This focus highlights the principal–agent linkages among
actors and the resulting incentives for good governance and health system
performance. The discussion identifies three disconnects that constitute challenges
for health system strengthening interventions that target improving
governance: (1) the gap between the good governance agenda and existing
capacities, (2) the discrepancy between formal and informal governance and (3)
the inattention to sociopolitical power dynamics. The article summarizes the three
country cases in the symposium and highlights their governance findings: health
sector reform in China, financial management of health resources in Brazilian
municipalities and budget reform in hospitals in Lesotho. The concluding sections
clarify how the three cases apply the model’s principal–agent linkages and
highlight the importance of filling the gaps remaining between problem diagnosis
and the development of practical guidance that supports ‘best fit’ solutions and
accommodates political realities in health systems strengthening.