The World Health Report 2000 ways sometimes does) address the way in which the systems key functions are to be im- With respect to the provision of services, all providers should be recognized and their future contribution-greater in some cases, less in others -should be outlined On financ ing, strategies to reduce dependence on out-of-pocket payments and to increase prepay- ment should be identified Roles of the principal financing organizations -private and public, domestic and external -and of households should be recognized and their future directions determined. The machinery of stewardship, designed to regulate and monitor how these functions change in accordance with policy, should also be made explicit. This is ikely to involve opportunities for consumer representatives to balance provider interests Danger exists when particular lines of policy, or whole reform strategies, become asso- ciated with a specific political party or minister of health. Regardless of whether the policy is good or bad, it becomes highly vulnerable. When that minister or party leaves office the olicy dies, usually before it has either succeeded or failed, because the next minister or administration is seldom willing to work under the predecessors banner. Rapid tumover of enior policy officials, and a politically charged environment, are both hazards to good stewardship(11). Establishing good stewardship can reduce exposure to"personality cap- ture"of particular policy directions, by creating an informed constituency of stakeholder pport, and ensuring that the interests, skills and knowledge needed to maintain a par- ticular policy direction are widely distributed All remaining stewardship tasks concern the implementation of policy, as distinct from its formulation and promotion. SETTING THE RULES, ENSURING COMPLIANCE Regulation is a widely recognized responsibility of health ministries and, in some coun- tries, of social security agencies. It covers both the framing of the rules to govern the behav iour of actors in the health system, and ensuring compliance with them. In keeping with Box 6.4 Stewardship: the Hisba system in Islamic countries The institution of Hisba was de- main foundation of Hisba was to the conduct of different crafts, the field of pharmaceutical sery- veloped to carry out the function promote new social norms and de- trades and public services, including ices, technical publications were of stewardship in Islamic countries p the required system to ensure health services. The muhtasib re- prepared, including monographs more than 1400 years ago. The the adherence of various sectors of ceived complaints from the public describing standards and specifi Hisba system is a moral as well as society to these norms. but could also order an investigation cations for various drugs as well on. The first muhtasib in Islam was methods of quality assurance whose raison d'etre is to ordain woman called Al Shifa, appointed in Medical services were also regu- The system also included inspe good and forbid evil. The functions Medina, the capital of the Islamic lated by the Hisba system. Physi- tions and enforcement mech of the muhtasib(the head of Hisba state, by the second calif, Omar ibn cians and other health specialists nisms ategories: those relating to( the and given authority to control the tions and possess the necessary Hisba system underwent drastic hts of)God; those relating to markets. Another woman called equipment before being licensed. modification with the advent of (the rights of) people; and those Samra bint Nuhayk was given a The muhtasib had to ensure compli- westem colonization its functions milar authority in Mecca, the sec- ance of practising physicians to were transformed into a number The second and third categories ond city, by the same calif. moral and ethical norms, induding of secular departments and its are related to community affa The muhtasib could appoint tech- equitable provision of services and moral content reduced. and municipal administration. The nically qualified staff to investigate protection of the public interest. In ontributed by the World Health Organization Regional Office for the Eastern Mediterranean Source: Al-Shaykh al-Imam Ibn Taymiya Public duties in Islam: the institution of the Hisba Markfield, UK, The islamic Foundation, 1985124 The World Health Report 2000 ways sometimes does) address the way in which the system’s key functions are to be im￾proved. With respect to the provision of services, all providers should be recognized and their future contribution – greater in some cases, less in others – should be outlined. On financ￾ing, strategies to reduce dependence on out-of-pocket payments and to increase prepay￾ment should be identified. Roles of the principal financing organizations – private and public, domestic and external – and of households should be recognized and their future directions determined. The machinery of stewardship, designed to regulate and monitor how these functions change in accordance with policy, should also be made explicit. This is likely to involve opportunities for consumer representatives to balance provider interests. Danger exists when particular lines of policy, or whole reform strategies, become asso￾ciated with a specific political party or minister of health. Regardless of whether the policy is good or bad, it becomes highly vulnerable. When that minister or party leaves office the policy dies, usually before it has either succeeded or failed, because the next minister or administration is seldom willing to work under the predecessor’s banner. Rapid turnover of senior policy officials, and a politically charged environment, are both hazards to good stewardship (11). Establishing good stewardship can reduce exposure to “personality cap￾ture” of particular policy directions, by creating an informed constituency of stakeholder support, and ensuring that the interests, skills and knowledge needed to maintain a par￾ticular policy direction are widely distributed. All remaining stewardship tasks concern the implementation of policy, as distinct from its formulation and promotion. SETTING THE RULES, ENSURING COMPLIANCE Regulation is a widely recognized responsibility of health ministries and, in some coun￾tries, of social security agencies. It covers both the framing of the rules to govern the behav￾iour of actors in the health system, and ensuring compliance with them. In keeping with Box 6.4 Stewardship: the Hisba system in Islamic countries The institution of Hisba was de￾veloped to carry out the function of stewardship in Islamic countries more than 1400 years ago. The Hisba system is a moral as well as a socioeconomic institution, whose raison d’être is to ordain good and forbid evil. The functions of the muhtasib (the head of Hisba system) can be classified into three categories: those relating to (the rights of ) God; those relating to (the rights of) people; and those relating to both. The second and third categories are related to community affairs and municipal administration. The main foundation of Hisba was to promote new social norms and de￾velop the required system to ensure the adherence of various sectors of society to these norms. The first muhtasib in Islam was a woman called Al Shifa, appointed in Medina, the capital of the Islamic state, by the second calif, Omar ibn Al Khattab, almost 1450 years ago, and given authority to control the markets. Another woman called Samra bint Nuhayk was given a similar authority in Mecca, the sec￾ond city, by the same calif. The muhtasib could appoint tech￾nically qualified staff to investigate the conduct of different crafts, trades and public services, including health services. The muhtasib re￾ceived complaints from the public but could also order an investigation on his or her own initiative. Medical services were also regu￾lated by the Hisba system. Physi￾cians and other health specialists had to pass professional examina￾tions and possess the necessary equipment before being licensed. The muhtasib had to ensure compli￾ance of practising physicians to moral and ethical norms, including equitable provision of services and protection of the public interest. In the field of pharmaceutical serv￾ices, technical publications were prepared, including monographs describing standards and specifi￾cations for various drugs as well as methods of quality assurance. The system also included inspec￾tions and enforcement mecha￾nisms. Like many other institutions, the Hisba system underwent drastic modification with the advent of western colonization: its functions were transformed into a number of secular departments and its moral content reduced. Contributed by the World Health Organization Regional Office for the Eastern Mediterranean. Source: Al-Shaykh al-Imam Ibn Taymiya. Public duties in Islam: the institution of the Hisba. Markfield, UK, The Islamic Foundation, 1985