Stewardship in the context of health systems is often narrowly understood as governance, but in fact it encompasses a wide range of functions carried out by the governments as they seek to achieve national health policy objectives and safeguard health and well-being of populations. Effective stewardship involves providing clear vision, strategic direction and continued oversight to the whole health system (public, private and voluntary sectors), as well as exerting influence on other actors whose activities impact health.

Stewardship often requires both political and technical action as it involves reconciling competing demands for limited resources in changing circumstances. The stewardship function may be divided between central and subnational authorities, but India’s Union Government, through its health ministry, remains the ‘steward of stewards’.

There are six core components of the stewardship function:

  • Policy guidance: Formulating health sector policies and strategies; defining goals and spending priorities across services, while identifying the roles of public, private and voluntary actors.
  • System design: Maintaining the strategic direction from policy development to implementation by ensuring alignment between the strategy and health system structure so as to improve efficiency and reduce duplication and fragmentation.
  • Collaboration and partnership building: Build strategic alliances across government sectors and with actors outside government- private sector and civil society to harmonize activities, influence action on key determinants of health and generate support for favourable public policies.
  • Intelligence and oversight: Ensuring generation, analysis and use of intelligence on trends and differentials in inputs, access, coverage and quality of services, financial protection and health outcomes across social gradient. Similarly gathering and using the intelligence on the effects of health and allied policies, the political environment and opportunities for action.
  • Regulation: Designing health related regulations and ensuring they are effectively and fairly enforced.
  • Accountability: Fostering transparency and establishing effective mechanisms to ensure that all health system actors are held publically accountable.