1. Steering Role National Health Authority Priscilla Rivas-Loría, Ph.D Advisor in Health Sector Reform Health Systems Strengthening Area, PAHO/WHO, WDC Priscilla Rivas-Loría, Ph.D Advisor in Health Sector Reform Health Systems Strengthening Area, PAHO/WHO, WDC Monitoring Health Systems Change and Health Reform English-Speaking Caribbean and Canada Monitoring Health Systems Change and Health Reform English-Speaking Caribbean and Canada Belize City, Belize 30 May - 1 June 2006 Belize City, Belize 30 May - 1 June 2006

2. WHY IS IT A PRIORITY ISSUE? WHY IS IT A PRIORITY ISSUE? 1.State Reform: reduction size of the State 2.Transfer of functions traditionally performed by public sector to private sector and civil society 3.Globalization: increase in the flow of (a) information, (b) capital, and (c) work force 4.Progressive erosion of the autonomy of the Nation-State leads to a weak governance capacity 5.Insufficient level of institutional development

3. HSR Regional Trends Influencing Steering Role Performance HSR Regional Trends Influencing Steering Role Performance 1.Intensification of decentralization processes. 2.Trend toward the separation of health system functions, such as financing, insurance and health services delivery. 3.Emergence of new public and private actors in the health sector. 4.Growing participation of private health insurance and private pre-payment mechanisms.

4. PROVISION ASSURANCE FINANCING STEERING ROLE Trend toward the separation of health system functions, such as financing, insurance and health services delivery. HSR Regional Trends Influencing Steering Role Performance HSR Regional Trends Influencing Steering Role Performance

5. 1.The exercise of responsibilities inherent to public policy in health, which take place within the framework of the new set of relationships between government and society in the modern State. It is performed by the Health Authority. What is the Steering Role Function in Health?

6. 1.Define and implement public decisions and actions to fulfill and guarantee the health needs of all stakeholders within the framework of the national development scheme. Objective Steering Role Function in Health Objective Steering Role Function in Health

7. Regulate Harmonize Provision Harmonize Provision Monitor Financing Monitor Financing Monitor Assurance Monitor Assurance Lead Steering Role Steering Role Dimensions of the Steering Role Exercise the EPHFs Exercise the EPHFs

8. HEALTH AUTHORITY HEALTH AUTHORITY FINANCING and ASSUARNCE PROVISION of HEALTH SERVICES REGULAte Lead EXCLUSIVE Responsibilities EXCLUSIVE Responsibilities Shared Responsabilities Responsibilities Essential Public Health Functions

9. HEALTH AUTHORITY 1.Is the custodian of the public good in health. 2.Its main objective is to safeguard, protect and promote the population’s health. 3.Structural differences in the composition of the Health Authority based on the federal or unitary nature character of the country, as well as the institutional organization of the health sector. 1.Is the custodian of the public good in health. 2.Its main objective is to safeguard, protect and promote the population’s health. 3.Structural differences in the composition of the Health Authority based on the federal or unitary nature character of the country, as well as the institutional organization of the health sector.

10. HEALTH AUTHORITY LEAD FINANCING & assurance REGULAte Public health HEALTH SERVICES PROVISION Economic Politics Social Exercise State responsibilities in health which cannot be delegated Health Authority (CITIZENS RIGHTS) (Power, Governance) (Economic power)

11. Why do Mapping? Diversity of Stakeholders and Institutions Scope of Activities Separation of Functions Context Diversity of Stakeholders and Institutions Scope of Activities Separation of Functions Context identify specific stakeholdes and scope of action of Health Authority ¿WHO DOES WHAT?

12. LEAD LEAD Capacity to guide the sector’s institutions and mobilize social institutions and groups in support of National Health Policy

13. REGULATION REGULATION Design normative framework to protect and promote population’s health and guarantee its enforcement