The importance of values in shaping how health systems governance and management can support universal health coverage

In this article, we use cultural theory to investigate the nature of health systems governance and management, showing that it may be helpful in identifying key aspects of the debate about how to promote universal health coverage. Cultural theory argues that 'how' we govern and manage health services depends on what we think about the nature of government organizations and the legitimacy of their scope of action. The values that are implied by universal health coverage underlie choices about 'how' health systems are governed and their organizations are managed. We draw two main conclusions. First, the translation of principles and goals into practice requires exceptional efforts to design adequate decision-making arrangements (the essence of governance) and management practices. Management and governance, or 'how' policies are decided and conducted, are not secondary to the selection of the best policy solutions (the 'what'). Second, governance and management solutions are not independent of the values that they are expected to serve. Instead, they should be designed to be consonant with these values. Cultural theory suggests-and experience supports-the idea that 'group identity' is favorable for shaping different forms of social life and public administrations. This approach should thus be a starting point for those who strive to obtain universal health coverage.