• Ultimate responsibility
for the performance of a country’s health system lies with
. The careful and responsible management of the well-being of the population
– stewardship – is the very essence of good government. The health of people
is always a national priority: government responsibility for it is continuous and permanent.
• Dollar for dollar spent on health, many countries are falling short of their performance
potential. The result is a large number of preventable deaths and lives stunted
by disability. The impact of this failure is born disproportionately by the poor.
• Health systems are not just concerned with improving people’s health but with protecting
them against the financial costs of illness
. The challenge facing governments
in low income countries is to reduce the regressive burden of out-of-pocket payment
for health by expanding prepayment schemes, which spread financial risk and reduce
the spectre of catastrophic health care expenditures.
• Within governments, many health ministries focus on the public sector often disregarding
the – frequently much larger – private finance and provision of care. A growing
challenge is for governments to harness the energies of the private and voluntary
in achieving better levels of health systems performance, while offsetting the
failures of private markets
• Stewardship is ultimately concerned with oversight of the entire system
myopia, tunnel vision and the turning of a blind eye to a system’s failings. This report
is meant to make that task easier by bringing new evidence into sharp focus.