Health system stewardship and evidence informed health policy

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Alvarez-Rosete, A ; Hawkins, B ; Parkhurst, J (2013)
  • Publisher: London School of Hygiene and Tropical Medicine

This Working Paper reviews the recent international debates on the role of the state in health system governance, and uses those discussions to establish the legitimate role of the state in ensuring the appropriate use of evidence for health policy making. Specifically it examines the concept of stewardship which has emerged within recent global health governance debates, applying this concept to the stewardship of evidence. The stewardship function of national ministries of health was originally introduced by the World Health Organization in the 2000 World Health Report, but has been subsequently debated by authors who have associated the concept with a range of government and service provision functions. This paper develops a clearer and more nuanced understanding of the concept of stewardship to differentiate it from the related, yet distinct, concept of governance. We argue that the unique, and therefore conceptually useful, aspect stewardship lies in the way it allocates a single ultimate responsibility for the health of the population. The WHO has further established that it is national ministries of health, specifically, which possess the legitimacy to assume the functions as stewards of population health. The stewardship concept has been established with a range of functional characteristics, including the appropriate use of information to guide health planning and decision making. Taken together, these elements have direct implications for conceptualising how to ensure appropriate use of evidence in health policy. Ministries of health, as population health stewards, tasked with appropriate information use, possess a responsibility to ensure health system decisions are appropriately informed by evidence. In order to do this, they must establish institutional structures and procedures that function to synthesise, disseminate and apply health information and research evidence for use in policy making.
  • References (22)
    22 references, page 1 of 3

    Alvarez-Rosete A. 2007. Modernising policy making. In: Hann A (ed). Health Policy and Politics. Aldershot: Ashgate, 41-57.

    Alvarez-Rosete A. 2008. The role of the state in public health. In: Heggenhougen K (ed). International Encyclopedia of Public Health. Elsevier, 211-18.

    Balabanova D, Oliveira-Cruz V, Hanson K. 2008. Health Sector Governance and Implications for the Private Sector. Technical partner paper 9. New York: The Rockefeller Foundation.

    Bell S, Hindmoor A. 2009. Rethinking governance: the centrality of the state in modern society. Cambridge: Cambridge University Press.

    Bevir M. 2010. Democratic governance. Princeton, New Jersey: Princeton University Press.

    Brown LD, Isett KR, Hogan M. 2010. Stewardship in Mental Health Policy: Inspiration, Influence, Institution?. Journal of Health Politics, Policy and Law 35, no. 3, June: 389-405.

    Brownson R C, Chriqui JF, Stamatakis KA. 2009. Understanding Evidence-Based Public Health Policy. American Journal of Public Health 99, no. 9: 1576-83.

    Commission on the Social Determinants of Health. 2008. Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva: World Health Organization. Online at:, accessed 5 February 2013.

    Dobbins, M., P. Robeson, et al. 2009. A description of a knowledge broker role implemented as part of a randomized controlled trial evaluating three knowledge translation strategies. Implementation Science 4, no. 1.

    Durán A, Kutzin J, Martín-Moreno JM, Travis P. 2011. Understanding health systems: scope, functions and objectives. In: McKee M, Figueras J (eds). Health Systems: Health, Wealth, Society and Well-being. Maidenhead: Open University Press & McGraw-Hill.

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