The concept of stewardship in health policy.

TLDR

There is widespread agreement that state authority in health should be realigned to achieve policy objectives, often framed as a search for good governance serving the public interest. The paper examines the World Health Report 2000 proposal that stewardship can reconfigure health governance and explores its potential to guide normatively based, economically efficient state decision‑making. The authors trace stewardship’s evolution from religious roots to ecological and sociological variants and examine dilemmas that could hinder a shift in state behaviour. We conclude that the concept of stewardship holds substantial promise if adequately developed and effectively implemented.

Abstract

There is widespread agreement that both the configuration and the application of state authority in the health sector should be realigned in the interest of achieving agreed policy objectives. The desired outcome is frequently characterized as a search for good governance serving the public interest. The present paper examines the proposal in The World Health Report 2000 that the concept of stewardship offers the appropriate basis for reconfiguration. We trace the development of stewardship from its initial religious formulation to more recent ecological and sociological permutations. Consideration is given to the potential of stewardship for encouraging state decision-making that is both normatively based and economically efficient. Various dilemmas that could impede or preclude such a shift in state behaviour are examined. We conclude that the concept of stewardship holds substantial promise if adequately developed and effectively implemented.