TERRITORIAL HEALTH GOVERNANCE MODELS AND ORGANIZATIONAL INNOVATION: A SYSTEMATIC SCOPING REVIEW AND ANALYTICAL INSIGHTS FOR MOROCCO’S GST REFORM

Abstract

Abstract

1. Fragmented care, coordination failures across levels, and uneven territorial performance have long shaped debates in health systems, with territorial governance arrangements emerging as an important institutional response across contexts. Yet the academic literature remains dispersed, with no shared framework for comparing how governance models are designed, adapted, or evaluated across contexts. This study maps the main territorial health governance models identified in the international literature and examines the institutional factors shaping their trajectories. A systematic scoping review was conducted following PRISMA-ScR guidelines, covering 28 peer-reviewed studies published between 2000 and 2025 and indexed in Scopus database. The synthesis identifies four reform directions: decentralization and equity, territorial integration, participatory governance, and hybrid accountability. These reflect distinct forms of organizational innovation, involving changes in coordination mechanisms, authority distribution, and accountability arrangements. The findings suggest that territorial governance is best understood as a context-specific process of institution building, which limits the direct transferability of models across settings. In Morocco, the ongoing implementation of the Groupements Sanitaires Territoriaux points to the importance of context-sensitive adaptation in the design and delivery of territorial health reforms.

Keywords: territorial health governance; organizational innovation; decentralization; health system reform; scoping review.