Strengthening Stewardship and Regulation
"Stewardship refers to the wide range of functions carried out by [health authorities] governments as they seek to achieve national health policy objectives. In addition to improving overall levels of population health, objectives are likely to be framed in terms of equity, coverage, access, quality, and patients' rights. National policy may also define the relative roles and responsibilities of the public, private and voluntary sectors - as well as civil society - in the provision and financing of health care… It will include: maintaining the strategic direction of policy development and implementation; detecting and correcting undesirable trends and distortions; articulating the case for health in national development; regulating the behaviour of a wide range of actors - from health care financiers to health care providers; and establishing effective accountability mechanisms. Beyond the formal health system stewardship means ensuring that other areas of government policy and legislation promote - or at least do not undermine - peoples' health..." (WHO).

A key instrument of stewardship, together with policy formulation and legislation, is the regulatory function, which operationalizes the policy directions of stewardship setting the rules for all actors of the health system. In our work (in line with many others) we distinguish and work in two core areas of Stewardship: Sector Intelligence (policy formulation, planning and strategic information collecting and management), and Sector Regulation. Both areas are critical for the performance of the health system. Strengthening the capacity of health authorities, ministries of health, and specialized agencies on sector intelligence and regulation is a key component of systems transformations worldwide.  CHD works and provides advice on both as a core component of improving Health Systems Strengthening.

Strengthening Sector Inteligence

The capacity of health authorities (Governments, Health authorities, regulator, and others) supported by information and analytics capabilities is central to the development and performance of the health system in protecting and improving health, financial protection and satisfaction and dignity of care. This includes mind-set and capabilities to focus on actions not only in the health care sector but, in engaging in and with all policies in the economy to create better health for all. Critical areas of capabilities should include, among others:
  • Up-to-date data and information for policy and management of level, distribution and geographical characteristics of health status of populations, epidemiological surveillance, financial protection, access to health care and public health interventions, environmental and animal health, and satisfaction.
  • Up-to-date data and information for policy and for decision making of overall (public, private, and other) health sector financing, health sector infrastructure, human resources for health, health related industry (pharma, medical devices and medical equipment).
  • Own or have expeditious access to state of the art analytical capacity on technology assessment, cost/effectiveness analysis, and evidence for health care and public health interventions.
  • Effective management (operational and financial) of Public Health (population level) programs and interventions including communications, education, and public health crisis and disaster management.
  • Effective multi-sector capabilities (health, economics, sociology, communications, political economy, legislation) for engaging in public policy for health beyond health care.
  • Effective capabilities for guiding and informing overall human resources, health care, and public health infrastructure development, and of country health care delivery model(s) including primary health care and gate-keeper policies.
In essence, Sector Intelligence means being able to strategically guide the formulation of policies and the actions of all actors in the sector with state of the art evidence and analytics and with a focus on health beyond health care.

CHD works and advice overall government authorities, health system authorities and leaders and key actors on the importance of strengthening the Sector Intelligence Function on how to actually do it.

Sector Regulation

Regulation, in all its dimensions (licensing, accreditation, financial, prudential, consumer protection, care and professions quality, food, pharma, medical devices, and other), is a key instrument of effective stewardship. Many countries exercise the regulation functions directly through the central government (e.g. the Ministry of Health that directly acts as regulator) or, increasingly, many separate parts of the regulation in independent public entities that relate to but are independent of the central government administration. 

Achieving effective regulation, one that will maximize the wellbeing of the population, requires, among other characteristics:
  • Regulation that reflects the legislative, legal and policy framework generated the state authorities constitutionally entitled to do so rather than by the regulator itself.
  • Regulator and regulatory capacity and capabilities that generate quality regulation and reflect the state of the art world-wide pertinent to the country or sub-national level as appropriate
  • A governance arrangement that ensures regulatory independence and equity in the development and enforcement of such regulation (the regulation is equal in nature and enforcement for all actors in the same role.)

Policy makers and system leaders face multiple options regarding regulation governance, developing capabilities, and specific regulatory issues. Key decisions include, among many others:
  • Does health sector regulation merit a specific governance and regulatory framework (as most countries do these days) or should all or part of it be subjected to general regulation applicable to all sectors of the economy?
  • If separate regulation is needed, do we set the regulation function at a central government level (e.g. Ministry of Health) or separate it in one or more specialized agencies?
  • What parts of the regulation areas will be regulated by public government agencies and what parts (if any) will be defined as self-regulated by the actors involved?
  • Will regulatory agencies regulate under one agency multiple aspects of the health system (e.g. service providers, health insurance, other) or will each of them be regulated under a different framework and/or agency?
  • What technical expertise to develop it-self or what should be contracted or delegated (e.g. fiduciary regulation, prudential regulation, auditing, etc).
  • What is the best implementation and transition strategy from the current level of regulation to the desired one in consideration to fiscal, economic, labor, and political implications?

​CHD works and advice overall government authorities, health system authorities and leaders and key actors on the what is required for effective regulation and on the how-to building and implementing regulatory capacity on health insurance, health service, provision, and health related industries, including transition strategies for implementation.