HOW IS THE PUBLIC INTEREST PROTECTED? GOVERNMENTS AS STEWARDS OF HEALTH RESOURCES tewardship is the last of the four health systems functions examined in this report, nd it is arguably the most important. It ranks above and differs from the others service delivery, input production, and financing -for one outstanding reason: the ultimate responsibility for the overall performance of a countrys health system must always lie with government Stewardship not only influences the other functions, it makes possible the attainment of each health system goal: improving health, responding to the legitimate expectations of the population, and fairness of contribution. The government must ensure that stewardship percolates through all levels of the health system in order to maximize that attainment Stewardship has recently been defined as a"function of a government responsible for the welfare of the population, and concerned about the trust and legitimacy with which its activities are viewed by the citizenry"(1). It requires vision, intelligence and influence, pri marily by the health ministry, which must oversee and guide the working and develop ment of the nations health actions on the governments behalf. Much of this chapter, therefore, addresses the ministrys role. Some aspects of stewardship in health must be assumed by government as a whole Affecting the behaviour of health actors in other sectors of the economy, or ensuring the right size and skill mix of the human resources produced for the health system, may be beyond the ministrys reach. The government ought to ensure coherence and consistency across departments and sectors, where necessary by an overall reform of public administra Outside of government, stewardship is also a responsibility for purchasers and provid ers of health services who must ensure that as much health as possible results from their spending. And stewardship in health has an international dimension, relating to extemal But government remains the prime mover. Today in most countries the role of the state in relation to health is changing People,s expectations of health systems are greater than ever before, yet limits exist on what governments can finance and on what services they can deliver. Governments cannot stand still in the face of rising demands. They face complex dilemmas in deciding in which direction to move: they cannot do everything. But in terms of effective stewardship, their key role is one of oversight and trusteeship -to follow the advice of“ row less and steer more"”(2,3)How is the Public Interest Protected? 119 6 HOW IS THE PUBLIC INTEREST PROTECTED? GOVERNMENTS AS STEWARDS OF HEALTH RESOURCES  tewardship is the last of the four health systems functions examined in this report, and it is arguably the most important. It ranks above and differs from the others – service delivery, input production, and financing – for one outstanding reason: the ultimate responsibility for the overall performance of a country’s health system must always lie with government. Stewardship not only influences the other functions, it makes possible the attainment of each health system goal: improving health, responding to the legitimate expectations of the population, and fairness of contribution. The government must ensure that stewardship percolates through all levels of the health system in order to maximize that attainment. Stewardship has recently been defined as a “function of a government responsible for the welfare of the population, and concerned about the trust and legitimacy with which its activities are viewed by the citizenry” (1). It requires vision, intelligence and influence, pri￾marily by the health ministry, which must oversee and guide the working and develop￾ment of the nation’s health actions on the government’s behalf. Much of this chapter, therefore, addresses the ministry’s role. Some aspects of stewardship in health must be assumed by government as a whole. Affecting the behaviour of health actors in other sectors of the economy, or ensuring the right size and skill mix of the human resources produced for the health system, may be beyond the ministry’s reach. The government ought to ensure coherence and consistency across departments and sectors, where necessary by an overall reform of public administra￾tion. Outside of government, stewardship is also a responsibility for purchasers and provid￾ers of health services who must ensure that as much health as possible results from their spending. And stewardship in health has an international dimension, relating to external assistance. But government remains the prime mover. Today in most countries the role of the state in relation to health is changing. People’s expectations of health systems are greater than ever before, yet limits exist on what governments can finance and on what services they can deliver. Governments cannot stand still in the face of rising demands. They face complex dilemmas in deciding in which direction to move: they cannot do everything. But in terms of effective stewardship, their key role is one of oversight and trusteeship – to follow the advice of “row less and steer more”(2, 3)