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

IntroductionWith 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.MethodsThis 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.ResultsThe 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 t