Steering Role Priscilla Rivas-Loría Advisor, Health Sector Reform PAHO/WHO. Washington, D.C.
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Transcript of Steering Role Priscilla Rivas-Loría Advisor, Health Sector Reform PAHO/WHO. Washington, D.C.
DECENTRALIZATION OF HEALTH SYSTEMS
SEPARATION OFFUNCTIONS
DETERIORATION OF PUBLICHEALTH
Scenario Derived from the Reforms
New public and private actors
Decentralization / de-concentration of
Public Health services and
individual-level care
Increase in the participation of
private insurances
Need for Strengthening the Steering
Role
Conceptual and Methodological Evolution of the Steering Role in Health
GRAPHIC 1: Conceptual and Methodological Evolution of the Steering Role in Health
Resolution CD40.R12The Steering Role of Ministries of Health in Sectoral Reform Processes
Elaboration of the Methodological Guidelines for the Performance Evaluation of the Steering Role
Sub-regional Training Workshop, Central America and the Spanish CaribbeanPerformance and Strengthening of the National Authority’s Steering Role
CD 40/13 Sub-committee on Planning and Programming The Steering Role of Ministries of Health in Reform Processes
Sub-Regional Meeting for Central America, Guatemala: The Sectoral Steering Role and Leadership of the Ministry of Health
Expert Meeting Washington, DC Development of Institutional Capacity to perform the Steering Role
Elaboration of the Guidelines for Mapping the National Health Authority
Expert Meeting – Validation of Methodological Guidelines Performance Evaluation of the NHA Steering Role
Pilot Application in El Salvador Methodological Guidelines for the Performance Evaluation of the Steering Role
Source:
Conceptual Framework and Methodological Instrument
www.lachealthsys.org“Steering Role Capacity of the National Health Authority: Strengthening its Performance”
What is the Steering Role in Health?
• It is the exercise of the substantive responsibilities and competencies of public policy in health that are characteristic and indelegable in the context of the new schemes of relationships between government and society in the modern State.
• It is a competence that is characteristic of government and exercised through the Health Authority.
Health Authority
• The Health Authority is the custodian of the public good in health.
• It is comprised of the group of State institutions responsible for protecting the public good in health.
• Structural differences in each country in terms of its composition.
• Dependent on the federal or unitary structure and on the nature of the sector’s institutional organization.
Regulation
Harmonization of Provision
Financing
Assurance
Conduct/Lead
Steering role
Development of EPHF
Dimensions of the Steering Role
HEALTH AUTHORITY
FINANCING
ASSURANCE
REGULATION
SERVICE PROVISION
CONDUCT/LEAD
Exclusive Responsibilities
Shared Responsibilities
ESSENTIAL PUBLIC HEALTH
FUNCTIONS
DIMENSIONS OF EXCLUSIVE RESPONSIBILITY OF THE HEALTH
AUTHORITY
CONDUCT/LEAD FINANCING
ASSURANCEREGULATION
PUBLIC HEALTH SERVICE PROVISION
EconomicPolitical
Social
Direct exercise of the substantive and indelegable responsibilities in
Health that correspond to the State
HEALTH AUTHORITY
(citizens’ right)
(power, governability)(industry, economic interest)
Health Authority
Conduct/Lead• Health Situation Analysis.
• Definition of Health Priorities and Goals.
• Formulation, Dissemination, Monitoring and Evaluation of health strategies, policies and plans.
• Leadership, Consensus, Mobilization of Actors and Resources in the Sector.
Conduct/Lead• Health Promotion, social participation and control in
health.
• Harmonization of International Technical Cooperation in Health.
• Political and Technical Participation in International and Sub-Regional Organizations.
• Evaluation of Health System Performance, including measurement of the fulfillment of goals; of the resources utilized; and of the efficiency of the health system.
Conduct/Lead
Health situation analysis
Definition of health
priorities and goals
Formulation of health policies,
strategies, plans and programs
Reach consensus
and mobilize actors and resources
BRAZIL
MEXICO
PERU
Conduct/Lead
BRAZIL
MEXICO
PERU
Promotion of public health, participation
and social control in
health
Harmonize technical
cooperation of international organizations
Political and technical
participation in
international organizations
Evaluation of health
systems performance
Regulation• Institutional and legal framework for the exercise
of the steering role
• Fiscalization to ensure fulfillment of regulations
• Regulation of medical supplies and health technology; of goods and services; of the environment
• Regulation and certification of human resources in health
Regulation
BRAZIL
MEXICO
PERU
Institutional and legal
framework backing for exercise of
steering role
Fiscalization to ensure
fulfillment of regulations
Regulation of medical
supplies and health
technology, goods and services
Regulation and
certification of Human
Resources in Health
Financing
• Formulation of policies to correct distortions in sectoral financing.
• Monitor the sectoral financing process.
• Negotiate with principal providers.
• Redistribute funds to compensate for market asymmetries.
• Define criteria for resource allocation.
Financing
BRAZIL
MEXICO
PERU
Correct sectoral
distortions in $ and increase equity
Monitoring of financing
process
Negotiation with
principal providers
Redistri-bution of $
to compensate for market asymme-
tries
Define criteria
for resource allocation
Assurance
• Definition of Guaranteed Package of Services
• Definition of populations and territories that will be covered by the Package of Services
• Regulation and Control of Public and Private Insurance Plans
Assurance
BRAZIL
MEXICO
PERU
Definition of guaranteed package of
services
Definition of populations that will be covered
by the guaranteed package of
services
Regulation and control of public
and private insurance plans
Harmonization of Service Provision
• Service Planning using Regional or Functional criteria
• Develop Regulatory Mechanisms for Protecting the Public and Guaranteeing Minimum Standards of Quality for Service Provision
• Promotion of Coalitions and Provision of Incentives for Self-Regulation