Ensuring the good health of its people is the central purpose of health systems. However, people’s participation in the evolution of health systems is minimal. Low health literacy and centralized top-down governance systems are the main reasons for low participation. Easy access to health information from the web and social media, coupled with mushrooming of point-of-care and wearable monitoring and diagnostic equipment and self-care applications is changing the status quo. However, there is the inherent risk of accessing misinformation, wrong interpretation of the data, and misguided self-care.

A core function of public health systems is to communicate the right health education and right information so as to enable people to participate in their own health promotion, disease prevention, and control. It has become equally important to counter wrong education, wrong information, and wrong self-care tools. Second, there is a need to ensure that technological solutions do not lead to unintended harm to people. The third, is to listen to people’s actual health needs, rather than basing various decisions on perceived health needs. Fourth is to address the potential for an emerging new divide between people who are health-wise and digitally literate and those who are not.

While the emphasis is on people’s right to access essential healthcare, it is important to bring out people’s responsibility in promoting their own and others’ health, and in preventing disease for themselves and for others through public health literacy. Wearing a face mask in public places not only protects people from contracting respiratory infections and getting exposed to various airborne pollutants but also protects others from transmissible chest infections. This behavior shall arise out of proper health literacy than a legal mandate for it to be effective.

Health literacy regarding their fundamental rights to access health and their rights as consumers of healthcare services, goods, and insurance beneficiaries is essential to empower people to have an oversight on the functioning of the representatives that they have elected to represent their needs and the private sector from whom they purchase services and goods. Empowerment coupled with personal responsibility and accountability for their behaviors is vital for mature governance systems. Information symmetry arising out of health literacy leads to a healthy balance of power between various actors of governance.

People participate in governance through their elected representatives to the governing bodies. When these representatives strive to address their needs, they gain the trust of the people they represent and when they neglect their own people, they lose their confidence and trust. Hence, people’s confidence and trust in their leadership and governance systems are vital for social development. When people lose trust in their leadership, they look up to non-governmental organizations, media, and social activists to represent their needs.

Empowerment of local governance systems is essential for the full participation of people in governance. Empowered local governing bodies are highly responsive to the people on the ground than centralized systems. Governments have different responsibilities at different levels. Global governing bodies are responsible for global commons, global public goods, and global regulations. National governing bodies are responsible for national commons, goods, and security. Subnational and local governing bodies are more focused on operationalizing global and national policies and on responding to local issues and emergencies.

Many equate governance with governments. However, governance is an interplay between various actors for a shared purpose or objective. Each actor has certain rights, roles, and responsibilities to play in governance. Empowering each actor to exercise their rights, defining the roles of each actor for them to be responsible for, distributing the resources and delegating needed authority to perform their roles, and making each actor accountable for their actions is essential for the good governance of any system. The same applies to the governance of health systems.

Self-help groups (SHGs) are emerging to take care of themselves and their neglected needs when traditional governance systems falter in their functioning. Women SHGs have emerged as powerful alternatives in governance systems. Similarly, patients with a particular disease come together to help each other and also to represent their neglected needs with a more powerful voice. Civil society organizations are emerging to help people who are weak, poor, and marginalized. Social media has emerged as an important tool in the hands of people to channel their views, neglected needs, and demands. While all these are part of a thriving democracy, they are also symbols of failing governance systems.

Hence, it is increasingly evident that there should be defined institutional mechanisms to involve key stakeholders in governance processes, be it policy formulation or its implementation or promulgation of laws and their enforcement. There should be mutual trust and respect with a fine balance of power between key actors for the evolution of good governance systems. We learn that countries that have participatory governance systems performed better during the Covid-19 pandemic, endorsing the above views.

Dr. Krishna Reddy Nallamalla,
President, InOrder       

Photo Credits:  ADB Blog 

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