The Chapter describes health system governance as the aggregation of principles and normative values within the political system in which a health system functions. There is increasing appreciation of the central role of governance in influencing all elements of the health system. The five key governance principles or elements in health are strategic vision, participation, accountability, transparency, and rule of law. These, and other, governance principles have an influence strategic planning and decisionmaking, regulation, partnerships, and insurance in health. Multisectoral governance in health involves government and non-government agencies to address multidimensional challenges of differing levels of complexity across multiple sectors. Ministries of health need to assume new responsibilities in the 21st century and adopt roles that include – de jure governance processes, preparation for and response to change in context, relationship management, and values management. More work is needed to delineate the scope and influence on all health system functions, assessment tools and monitoring indicators, and to develop interventions for improving governance of the health system.

Whilst Saudi government decision-making remains ‘top-down’, the dynamic within this approach has shifted as the top-down system incorporates a consultation process that includes newly established civil society institutions alongside recognition that public opinion cannot always be ignored in the new/social media age. Indeed, of particular significance in Saudi Arabia is growing public awareness, particularly amongst young educated Saudis, of the need for government accountability, transparency and best practices. In addition, there have been indications that the Al Saud leadership – to a degree – recognizes the necessity of being answerable to society on domestic policy-making issues that affect citizens’ lives. Therefore, the aim of this chapter is to assess perceptions of new media usage, most specifically social media, as well as the importance of public opinion, government transparency and awareness of political issues, and the impact these have on daily life as linked to politico-economic and socio-cultural change in Saudi Arabia.