Stewardship of quality of care in health systems: Core functions, common pitfalls, and potential solutions
| Date | 01 February 2019 |
| Published date | 01 February 2019 |
| DOI | http://doi.org/10.1002/pad.1835 |
SPECIAL ISSUE ARTICLE
Stewardship of quality of care in health systems: Core
functions, common pitfalls, and potential solutions
Benjamin T.B. Chan
1,2,3
|Jeremy H.M. Veillard
2,1
|Krycia Cowling
2
|
Niek S. Klazinga
4,5
|Adalsteinn D. Brown
1
|Sheila Leatherman
6
1
University of Toronto, Canada
2
World Bank Group, Washington, USA
3
Northern Ontario School of Medicine,
Sudbury, Canada
4
Amsterdam University Medical Centres
(AMC), Amsterdam, The Netherlands
5
Organization for Economic Co‐operation and
Development, Paris, France
6
University of North Carolina, USA
Correspondence
Dr. Benjamin T. B. Chan, Institute for Health
Policy, Management and Evaluation,
University of Toronto, Toronto, Ontario,
Canada.
Email: drben.chan@utoronto.ca
Summary
National Ministries of Health in low‐and middle‐income countries (LMICs) have a key
role to play as stewards of the quality agenda in their health systems. This paper uses a
previously developed six‐point framework for stewardship (strategy formulation,
intersectoral collaboration, governance and accountability, health system design,
policy and regulation, and intelligence generation) and identifies specific examples of
activities in LMICs in each of these domains, pitfalls to avoid, and possible solutions
to these pitfalls. Many LMICs now have quality strategies with clear vision statements.
There are good examples of quality agencies and donor collaboration councils to coor-
dinate activities across different sectors. There are multiple options for accountability,
including public reporting, community accountability structures, results‐based
payment, accreditation, and inspection. To improve health system design, available
tools include decision support tools, task‐shifting models, supply chain management,
and programs to train quality improvement staff. Policy options include legislation on
disclosure of adverse events, and regulations to ensure skills of health care providers.
Lastly, health information tools include patient registries, facility surveys, hospital
discharge abstracts, standardized population and patient surveys, and dedicated
agencies for reporting on quality. Policy‐makers can use this article to identify options
for driving the quality agenda and address anticipated implementation barriers.
KEYWORDS
accountability, health information management, health policy, less‐developed countries, quality
improvement, quality of health care, quality strategy, stewardship
1|INTRODUCTION
Health system stewardship is an important function of national health
ministries. Governments are entrusted by the population with the role
of global oversight of the functioning of the health system, to ensure
that it contributes to the population's well‐being and improved health
outcomes. Although different authors have developed varying
definitions of stewardship (Armstrong, 1997; Davis, Schoorman, &
Donaldson, 1997; Kass & Catron, 1990; Saltman & Ferroussier‐Davis,
2000; Travis, Egger, Davies, & Mechbal, 2002; World Health Organi-
zation [WHO], 2000), common themes across all definitions are that
governments are expected to make informed decisions, follow ethical
guidelines, work within a framework of societal norms and values, and
be accountable and transparent to the public about results.
A previous paper identified six generic health system stewardship
functions: strategy formulation and policy development; intersectoral
collaboration and action; health system governance and accountability;
attention to system design; health system regulation; and intelligence
(data and analysis) generation (Veillard, Brown, Barns, Permanand, &
Klazinga, 2011). This paper elaborates on how these six stewardship
functions pertain specifically to the management of quality of care.
Examples of activities under each function are presented, from low‐
Received: 13 May 2018 Revised: 11 July 2018 Accepted: 15 August 2018
DOI: 10.1002/pad.1835
34 © 2018 John Wiley & Sons, Ltd. Public Admin Dev. 2019;39:34–46.wileyonlinelibrary.com/journal/pad
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