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Steering Role. Priscilla Rivas-Loría Advisor, Health Sector Reform PAHO/WHO. Washington, D.C. Scenario Derived from the Reforms. DECENTRALIZATION OF HEALTH SYSTEMS. Decentralization / de-concentration of Public Health services and individual-level care. New public and private actors.

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Steering Role


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    1. Steering Role Priscilla Rivas-Loría Advisor, Health Sector Reform PAHO/WHO. Washington, D.C.

    2. Scenario Derived from the Reforms DECENTRALIZATION OF HEALTH SYSTEMS Decentralization / de-concentration of Public Health services and individual-level care New public and private actors Need for Strengthening the Steering Role SEPARATION OF FUNCTIONS DETERIORATION OF PUBLICHEALTH Increase in the participation of private insurances

    3. Conceptual and Methodological Evolution of the Steering Role in Health GRAPHIC 1: Conceptual and Methodological Evolution of the Steering Role in Health Elaboration of the Methodological Guidelines for the Performance Evaluation of the Steering Role Resolution CD40.R12 The Steering Role of Ministries of Health in Sectoral Reform Processes Sub-regional Training Workshop, Central America and the Spanish Caribbean Performance and Strengthening of the National Authority’s Steering Role Elaboration of the Guidelines for Mapping the National Health Authority Sub-Regional Meeting for Central America, Guatemala: The Sectoral Steering Role and Leadership of the Ministry of Health Expert Meeting – Validation of Methodological Guidelines Performance Evaluation of the NHA Steering Role Expert Meeting Washington, DC Development of Institutional Capacity to perform the Steering Role CD 40/13 Sub-committee on Planning and Programming The Steering Role of Ministries of Health in Reform Processes Pilot Application in El Salvador Methodological Guidelines for the Performance Evaluation of the Steering Role Source:

    4. www.lachealthsys.org Conceptual Framework and Methodological Instrument “Steering Role Capacity of the National Health Authority: Strengthening its Performance”

    5. 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.

    6. 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.

    7. Dimensions of the Steering Role Harmonization of Provision Financing Regulation Steering role Assurance Conduct/Lead Development of EPHF

    8. DIMENSIONS OF EXCLUSIVE RESPONSIBILITY OF THE HEALTH AUTHORITY Shared Responsibilities ASSURANCE SERVICE PROVISION FINANCING HEALTH AUTHORITY CONDUCT/LEAD Exclusive Responsibilities REGULATION ESSENTIAL PUBLIC HEALTH FUNCTIONS

    9. Health Authority Direct exercise of the substantive and indelegable responsibilities in Health that correspond to the State CONDUCT/LEAD FINANCING Political Economic (power, governability) (industry, economic interest) REGULATION ASSURANCE HEALTH AUTHORITY SERVICE PROVISION PUBLIC HEALTH Social (citizens’ right)

    10. 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

    11. 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

    12. Conduct/Lead Formulation of health policies, strategies, plans and programs Reach consensus and mobilize actors and resources Definition of health priorities and goals Health situation analysis BRAZIL MEXICO PERU

    13. Conduct/Lead Political and technical participation in international organizations Evaluation of health systems performance Promotion of public health, participation and social control in health Harmonize technical cooperation of international organizations BRAZIL MEXICO PERU

    14. 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

    15. Regulation Institutional and legal framework backing for exercise of steering role Regulation of medical supplies and health technology, goods and services Regulation and certification of Human Resources in Health Fiscalization to ensure fulfillment of regulations BRAZIL MEXICO PERU

    16. 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.

    17. Financing Define criteria for resource allocation Correct sectoral distortions in $ and increase equity Negotiation with principal providers Redistri-bution of $ to compensate for market asymme-tries Monitoring of financing process BRAZIL MEXICO PERU

    18. 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

    19. Assurance Definition of populations that will be covered by the guaranteed package of services Definition of guaranteed package of services Regulation and control of public and private insurance plans BRAZIL MEXICO PERU

    20. 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

    21. Service Provision Function Planning using regional or functional criteria Development of regulatory mechanisms for protecting the public and guaranteeing minimum standards of quality Promotion of coalitions and provision of incentives for self-regulation COUNTRY BRAZIL MEXICO PERU