Steering
Defining and managing the substantive and nondelegable areas with respect to sectoral management activities, regulating and implementing the essential public health functions linked with the exercise of the health authority, financing, insurance coverage, and service delivery, especially to guarantee universal and equitable access to quality health care. [1]
WHO Definition of Steering
Defining and managing the substantive and nondelegable areas with respect to sectoral management activities, regulating and implementing the essential public health functions linked with the exercise of the health authority, financing, insurance coverage, and service delivery, especially to guarantee universal and equitable access to quality health care.
The breadth of the steering role of the ministries of health will depend on the degree of public sector responsibility, the degree of decentralization, and the division of labor in the institutional structure of each country
Additional Notes on Steering
On Steering vs. Stewardship [2]
There are some similarities and distinctions worth making between stewardship as conceptualized in the WHO health system performance assessment framework, the related concept of the “steering role” of ministries of health, and “Core” or “Essential” Public Health Functions (EPHF) [3,4]. The only real difference between the literature on the “steering role” and stewardship is that the “steering role” documents are specifically devoted to the roles of health ministries in different processes of health sector reform, whereas stewardship is a function of the whole health system, and its assessment involves considering more than ministries of health. With regard to the Essential Public Health Functions, many of them do contain key elements of stewardship. However, the scope of stewardship is broader. It includes ensuring oversight, regulation and accountability of all actors involved in any of the four health system functions – including financing and all aspects of resource generation. Stewardship also excludes those aspectsof Essential Public Health Functions which more appropriately come under provision or resource generation – for example human resource development and training in public health.
On “old” versus “new” steering: [5]
In older steering modes of command and control, coordination and policy were developed and executed with given entities and preset delineated pathways. In this mode, communication was understood as a means to direct, inform and persuade and, in its pathological form, to manipulate. Here steering was equated with the control of information and its operationalization. By contrast, in the new mode of steering the challenge is not to control information per se but more to manage information flows given that productivity (and power) is not generated in these flows. In this sense, the new informational logic tends to generate elisions of communication and management in order to deal with the dynamism and unpredictable outcomes of new [network] governance interaction...This suggests that 'steering' is at the same time a 'learning' process in the new mode of governance. The new dynamism of developing and evolving problem sets and policy challenges means that to steer effectively requires a constant process of recursive learning.
On Steering groups
A group of people brought together to oversee a piece of work such as a HIA (Health Impact Assessment). Typically, a steering group might be made up of up of representatives of relevant professional groups, key statutory agencies and the local community and its terms of reference might include · overseeing development and progress of the work; · agreeing the methodological framework and timescales; · providing an input of local knowledge and information; · acting as a bridge between partners; · facilitating the implementation of the assessment's recommendations; and · helping to assimilate and disseminate the emerging lessons.
[1] Steering role of the ministries of health in the processes of health sector reform. Washington, DC, Pan American Health Organization and World Health Organization, 1997 (document CD40/13).
[2] Travis P., Egger D., Davies P &Mechbal A. 2002. Towards better stewardship: concepts and critical issues. WHO.
[3] Public health in the Americas. Instrument for performance measurement of essential public health functions. Pan American Health Organization; World Health Organization; Centers for Disease Control and Prevention; Centro Latino Americano de Investiaación en Sistemas de Salud, Washington, DC, 2001.
[4] Project operating guideline: the structure and sustainable delivery of essential public health functions in the Western Pacific Region.. Manila, WHO Regional Office for the Western Pacific, 2001.
[5] Crozier M. Listening, learning, steering: new governance, communication and interactive policy formation. Policy & Politics. 2008 Jan 16;36(1):3-19.
[6] WHO Health Impact Assesment https://www.who.int/hia/about/glos/en/index2.html