Overview tional level, stewardship means mobilizing the collective action of countries to generate global public goods such as research, while fostering a shared vision towards more equita le development across and within countries. It also means providing an evidence base to assist countries'efforts to improve the performance of their health systems But this report finds that some countries appear to have issued no national health policy statement in the past 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 unrealistic expansion of the publicly funded health care system, sometimes well in excess of national economic growth. Eventually, the policy and planning document seen as infeasible and is ignored. A policy framework should recognize all three health system goals and identify strate- gies to improve the attainment of each. But not all countries have explicit policies on the overall goodness and fairness of the health system. Public statements about the desired balance among health outcomes, system responsiveness and fairness in financial contribu tion are yet to be made in many countries. Policy should address the way in which the ystem's key functions are to be improve This report finds that, within governments, many health ministries are seriously short sighted, focusing on the public sector and often disregarding the - frequently much larger private provision of care. At worst, governments are capable of turning a blind eye to a black market"in health, where widespread corruption, bribery, "moonlighting"and other illegal practices have flourished for years and are difficult to tackle successfully. Their vision does not extend far enough to help construct a healthier future. Moreover, some health ministries are prone to losing sight completely of their most important target: the population at large. Patients and consumers may only come into view when rising public dissatisfaction forces them to the ministrys attention. Many health ministries condone the evasion of regulations that they themselves have created or are supposed to implement in the public interest Rules rarely enforced are invi tations to abuse. A widespread example is the condoning of public employees charging illicit fees from patients and pocketing the proceeds, a practice known euphemistically as informal charging". Such corruption deters poor people from using services they need, making health financing even more unfair, and it distorts overall health priorities PROVIDING BETTER SERVICE Too many governments know far too little about what is happening in the provision of services to their people. In many countries, some if not most physicians work simultane ously for the government and in private practice. When public providers illegally use public acilities to provide special care to private patients, the public sector ends up subsidizing unofficial private practice. Health professionals are aware of practice-related laws but know that enforcement is weak or non-existent. Professional associations, nominally responsibl for self-regulation, are too often ineffective Oversight and regulation of private sector providers and insurers must be placed high on national policy agendas. At the same time it is crucial to adopt incentives that are sensi- tive to performance. Good policy needs to differentiate between providers (public or pri- vate)who are contributing to health goals, and those who are doing damage, and encourage or sanction appropriately Policies to change the balance between providers' autonomy and accountability need to be monitored closely in terms of their effect on health, responsive- ness and the distribution of the financing burdenOverview xv tional level, stewardship means mobilizing the collective action of countries to generate global public goods such as research, while fostering a shared vision towards more equita￾ble development across and within countries. It also means providing an evidence base to assist countries’ efforts to improve the performance of their health systems. But this report finds that some countries appear to have issued no national health policy statement in the past 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 unrealistic expansion of the publicly funded health care system, sometimes well in excess of national economic growth. Eventually, the policy and planning document is seen as infeasible and is ignored. A policy framework should recognize all three health system goals and identify strate￾gies to improve the attainment of each. But not all countries have explicit policies on the overall goodness and fairness of the health system. Public statements about the desired balance among health outcomes, system responsiveness and fairness in financial contribu￾tion are yet to be made in many countries. Policy should address the way in which the system’s key functions are to be improved. This report finds that, within governments, many health ministries are seriously short￾sighted, focusing on the public sector and often disregarding the – frequently much larger – private provision of care. At worst, governments are capable of turning a blind eye to a “black market” in health, where widespread corruption, bribery, “moonlighting” and other illegal practices have flourished for years and are difficult to tackle successfully. Their vision does not extend far enough to help construct a healthier future. Moreover, some health ministries are prone to losing sight completely of their most important target: the population at large. Patients and consumers may only come into view when rising public dissatisfaction forces them to the ministry’s attention. Many health ministries condone the evasion of regulations that they themselves have created or are supposed to implement in the public interest. Rules rarely enforced are invi￾tations to abuse. A widespread example is the condoning of public employees charging illicit fees from patients and pocketing the proceeds, a practice known euphemistically as “informal charging”. Such corruption deters poor people from using services they need, making health financing even more unfair, and it distorts overall health priorities. PROVIDING BETTER SERVICES Too many governments know far too little about what is happening in the provision of services to their people. In many countries, some if not most physicians work simultane￾ously for the government and in private practice. When public providers illegally use public facilities to provide special care to private patients, the public sector ends up subsidizing unofficial private practice. Health professionals are aware of practice-related laws but know that enforcement is weak or non-existent. Professional associations, nominally responsible for self-regulation, are too often ineffective. Oversight and regulation of private sector providers and insurers must be placed high on national policy agendas. At the same time it is crucial to adopt incentives that are sensi￾tive to performance. Good policy needs to differentiate between providers (public or pri￾vate) who are contributing to health goals, and those who are doing damage, and encourage or sanction appropriately. Policies to change the balance between providers’ autonomy and accountability need to be monitored closely in terms of their effect on health, responsive￾ness and the distribution of the financing burden