Factors influencing national public health governance capacity: based on NCA and fsQCA

Introduction With the acceleration of globalization, a series of public health emergencies have not only threatened population health but also significantly impacted global economic and political stability, highlighting the urgency for effective public health governance. Methods This study employs the TOE framework to examine 149 countries as case studies, utilizing Necessary Condition Analysis (NCA) and fuzzy-set Qualitative Comparative Analysis (fsQCA) to investigate the interactive effects and pathway selections of technological, organizational, and environmental conditions on national public health governance capacity. Results The findings reveal the following: (1) No single factor constitutes a necessary condition for high-level public health governance capacity. (2) Technological, organizational, and environmental factors operate in complex “multiple concurrent” configurations, generating diverse pathways that drive national public health governance capacity, illustrating the principle of “different routes leading to the same destination.” (3) Four configurational pathways that enhance national public health governance capacity are identified: configurations jointly explained by technological and organizational factors; configurations collectively determined by technological, organizational, and environmental factors; configurations independently explained by organizational factors; configurations jointly explained by organizational and environmental factors. (4) Representative nations across these four configurational pathways are predominantly high-income countries, with some upper-middle-income countries, while lower-middle-income and low-income countries are notably absent. Discussion This research recommends that countries develop targeted strategies to enhance public health governance capacity based on their specific characteristics and resource endowments. Simultaneously, assisting low-income countries in overcoming resource constraints and integrating them into global governance frameworks remains essential.