1. Steering Role Priscilla Rivas-Loría Advisor, Health Sector Reform PAHO/WHO. Washington, D.C.

2. DECENTRALIZATION OF HEALTH SYSTEMS SEPARATION OF FUNCTIONS DETERIORATION OF PUBLIC HEALTH Scenario Derived from the Reforms New public and private actors Decentralization / de- concentration of Public Health services and individual-level care Increase in the participation of private insurances Need for Strengthening the Steering Role

3. Conceptual and Methodological Evolution of the Steering Role in Health GRAPHIC 1: Conceptual and Methodological Evolution of the Steering Role in Health Resolution CD40.R12 The Steering Role of Ministries of Health in Sectoral Reform Processes Elaboration of the Methodological Guidelines for the Performance Evaluation of the Steering Role Sub-regional Training Workshop, Central America and the Spanish Caribbean Performance and Strengthening of the National Authority’s Steering Role CD 40/13 Sub-committee on Planning and Programming The Steering Role of Ministries of Health in Reform Processes Sub-Regional Meeting for Central America, Guatemala: The Sectoral Steering Role and Leadership of the Ministry of Health Expert Meeting Washington, DC Development of Institutional Capacity to perform the Steering Role Elaboration of the Guidelines for Mapping the National Health Authority Expert Meeting – Validation of Methodological Guidelines Performance Evaluation of the NHA Steering Role Pilot Application in El Salvador Methodological Guidelines for the Performance Evaluation of the Steering Role Source:

4. Conceptual Framework and Methodological Instrument www.lachealthsys.org “Steering Role Capacity of the National Health Authority: Strengthening its Performance”

5. What is the Steering Role in Health? It is the exercise of the substantive responsibilities and competencies of public policy in health that are characteristic and indelegable in the context of the new schemes of relationships between government and society in the modern State. It is a competence that is characteristic of government and exercised through the Health Authority.

6. Health Authority The Health Authority is the custodian of the public good in health. It is comprised of the group of State institutions responsible for protecting the public good in health. Structural differences in each country in terms of its composition. Dependent on the federal or unitary structure and on the nature of the sector’s institutional organization.

7. Regulation Harmonization of Provision Financing Assurance Conduct/Lead Steering role Development of EPHF Dimensions of the Steering Role

8. HEALTH AUTHORITY FINANCING ASSURANCE REGULATION SERVICE PROVISION CONDUCT/LEAD Exclusive Responsibilities Shared Responsibilities ESSENTIAL PUBLIC HEALTH FUNCTIONS DIMENSIONS OF EXCLUSIVE RESPONSIBILITY OF THE HEALTH AUTHORITY

9. CONDUCT/LEADFINANCING ASSURANCEREGULATION PUBLIC HEALTH SERVICE PROVISION Economic Political Social Direct exercise of the substantive and indelegable responsibilities in Health that correspond to the State HEALTH AUTHORITY (citizens’ right) (power, governability) (industry, economic interest) Health Authority

10. Conduct/Lead Health Situation Analysis. Definition of Health Priorities and Goals. Formulation, Dissemination, Monitoring and Evaluation of health strategies, policies and plans. Leadership, Consensus, Mobilization of Actors and Resources in the Sector.

11. Conduct/Lead Health Promotion, social participation and control in health. Harmonization of International Technical Cooperation in Health. Political and Technical Participation in International and Sub-Regional Organizations. Evaluation of Health System Performance, including measurement of the fulfillment of goals; of the resources utilized; and of the efficiency of the health system.

12. Conduct/Lead Health situation analysis Definition of health priorities and goals Formulation of health policies, strategies, plans and programs Reach consensus and mobilize actors and resources BRAZIL MEXICO PERU

13. Conduct/Lead BRAZIL MEXICO PERU Promotion of public health, participation and social control in health Harmonize technical cooperation of international organizations Political and technical participation in international organizations Evaluation of health systems performance

14. Regulation Institutional and legal framework for the exercise of the steering role Fiscalization to ensure fulfillment of regulations Regulation of medical supplies and health technology; of goods and services; of the environment Regulation and certification of human resources in health

15. Regulation BRAZIL MEXICO PERU Institutional and legal framework backing for exercise of steering role Fiscalization to ensure fulfillment of regulations Regulation of medical supplies and health technology, goods and services Regulation and certification of Human Resources in Health

16. Financing Formulation of policies to correct distortions in sectoral financing. Monitor the sectoral financing process. Negotiate with principal providers. Redistribute funds to compensate for market asymmetries. Define criteria for resource allocation.

17. Financing BRAZIL MEXICO PERU Correct sectoral distortions in $ and increase equity Monitoring of financing process Negotiation with principal providers Redistri- bution of $ to compensate for market asymme- tries Define criteria for resource allocation

18. Assurance Definition of Guaranteed Package of Services Definition of populations and territories that will be covered by the Package of Services Regulation and Control of Public and Private Insurance Plans

19. Assurance BRAZIL MEXICO PERU Definition of guaranteed package of services Definition of populations that will be covered by the guaranteed package of services Regulation and control of public and private insurance plans

20. Harmonization of Service Provision Service Planning using Regional or Functional criteria Develop Regulatory Mechanisms for Protecting the Public and Guaranteeing Minimum Standards of Quality for Service Provision Promotion of Coalitions and Provision of Incentives for Self-Regulation

21. Service Provision Function BRAZIL MEXICO PERU COUNTRY Planning using regional or functional criteria Development of regulatory mechanisms for protecting the public and guaranteeing minimum standards of quality Promotion of coalitions and provision of incentives for self-regulation