Unpacking Zimbabwe's Sub-national Health Systems Governance Dynamics in the 21st Century: A Scoping Review

Abstract

Health system governance is growing in prominence globally, with increasing recognition of it’s role in health system performance, particularly in low-and middle-income countries. Zimbabwe’s Ministry of Health and Child Care (MOHCC) emphasizes the criticality of effective health governance for equitable and universal health coverage. However, despite the efforts, governance challenges persist, and the subject remains under-explored in Zimbabwe. This scoping review systematically maps and synthesizes evidence on subnational health system governance in Zimbabwe in the 21st century. Databases searched include PubMed Central, Science Direct, Springer Nature Link, ProQuest, Google Scholar, and grey literature. Based on the employed search criteria, ten studies were identified and included in the review. The review found persistent governance challenges across governance domains, across governance levels and throughout the period under review. Poor accountability, weak leadership capacity, inadequate decision-space, undervalued community governance structures were frequently cited. Few studies demonstrated potential for enhancing health governance through deliberate efforts to capacitate governance structures and systematically institutionalize governance in the wider health functions. The review found that evidence on subnational health governance in Zimbabwe was scant. Strengthening the evidence base on subnational health governance through empirical research will be essential for informing future health sector reforms that strengthen governance at the subnational level.