Authors Explore Stewardship's Role in Strengthening Health Systems and Sustainability
An event hosted by Health Policy Plus (HP+) on June 4, 2019, showcased the synergies between stewardship of country health systems and the objectives of USAID’s journey to self-reliance, its strategic approach to building countries' capacity to address their own development challenges. The event, which launched a special issue of the journal Public Administration and Development, “Stewardship and Health Systems Strengthening,” explored the concept of stewardship and its underlying six key functions, as outlined by the World Health Organization.
David Jacobstein, a democracy specialist in USAID’s Democracy, Human Rights, and Governance Center, spoke at the event, noting that it is no longer enough to work in a country and hope that political will may catch up. If self-reliance is the goal, he explained, the development community needs to reframe its role to ask: How can we support countries in the direction they are moving?
Derick Brinkerhoff, emeritus distinguished fellow in international public management at RTI, and Harry Cross, technical director for health at Palladium, co-edited the special issue, inviting papers from a range of players in international development. Brinkerhoff opened the day by reminding us that stewardship is not just an abstraction—when talking about stewardship we are often simply talking about the way people act.
Suneeta Sharma, vice president for health and director of the USAID-funded HP+ project, provided the introductory overview of the special issue and stressed the practicality of stewardship. She outlined its key functions to: (1) formulate strategic policy direction, (2) establish policy instruments, (3) ensure effective system structures, (4) build and sustain relationships/partnerships, (5) ensure accountability and transparency, and (6) generate intelligence.
The issue includes an overview co-authored by Brinkerhoff, Cross, Sharma, and Taylor Williamson, manager of health systems at RTI International. Articles include: Government stewardship and primary health care in Guatemala since 1996; Stewardship of health security: the challenges of applying the One Health approach; Strengthening family planning stewardship with a total market approach: Mali, Uganda, and Kenya experiences; and Stewardship of quality of care in health systems: Core functions, common pitfalls, and potential solutions. Representing their co-authors, Cross, Williamson, Cindi Cisek of Palladium, and Benjamin Chan of the University of Toronto and the World Bank presented key points from their papers. Linda Cahaelen, health development officer in USAID’s Office of Population and Reproductive Health and HP+ agreement officer representative, stressed the project’s leadership role in advancing stewardship and accountability in health policy development and implementation.
In a concluding discussion, moderated by Palladium’s Jay Gribble, Harry Cross summarized that “the road to self-reliance is dependent on the health system…it’s the road to sustainability. By improving stewardship functions, countries can achieve self-reliance.”