Steering Role

Priscilla Rivas-Loría

Advisor, Health Sector Reform

PAHO/WHO. Washington, D.C.

DECENTRALIZATION OF HEALTH SYSTEMS

SEPARATION OFFUNCTIONS

DETERIORATION OF PUBLICHEALTH

Scenario Derived from the Reforms

New public and private actors

Decentralization / de-concentration of

Public Health services and

individual-level care

Increase in the participation of

private insurances

Need for Strengthening the Steering

Role

Conceptual and Methodological Evolution of the Steering Role in Health

GRAPHIC 1: Conceptual and Methodological Evolution of the Steering Role in Health

Resolution CD40.R12The Steering Role of Ministries of Health in Sectoral Reform Processes

Elaboration of the Methodological Guidelines for the Performance Evaluation of the Steering Role

Sub-regional Training Workshop, Central America and the Spanish CaribbeanPerformance and Strengthening of the National Authority’s Steering Role

CD 40/13 Sub-committee on Planning and Programming The Steering Role of Ministries of Health in Reform Processes

Sub-Regional Meeting for Central America, Guatemala: The Sectoral Steering Role and Leadership of the Ministry of Health

Expert Meeting Washington, DC Development of Institutional Capacity to perform the Steering Role

Elaboration of the Guidelines for Mapping the National Health Authority

Expert Meeting – Validation of Methodological Guidelines Performance Evaluation of the NHA Steering Role

Pilot Application in El Salvador Methodological Guidelines for the Performance Evaluation of the Steering Role

Source:

Conceptual Framework and Methodological Instrument

www.lachealthsys.org“Steering Role Capacity of the National Health Authority: Strengthening its Performance”

What is the Steering Role in Health?

• It is the exercise of the substantive responsibilities and competencies of public policy in health that are characteristic and indelegable in the context of the new schemes of relationships between government and society in the modern State.

• It is a competence that is characteristic of government and exercised through the Health Authority.

Health Authority

• The Health Authority is the custodian of the public good in health.

• It is comprised of the group of State institutions responsible for protecting the public good in health.

• Structural differences in each country in terms of its composition.

• Dependent on the federal or unitary structure and on the nature of the sector’s institutional organization.

Regulation

Harmonization of Provision

Financing

Assurance

Conduct/Lead

Steering role

Development of EPHF

Dimensions of the Steering Role

HEALTH AUTHORITY

FINANCING

ASSURANCE

REGULATION

SERVICE PROVISION

CONDUCT/LEAD

Exclusive Responsibilities

Shared Responsibilities

ESSENTIAL PUBLIC HEALTH

FUNCTIONS

DIMENSIONS OF EXCLUSIVE RESPONSIBILITY OF THE HEALTH

AUTHORITY

CONDUCT/LEAD FINANCING

ASSURANCEREGULATION

PUBLIC HEALTH SERVICE PROVISION

EconomicPolitical

Social

Direct exercise of the substantive and indelegable responsibilities in

Health that correspond to the State

HEALTH AUTHORITY

(citizens’ right)

(power, governability)(industry, economic interest)

Health Authority

Conduct/Lead• Health Situation Analysis.

• Definition of Health Priorities and Goals.

• Formulation, Dissemination, Monitoring and Evaluation of health strategies, policies and plans.

• Leadership, Consensus, Mobilization of Actors and Resources in the Sector.

Conduct/Lead• Health Promotion, social participation and control in

health.

• Harmonization of International Technical Cooperation in Health.

• Political and Technical Participation in International and Sub-Regional Organizations.

• Evaluation of Health System Performance, including measurement of the fulfillment of goals; of the resources utilized; and of the efficiency of the health system.

Conduct/Lead

Health situation analysis

Definition of health

priorities and goals

Formulation of health policies,

strategies, plans and programs

Reach consensus

and mobilize actors and resources

BRAZIL

MEXICO

PERU

Conduct/Lead

BRAZIL

MEXICO

PERU

Promotion of public health, participation

and social control in

health

Harmonize technical

cooperation of international organizations

Political and technical

participation in

international organizations

Evaluation of health

systems performance

Regulation• Institutional and legal framework for the exercise

of the steering role

• Fiscalization to ensure fulfillment of regulations

• Regulation of medical supplies and health technology; of goods and services; of the environment

• Regulation and certification of human resources in health

Regulation

BRAZIL

MEXICO

PERU

Institutional and legal

framework backing for exercise of

steering role

Fiscalization to ensure

fulfillment of regulations

Regulation of medical

supplies and health

technology, goods and services

Regulation and

certification of Human

Resources in Health

Financing

• Formulation of policies to correct distortions in sectoral financing.

• Monitor the sectoral financing process.

• Negotiate with principal providers.

• Redistribute funds to compensate for market asymmetries.

• Define criteria for resource allocation.

Financing

BRAZIL

MEXICO

PERU

Correct sectoral

distortions in $ and increase equity

Monitoring of financing

process

Negotiation with

principal providers

Redistri-bution of $

to compensate for market asymme-

tries

Define criteria

for resource allocation

Assurance

• Definition of Guaranteed Package of Services

• Definition of populations and territories that will be covered by the Package of Services

• Regulation and Control of Public and Private Insurance Plans

Assurance

BRAZIL

MEXICO

PERU

Definition of guaranteed package of

services

Definition of populations that will be covered

by the guaranteed package of

services

Regulation and control of public

and private insurance plans

Harmonization of Service Provision

• Service Planning using Regional or Functional criteria

• Develop Regulatory Mechanisms for Protecting the Public and Guaranteeing Minimum Standards of Quality for Service Provision

• Promotion of Coalitions and Provision of Incentives for Self-Regulation

Service Provision Function

BRAZIL

MEXICO

PERU

COUNTRY

Planning using

regional or functional

criteria

Development of regulatory

mechanisms for protecting the public

and guaranteeing minimum standards of

quality

Promotion of coalitions and provision of

incentives for self-regulation