The World Health Report fessional standards"(9). Ensuring probity in decisions on capital projects and other large purchasing decisions(equipment, pharmaceutical orders), where corruption may be par- Some recent developments create opportunities for better vision and more innovative stewardship. Greater autonomy in decisions relating to purchasing and service provision, example, shifts some responsibility away from central or local government. But it creates new tasks for government in overseeing that both purchasing and provision are carried out in accordance with overall policy. Accumulated experience of practices such as contracting is now available(10) and rapid technological advances enable the fast, inexpensive han- ding of huge amounts of information, thus making it easier in principle for stewards to visualize the whole health system. The notion of stewardship over all health actors and actions deserves renewed empha sis. Much conceptual and practical discussion is needed to improve the definition and meas- urement of how well stewardship is actually implemented in different settings But sev formulating health policy -defining the vision and direction, exerting influence-approaches to regulatic ing and using intelligence These tasks are discussed below HEALTH POLICY VISION FOR THE FUTURE An explicit health policy achieves several things: it defines a vision for the future which in turn helps establish benchmarks for the short and medium term. It outlines priorities and the expected roles of different groups. It builds consensus and informs people, and in doing so fulfils an important role of governance. The tasks of formulating and implement ing health policy clearly fall to the health ministry ome countries appear to have issued no national health policy statement in the last decade; in others, policy exists in the form of documents which gather dust and are never translated into action. Too often, health policy and strategic planning have envisaged unre Box 6.2 Ghana's medium-term health policy framework Forging linkages between private effective use of all available re- process of consultation, the follow- and public providers of health care logistics such as drugs sources from government, g strategies were identified as to ensure consensus and that all her consumables, equip- nongovernmental organiza- providing the means to better per- resources are focused on a com- ment, and vehicles at all levels of tions, and private, mission and formance in health the health system donor sources. Ways of mobilize Re-prioritization of health serv-.Expansion and rehabilitation of Strengthening the monitoring ing additional resources with a res to ensure that primary health infrastructure to increase and regulatory systems withi ealth care services(i.e. services coverage and improve quality the health service to ensure more ore accessible and affordable with maximum benefits in terms Strengthening human resource effective implementation of pro- will also be explor of morbidity and mortality re- Promoting intersectoral action uction) receive more empha ing as a means of providing and for health development, par retaining adequate numbers of communities to take more re- ticularly in the areas of food and The strengthening and decen- good quality and well-motivated sponsibility for their health nutrition, employment, educa- tralization of management health teams to provide the serv- .Improving the financing of health tion, water and sanitation within the context of a national ices care by ensuring the efficient and Source: Medium-term health strategy towards vision 2020 Republic of Ghana Accra, Ministry of Health, 1995.122 The World Health Report 2000 Box 6.2 Ghana’s medium-term health policy framework In Ghana, after an extensive process of consultation, the follow￾ing strategies were identified as providing the means to better per￾formance in health. • Re-prioritization of health serv￾ices to ensure that primary health care services (i.e. services with maximum benefits in terms of morbidity and mortality re￾duction) receive more emphasis in resource allocation. • The strengthening and decen￾tralization of management within the context of a national health service. • Forging linkages between private and public providers of health care to ensure consensus and that all resources are focused on a com￾mon strategy. • Expansion and rehabilitation of health infrastructure to increase coverage and improve quality. • Strengthening human resource planning, management and train￾ing as a means of providing and retaining adequate numbers of good quality and well-motivated health teams to provide the serv￾ices. • Provision and management of adequate logistics such as drugs and other consumables, equip￾ment, and vehicles at all levels of the health system. • Strengthening the monitoring and regulatory systems within the health service to ensure more effective implementation of pro￾grammes. • Empowering households and communities to take more re￾sponsibility for their health. • Improving the financing of health care by ensuring the efficient and effective use of all available re￾sources from government, nongovernmental organiza￾tions, and private, mission and donor sources. Ways of mobiliz￾ing additional resources with a view to making the services more accessible and affordable will also be explored. • Promoting intersectoral action for health development, par￾ticularly in the areas of food and nutrition, employment, educa￾tion, water and sanitation. Source: Medium-term health strategy: towards vision 2020 Republic of Ghana. Accra, Ministry of Health, 1995. fessional standards” (9). Ensuring probity in decisions on capital projects and other large purchasing decisions (equipment, pharmaceutical orders), where corruption may be par￾ticularly lucrative, is another frequent challenge to good stewardship. Some recent developments create opportunities for better vision and more innovative stewardship. Greater autonomy in decisions relating to purchasing and service provision, for example, shifts some responsibility away from central or local government. But it creates new tasks for government in overseeing that both purchasing and provision are carried out in accordance with overall policy. Accumulated experience of practices such as contracting is now available (10) and rapid technological advances enable the fast, inexpensive han￾dling of huge amounts of information, thus making it easier in principle for stewards to visualize the whole health system. The notion of stewardship over all health actors and actions deserves renewed empha￾sis. Much conceptual and practical discussion is needed to improve the definition and meas￾urement of how well stewardship is actually implemented in different settings. But several basic tasks can already be identified: • formulating health policy – defining the vision and direction; • exerting influence – approaches to regulation; • collecting and using intelligence. These tasks are discussed below. HEALTH POLICY – VISION FOR THE FUTURE An explicit health policy achieves several things: it defines a vision for the future which in turn helps establish benchmarks for the short and medium term. It outlines priorities and the expected roles of different groups. It builds consensus and informs people, and in doing so fulfils an important role of governance. The tasks of formulating and implement￾ing health policy clearly fall to the health ministry. Some countries appear to have issued no national health policy statement in the last decade; in others, policy exists in the form of documents which gather dust and are never translated into action. Too often, health policy and strategic planning have envisaged unre-