Stewardship in Health System Dr Shahram Yazdani Shahid

Stewardship in Health System Dr. Shahram Yazdani Shahid Beheshti University of Medical Sciences School of Medical Education Strategic Policy Sessions: 23

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 Operations Risk Reduction, Public Health, Clinical Services, Research, Education, … Health Outcomes

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

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

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

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

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

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

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

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

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

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

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

Policy Implementation Policies Public, Administrative, Clinical Intrasectoral Governance Intersectoral Leadership Policy Formulation Intrasectoral Operations Intersectoral Operations Policy Legislations Policy Evaluation Policy Implementation Health Outcomes

Stewardship Policy Making Intrasectoral Governance Intersectoral Leadership Intrasectoral Operations Intersectoral Operations Health Outcomes

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

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

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

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

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

Inputs to Evidence Based Policy Making ØWhat is the current body of evidence? §Systematic Review of International Literature ØWhat are the evidence gaps that should be filled ? §Original National Research ØWhat is the current practice and success stories? §National and International Benchmarking §Comparative Studies ØWhat is the unique specification and requirements? §Situation Analysis ØWhat is the current mode of practice? §Performance Monitoring ØWhat is the effect of previous policies? §Impact Evaluation Evidence Based Policymaking

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?