The concept of stewardship in health policy

There is widespread agreement that both the configuration and the applicati on of state authority in the health sector should be realigned in the inter est of achieving agreed policy objectives. The desired outcome is frequentl y characterized as a search for good governance serving the public interest . The present paper examines the proposal in The World Health Report 2000 t hat the concept of stewardship offers the appropriate basis for reconfigura tion. We trace the development of stewardship from its initial religious fo rmulation to more recent ecological and sociological permutations. Consider ation is given to the potential of stewardship for encouraging state decisi on-making that is both normatively based and economically efficient. Variou s dilemmas that could impede or preclude such a shift in state behaviour ar e examined. We conclude that the concept of stewardship holds substantial p romise if adequately developed and effectively implemented.