Ideally, the different governments of the world should be the “stewards” of healthcare, making sure that healthcare is fair for everyone. It should also be the best healthcare system given the resources of the country. In fact, stewardship rises above service delivery, financing and input production when it comes to the job of the government to create excellent care. The country’s stewardship should be at every level of healthcare in order for it to work properly.
What is stewardship? It is the job of a government to be responsible for the welfare of its populace and it is concerned about the legitimacy and trust of the healthcare system the people see. It takes influence over healthcare, vision and intelligence when it comes to overseeing the healthcare system.
Some parts of stewardship are the responsibility of the entire government. Things like the behavior of the doctors and nurses in other parts of the economy or making sure the mix of human resources might be out of the reach of the government’s control. Instead, the government must ensure that the consistency and the coherence of the system are preserved. Stewardship can cross country boundaries when other countries provide aid to poorer countries.
While people need more in the way of health needs, the governments are becoming less and less able to handle them. The government can’t do everything to make healthcare the best it can be. What they need to do then is to focus on oversight and trusteeship—to steer the healthcare system in the right directions.
But stewardship is getting from bad to worse. Poor and middle income countries are having problems with bad bureaucracy and ineffective management of things such healthcare. Because of WWII and twentieth century thinking, they have established hierarchical public bureaucracy with rules that tie down what the providers can do. Unfortunately, it isn’t always simple to see what the exact problem is and exactly how to fix it.
The ministries of health are severely myopic and short sighted in many countries. They have lost sight of the real target, which is the population that needs the services. Sometimes public dissatisfaction lights a fire under the ministry but, if this doesn’t happen, healthcare suffers. They only see those closest to them, such as the provider’s needs, but don’t see those further out that are the ones who need treatment.
Ministries are good at dealing with a multitude of public sector organizations which might be funded by the government itself but they are not always seeing everyone in the grand picture of things and there are holes in the ministry’s functions.
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