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Governance is the role of the state in the health
sector. It involves the "regulatory and supervisory dimensions
of public policy." (41)
The manner in which governments undertake the role of governance
will vary and policy makers may wish to consider existing and
alternative methods of governance and the implications for policy
formulation.
Many observers agree "governments should be the
'stewards' of their national resources, maintaining and improving
them for the benefit of their populations. " (42)
In health this means:
· Government takes ultimate responsibility for careful management
of the well being of the population;
· Government establishes the best and fairest health systems;
· Government makes health a national priority;
This form of governance has been termed 'stewardship'.
It combines ethics, legitimacy and trust with accountability,
efficiency and substantive outcomes. "Outside of government, stewardship
is also a responsibility for purchasers and providers of health
services who must ensure that as much health as possible results
from their spending. In addition, stewardship in health has an
international dimension, relating to external assistance."(43)
This "approach, is substantially more interventionist than the
economically driven agency approach to state regulation which
some health economists have proposed." (44)
While stewardship may be considered an 'ideal' approach to governance
by many observers it is not necessarily the mission or ethos of
all governments. In addition, the term "Stewardship" does not
translate well for many languages and a more appropriate, alternative
term may be necessary. (First Meeting of the Latin America and
Caribbean Region, Consortium for Mental Health Policy and Services,
Chile 8-10, Nov, 2000; First Meeting of the Eastern Mediterranean
Region, Pakistan, January 20-31 January, 2001, Consortium for
Mental Health Policy and Services; First Meeting of the Western
Pacific Region, India, 2-3 March, 2001 Consortium for Mental Health
Policy and Services)
Stewardship has been divided into six sub functions
in the World Health Report 2000 that are useful for the policy
maker to consider in relation to the role of government and governance
in mental health policy formulation. We have added a seventh sub-function,
Research, based on feedback from Regional Meetings
convened by the Consortium for Mental Health Policy and Services
during 2000/2001.
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