Stewardship and health systems strengthening: An overview
| Author | Derick W. Brinkerhoff,Harry E. Cross,Suneeta Sharma,Taylor Williamson |
| Date | 01 February 2019 |
| Published date | 01 February 2019 |
| DOI | http://doi.org/10.1002/pad.1846 |
SPECIAL ISSUE ARTICLE
Stewardship and health systems strengthening: An overview
Derick W. Brinkerhoff
1
|Harry E. Cross
2
|Suneeta Sharma
2
|Taylor Williamson
3
1
RTI International, USA
2
Palladium, USA
3
RTI International, UK
Correspondence
Derick Brinkerhoff, RTI International, USA.
Email: dbrinkerhoff.emeritus@rti.org
Summary
The World Health Organization (WHO) introduced the concept of stewardship to
clarify the practical components of governance in the health sector. For the
WHO, stewardship concentrated on how government actors take responsibility
for the health system and the wellbeing of the population, fulfill health system
functions, assure equity, and coordinate interaction with government and society.
This article overviews the contents of this special issue, which offers examples of
how health stewards in a variety of countries have addressed issues of health secu-
rity, primary care expansion, family planning, and quality of care. The contributors'
articles draw lessons for policy, programs, and management useful for practitioners
and scholars. Our overview identifies several themes emerging from the articles: the
foundational role of legal frameworks for effective stewardship, the importance of
institutional arrangements as enablers, the influence of regional and global entities
on national stewardship, the connection between credible decision‐making struc-
tures and stewardship, and pathways to sustainable financing and domestic
resource mobilization. The discussion concludes with highlighting several gaps in
knowledge and practice related to health stewardship.
KEYWORDS
governance, health,health systems, low‐income countries, stewardship, outcomes, WHO
1|INTRODUCTION
The conceptof stewardship has retained a centralplace in the sprawling
lexicon of health governance definitions and frameworks since it was
introduced nearly 20 years ago in the World Health Organization's
(WHO's) World Health Report 2000. As Saltman and Ferroussier‐Davis
(2000) discuss, the stewardship notion combines an ethical and moral
dimension with managerial principles of efficiency and effectiveness
directed toward addressing national health. State actors with
responsibilities for a population's health performas stewards when they
exercise authority and employ resources for the common good above
and beyond narrowefficiency and effectivenessobjectives.
Several current global policy issues have raised the profile
of health stewardship as a focus of both study and practice related to
health systems. Stewardship's provision of strategic guidance and
oversight of a country's health system makes it a key contr ibutor to
•achieving the health targets in the 2030 Sustainable Development
Goals;
•managing low‐income countries' transition from reliance on
external resources and expertise to country leadership and
domestic resource mobilization;
•mobilizing both capacity and commitment of the public and
private sectors, along with civil society, to strengthen the health
system and improve health outcomes; and
•mitigating inequality and discrimination in access, coverage, and
utilization of health services.
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This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided
the original work is properly cited.
© 2019 The Authors Public Administration and Development Published by John Wiley & Sons Ltd.
Received: 25 December 2018 Accepted: 25 December 2018
DOI: 10.1002/pad.1846
4Public Admin Dev. 2019;39:4–10.wileyonlinelibrary.com/journal/pad
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