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’.