaucracy), or overly diffuse and contradictory accountability (with organizations trying to serve too many governments or others at once). The problem of participation might be lack of participation, or it might be so many or such complex forms of participation that only well resourced lobbies can master the system.

‘A vision without a context is a hallucination’: the importance of adapting governance concepts to specific contexts

Each of these domains can be strengthened using a number of mechanisms in certain contexts, and governance analysis and improvement is about identifying whether the problem is one of governance and then which policies, in which domains, will help. In practice it has been difficult to get beyond the simple statement that “context is important”. TAPIC is a tool for conducting the rigorous and context-sensitive analysis of particular systems and policies that is necessary to identify and remedy governance failings and make future policy problems less likely.

Is it a governance problem, what kind of governance problem is it, and what might address it?

The way to use TAPIC, therefore, is as a tool to go beyond the simple assertion that governance matters but is complex and context-dependent. Instead, break down governance problems: is it primarily a governance problem? If so, in which domains of governance does it primarily lie: transparency, accountability, participation, integrity or capacity? Once we know that, we can ask what kind of problem it is within those domains, and try to identify the policy tool that best addresses the problem at the lowest cost in energy, time and money. Rather than aspiring to good governance without regard to context, or taking actions that might not work, TAPIC focuses us on particular domains of governance within which problems arise and the tools that might work to address the problems.