Applying Siddiqi et al’s governance framework to trauma care systems in Ghana, Rwanda and South Africa
| S/N | Governance principle | Explanation of principles based on Siddiqi et al’s framework | Domain captured for trauma care | Maximum score for principle |
| 1 | Strategic vision | Through an understanding of the historical, cultural and social complexities of society, leaders have a strong sense of direction for the achievement of long and broad health and human development goals. | There is a detailed long-term strategic plans to improve trauma care. | 12 |
| 2 | Participation and consensus orientation | Everyone or interest groups or institutions acting on behalf of everyone should be given the chance to have a say in relation to decisions about health. This is built on the principle of freedom of association and speech as well as capacities to participate constructively. Good governance should be able to mediate between differing opinions among stakeholders on health, policies and procedures in order to reach a mutual understanding that is beneficial for all. | There is stakeholder participation and level of engagement in policy formulation and implementation for trauma. | 3 |
| 3 | Rule of law | Legal frameworks or policies relating to human rights on health especially should be applied impartially. | There is availability and enforcement of laws, guidelines and policies to support trauma care. | 6 |
| 4 | Transparency | There should be free flow of information on all health matters. There should be enough information available to all to not only monitor but also understand health matters. Processes, institutions and information should be directly accessible to those concerned with them. | There is transparency on commitments to trauma and available information on indicators and other trauma related information for providers (district) involved in local trauma service provision. | 3 |
| 5 | Responsiveness | Institutions and processes should promptly serve all stakeholders and ensure that their health and non-health needs are met without delays. | Trauma systems are responsive to trauma care needs of the population. | 10 |
| 6 | Equity and inclusiveness | Everyone should have the opportunity to improve or maintain their health and well-being. | There is equity in access to quality trauma care. | 8 |
| 7 | Effectiveness and efficiency | Institutions and processes should maximise available resources to render best healthcare services according to population needs, as well as influence improved health outcomes. | There is the existence of organisational capacity including human resource, communication processes to support quality trauma provision. | 6 |
| 8 | Accountability | People put in positions of trust from government, the private sector and civil society organisations should be accountable to the public and institutional stakeholders. Accountability in this sense varies depending on the type of institution or organisation and whether or not decisions are for internal or external purposes. | There is evidence of accountability between service providers and users in the provision of trauma care. | 3 |
| 9 | Intelligence and information | Essentials for understanding of the health system to guide the implementation of good policies that are based on empirical data to influence the behaviour of different interest groups that support the strategic vison for health. | There is availability of tools and capacity to capture trauma care data. | 2 |
| 10 | Ethics | Widely accepted principles of healthcare ethics: non-maleficence, beneficence and justice. This also includes ethics in healthcare research essential to safeguard the interest and rights of the patients. | There is enforcement of high ethical standards in trauma care provision and research. | 3 |
| Maximum score | 56 |
Questions for each governance principle are in table 3.