Arthur Mapanga
Governments, especially in low income countries, are in the most cases grappling with acute challenges associated with the delivery of adequate services to their citizens. In particular, the conceptualization and operationalization of good governance tenets in healthcare systems are an enduring mirage for fragile states. While literature affirms the critical role of effective governance in healthcare delivery systems, the failure of governments in fragile states such as Zimbabwe to provide effective access to equitable and quality healthcare services is symptomatic of weak governance mechanisms. Despite the many studies on health sector governance, there seem to be a persistent lack of clarity on the exact impediments to the effective and efficient governance in healthcare systems in fragile states of the world. This research sought to establish the inherent impediments to effective healthcare governance in fragile states. This was a twostage multimethod research which started with a directed literature search and focus group discussions to identify the themes that were used to develop the questionnaire for data collection to identify and confirm the inherent impediments to healthcare governance in fragile states. The research showed among others, that healthcare system governance in fragile states is prone to be influenced by the lack of justice-based leadership, leadership legitimacy, clear leadership roles and responsibilities, leadership probity, clear vision and mission, administrative efficiency, performance oriented culture, transparency and predictability, ethical decision-making, rulebound decision-making and action, delegated authority, leadership accountability, strong regulatory regimes, effective corruption prevention mechanisms and a strong community voice which combined present serious impediments to effective governance of healthcare delivery systems. In practical terms, fragile states healthcare governance may only be improved when the identified impediments are included in the development and implementation of healthcare delivery strategy.