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