@article {4165, title = {Linking governance mechanisms to health outcomes: A review of the literature in low- and middle-income countries.}, journal = {Social science \& medicine (1982)}, volume = {117C}, year = {2014}, month = {2014 Jul 14}, pages = {86-95}, abstract = {We conducted a synthesis of peer-reviewed literature to shed light on links between governance mechanisms and health outcomes in low- and middle-income countries. Our review yielded 30 studies, highlighting four key governance mechanisms by which governance may influence health outcomes in these settings: Health system decentralization that enables responsiveness to local needs and values; health policymaking that aligns and empowers diverse stakeholders; enhanced community engagement; and strengthened social capital. Most, but not all, studies found a positive association between governance and health. Additionally, the nature of the association between governance mechanisms and health differed across studies. In some studies (N~=~9), the governance effect was direct and positive, while in others (N~=~5), the effect was indirect or modified by contextual factors. In still other studies (N~=~4), governance was found to have a moderating effect, indicating that governance mechanisms influenced other system processes or structures that improved health. The remaining studies reported mixed findings about the association between governance and health (N~=~6), no association between governance and health (N~=~4), or had inconclusive results (N~=~2). Further exploration is needed to fully understand the relationship between governance and health and to inform the design and delivery of evidence-based, effective governance interventions around the world.}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2014.07.010}, author = {Ciccone, Dana Karen and Vian, Taryn and Maurer, Lydia and Bradley, Elizabeth H} }