Health System Governance Assessment in Protracted Crisis Settings Northwest Syria

Published: 17 November 2022| Version 1 | DOI: 10.17632/z2y4dgpgw9.1
Maher Alaref


This research aims to assess the extent to which the existing health governance structure (central bodies) was capable of performing the governance functions in the absence of a legitimate government in Northwest Syria. A governance assessment framework was adopted after an extensive literature review and group discussions. Four principles for the governance assessment framework were identified; legitimacy, accountability and transparency, effectiveness and efficiency, and strategic vision. Focus Group Discussions were held to assess the levels of the selected principles on the governance thermometer scale. Qualitative and quantitative data were collected and analyzed using NVivo 12 and SPSS 22 programs The level of the four principles on the governance thermometer scale was between the lowest and middle quintiles; ‘very poor or inactive’ and ‘fair and requires improvement’ respectively. The results indicate that the governance approach of Central Bodies in NWS is underdeveloped and summons comprehensive systematic development. The poor internal mechanisms, poor planning and coordination, and the absence of strategic vision were among the most frequent challenges to developing the approach.


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FGDs after a two-day workshop to discuss the concept of research and deduce contextualized health system governance assessment framework


King's College London


Health System, Governance, Assessment, Health, Syria


National Institute for Health and Care Research