title: Health system stewardship of National Health Ministries in the WHO European region: concepts, functions and assessment framework.
abstract: OBJECTIVE
  To propose an operational framework for assessing the completeness and consistency of the stewardship function of national health ministries.
  
  
  METHODS
  The authors carried out a purposive and multidisciplinary review of the literature and derived an operational framework through iterative discussions and participatory methods. The results of the literature review were compared to the authors' observations of stewardship in action and key functions were matched with case examples from Europe and North America.
  
  
  RESULTS
  The operational framework relates six functions of stewardship with national contexts, values and ultimate goals pursued by health systems: to define the vision for health and strategy to achieve better health; to exert influence across all sectors for better health; to govern the health system in a way that is consistent with prevailing values; to ensure that system design is aligned with health system goals; to better leverage available legal and regulatory instruments; and to compile, disseminate and apply intelligence.
  
  
  CONCLUSIONS
  Challenges in the implementation of stewardship relate to: limitations to the role of health ministries; and to governance, operational and change implementation issues. The framework proposed seems flexible enough to help assess the health system stewardship function; however it should be further tested in practice.
authors.affiliation: Research and Analysis, Canadian Institute for Health Information, 4110 Yonge Street - Suite 300, Toronto, Ontario M2P 2B7, Canada. jveillard@cihi.ca
authors.forename: Jeremy Henri Maurice
authors.initials: JH
authors.lastname: Veillard
authors.forename: Adalsteinn Davidson
authors.initials: AD
authors.lastname: Brown
authors.forename: Enis
authors.initials: E
authors.lastname: Barış
authors.forename: Govin
authors.initials: G
authors.lastname: Permanand
authors.forename: Niek Sebastian
authors.initials: NS
authors.lastname: Klazinga
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D005060:Europe; D006077:Government Agencies / Q000458:organization & administration / Q000592:standards; D019981:Health Care Sector / Q000458:organization & administration / Q000592:standards; D006291:Health Policy; D006801:Humans; D009313:National Health Programs / Q000458:organization & administration* / Q000592:standards