This chapter examines health systems from the perspective of governance, drawing on the knowledge and experience garnered over the past decade at the national and firm levels and supplementing that with health-specific evidence. It also examines the effectiveness of government and specifically the efficiency of its role in producing health care services. The chapter outlines the health care markets, the role of government and the definition and measurement of governance. It reviews the evidence from developing countries on various elements of governance and corruption in health care delivery. The growth, governance and corruption literature largely ignores governance when it comes to public policies in the social sectors. The chapter summarizes accumulated evidence on components of governance and corruption, including: perceptions of corruption and performance; management challenges in public systems; staff absenteeism; under-the-table or informal payments for health services; corrupt practices including misuse of public funds, irregularities in contracting and purchasing supplies, petty theft and the selling of positions and promotions.