Stewardship in Health System Shahid Beheshti University of Medical Sciences School of Medical Education Strategic 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 Policies Public, Administrative, Clinical Health Outcomes Operations Risk Reduction, Public Health, Clinical Services, Research, Education,…

Policies Public, Administrative, Clinical Health Outcomes Operations Risk Reduction, Public Health, Clinical Services, Research, Education,… Policy Formulation Policy Legislations Policy Implementation Policy Evaluation Policies are not self-implementable!

Policies Public, Administrative, Clinical Intrasectoral Operations Health Outcomes Intersectoral Operations Intra vs. Inter-sectoral operations

Policies Public, Administrative, Clinical Intrasectoral Operations Health Outcomes Intersectoral Operations Regulatory Standards Setting Regulatory Standards

Policies Public, Administrative, Clinical Intrasectoral Operations Health Outcomes Intersectoral Operations Regulatory Standards Performance Monitoring Performance Monitoring

Regulatory Activities (Reward & Punishment) Policies Public, Administrative, Clinical Intrasectoral Operations Health Outcomes Intersectoral Operations Regulatory Standards Performance Monitoring Regulatory Activities

Policies Public, Administrative, Clinical Intrasectoral Operations Health Outcomes Intersectoral Operations Regulatory Standards Performance Monitoring Regulatory Activities Accreditation Licensing Financial Flow Regulatory Activities (Reward & Punishment)

Policies Public, Administrative, Clinical Intrasectoral Operations Health Outcomes Intersectoral Operations Regulatory Standards Performance Monitoring Regulatory Activities Governance

Policies Public, Administrative, Clinical Intrasectoral Operations Health Outcomes Intersectoral Operations Intrasectoral Governance Intra-sectoral Governance

Policies Public, Administrative, Clinical Intrasectoral Operations Health Outcomes Intersectoral Operations Intrasectoral Governance Stakeholder analysis Advocacy Conflict Negotiation Affecting extra-sectoral operations

Inter-sectoral Leadership Policies Public, Administrative, Clinical Intrasectoral Operations Health Outcomes Intersectoral Operations Intrasectoral Governance Stakeholder analysis Advocacy Conflict Negotiation

Policies Public, Administrative, Clinical Intrasectoral Operations Health Outcomes Intersectoral Operations Intrasectoral GovernanceIntersectoral Leadership Inter-sectoral Leadership

Policy Implementation Policies Public, Administrative, Clinical Intrasectoral Operations Health Outcomes Intersectoral Operations Intrasectoral GovernanceIntersectoral 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 Policies Public, Administrative, Clinical Intrasectoral Operations Health Outcomes Intersectoral Operations Intrasectoral GovernanceIntersectoral Leadership Impact Evaluation

Policies Public, Administrative, Clinical Intrasectoral Operations Health Outcomes Intersectoral Operations Intrasectoral GovernanceIntersectoral Leadership Impact Evaluation Operation Monitoring Input for Policy-making

Policies Public, Administrative, Clinical Intrasectoral Operations Health Outcomes Intersectoral Operations Intrasectoral GovernanceIntersectoral Leadership Impact Evaluation Operation Monitoring HIS MIS The Importance of MIS & HIS

Policies Public, Administrative, Clinical Intrasectoral Operations Health Outcomes Intersectoral Operations Intrasectoral GovernanceIntersectoral Leadership Impact Evaluation Operation Monitoring HIS MIS Health Research Input for Policy-making

Policies Public, Administrative, Clinical Intrasectoral Operations Health Outcomes Intersectoral Operations Intrasectoral GovernanceIntersectoral Leadership Impact Evaluation Operation Monitoring HIS MIS Health Research Evidence Based Policy Making

Inputs to Evidence Based Policy Making Evidence Based Policymaking  What is the current body of evidence?  Systematic Review of International Literature  What is the current practice and success stories?  National and International Benchmarking  Comparative 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?