IT Service Management as an Operational Governance Framework for Healthcare Systems: A Policy Analysis of Procurement and Service Delivery

Operational inefficiencies in healthcare systems remain a major and under-addressed determinant of system performance, cost, and patient outcomes. Global evidence suggests that up to 20–40% of health expenditure is lost due to inefficiencies, including poor procurement practices, fragmented workflows, and weak coordination mechanisms. In parallel, stockouts of essential medicines affect 30–50% of healthcare facilities in many low- and middle-income countries, highlighting systemic failures in operational processes that directly compromise service delivery. Despite extensive focus on financing, workforce capacity, and access to services, current health system frameworks provide limited guidance on how internal operational workflows should be structured, governed, and monitored. This creates a critical policy gap between system-level objectives and their execution in routine healthcare operations. This study presents a policy analysis and conceptual framework examining the applicability of IT Service Management (ITSM), grounded in the ITIL framework, as an operational governance approach for healthcare systems. Drawing on cross-sectoral evidence from service management, health systems research, and procurement literature, the analysis maps ITSM practices to healthcare workflows and develops a service-oriented model for managing operational processes. The findings suggest that ITSM can function as a governance translation layer, aligning clinical demand, administrative workflows, and digital systems into a structured service architecture. By introducing standardized request mechanisms, incident-based management of disruptions, and measurable service-level performance, ITSM enables healthcare organizations to improve coordination, transparency, and accountability. This analysis positions ITSM as a policy-relevant governance framework for strengthening healthcare system performance, offering a scalable pathway to improving efficiency, service reliability, and system resilience.