Contributory NHI systems often involve a set of new functions in the health system, engage many stakeholders, either as policymakers, providers, or community members. Thus, effective governance requires institutional arrangements well established to carry out these functions effectively with accountability, good coordination, effective system learning and the optimal level of collaboration. NHI systems often establish a new dedicated contributory funding stream (an earmarked tax or premium payments) and a new public agency to manage the funds and purchase services from health care providers. This policy brief outlines the functions that NHI systems and agencies need to carry out to implement the system effectively and provides some options for
the institutional arrangements for NHI agencies.