stewardship in health system shahid beheshti university of medical sciences school of medical...

Stewardship in Health System

Shahid Beheshti University of Medical SciencesSchool of Medical EducationStrategic Policy Sessions: 23

Dr. Shahram Yazdani

Traditional Definitions of Stewardship

The Western concept of stewardship has religious roots.

In Genesis, God appoints humanity as the steward of creation.

The Old Testament also contains the story of Joseph, sold by his brothers into slavery, who becomes Putiphar’s and then the Pharaoh’s steward.

State-oriented Definition of Stewardship

WHO’s World Health Report 2000, views stewardship as ‘‘the effective trusteeship of national health’’.

The most basic approach defines stewardship as ‘‘the disinterested performance of a duty by government and/or its agents on behalf of a superior’’.

Policy-Operation Mismatch

PoliciesPublic, Administrative, Clinical

Health Outcomes

OperationsRisk Reduction, Public Health, Clinical Services, Research,

Education,…

PoliciesPublic, Administrative, Clinical

Health Outcomes

OperationsRisk Reduction, Public Health, Clinical Services, Research,

Education,…

Policy Formulation

Policy Legislations

Policy Implementation

Policy Evaluation

Policies are not self-implementable!

PoliciesPublic, Administrative, Clinical

Intrasectoral Operations

Health Outcomes

Intersectoral Operations

Intra vs. Inter-sectoral operations

PoliciesPublic, Administrative, Clinical

Intrasectoral Operations

Health Outcomes

Intersectoral Operations

Regulatory Standards

Setting Regulatory Standards

PoliciesPublic, Administrative, Clinical

Intrasectoral Operations

Health Outcomes

Intersectoral Operations

Regulatory StandardsPerformance

Monitoring

Performance Monitoring

Regulatory Activities (Reward & Punishment)

PoliciesPublic, Administrative, Clinical

Intrasectoral Operations

Health Outcomes

Intersectoral Operations

Regulatory StandardsPerformance

MonitoringRegulatoryActivities

PoliciesPublic, Administrative, Clinical

Intrasectoral Operations

Health Outcomes

Intersectoral Operations

Regulatory StandardsPerformance

MonitoringRegulatoryActivities

AccreditationLicensingFinancial Flow

Regulatory Activities (Reward & Punishment)

PoliciesPublic, Administrative, Clinical

Intrasectoral Operations

Health Outcomes

Intersectoral Operations

Regulatory StandardsPerformance

MonitoringRegulatoryActivities

Governance

PoliciesPublic, Administrative, Clinical

Intrasectoral Operations

Health Outcomes

Intersectoral Operations

Intrasectoral Governance

Intra-sectoral Governance

PoliciesPublic, Administrative, Clinical

Intrasectoral Operations

Health Outcomes

Intersectoral Operations

Intrasectoral Governance

Stakeholder analysis

Advocacy

Conflict Negotiation

Affecting extra-sectoral operations

Inter-sectoral Leadership

PoliciesPublic, Administrative, Clinical

Intrasectoral Operations

Health Outcomes

Intersectoral Operations

Intrasectoral Governance

Stakeholder analysis

Advocacy

Conflict Negotiation

PoliciesPublic, Administrative, Clinical

Intrasectoral Operations

Health Outcomes

Intersectoral Operations

Intrasectoral Governance Intersectoral Leadership

Inter-sectoral Leadership

Policy Implementation

PoliciesPublic, Administrative, Clinical

Intrasectoral Operations

Health Outcomes

Intersectoral Operations

Intrasectoral Governance Intersectoral Leadership

Policy Formulation

Policy Legislations

Policy Implementation

Policy Evaluation

Stewardship

Policy Making

Intrasectoral Operations

Health Outcomes

Intersectoral Operations

Intrasectoral GovernanceIntersectoral Leadership

Input for Policy-making

PoliciesPublic, Administrative, Clinical

Intrasectoral Operations

Health Outcomes

Intersectoral Operations

Intrasectoral GovernanceIntersectoral Leadership

Impact Evaluation

PoliciesPublic, Administrative, Clinical

Intrasectoral Operations

Health Outcomes

Intersectoral Operations

Intrasectoral GovernanceIntersectoral Leadership

Impact Evaluation

OperationMonitoring

Input for Policy-making

PoliciesPublic, Administrative, Clinical

Intrasectoral Operations

Health Outcomes

Intersectoral Operations

Intrasectoral GovernanceIntersectoral Leadership

Impact Evaluation

OperationMonitoring

HISMIS

The Importance of MIS & HIS

PoliciesPublic, Administrative, Clinical

Intrasectoral Operations

Health Outcomes

Intersectoral Operations

Intrasectoral GovernanceIntersectoral Leadership

Impact Evaluation

OperationMonitoring

HISMIS

Health Research

Input for Policy-making

PoliciesPublic, Administrative, Clinical

Intrasectoral Operations

Health Outcomes

Intersectoral Operations

Intrasectoral GovernanceIntersectoral Leadership

Impact Evaluation

OperationMonitoring

HISMIS

Health Research

Evidence Based Policy Making

Inputs to Evidence Based Policy Making

EvidenceBased

Policymaking

What is the current body of evidence?Systematic Review of International Literature

What is the current practice and success stories?National and International BenchmarkingComparative Studies

What is the unique specification and requirements? Situation Analysis

What is the current mode of practice?Performance Monitoring

What is the effect of previous policies? Impact Evaluation

What are the evidence gaps that should be filled ?Original National Research

Ideal Balance in Structure and Function in Public Sector

Information

Regulation

Finance

Policymaking

Mandates

Provision

Summary

Stewardship is the main function of health systems

Stewardship has three sub-functions Policy-making Intra-sectoral Governance Inter-sectoral Leadership

Any Question?