LIST OF WORKSHOPS

It is accepted that governance arrangements – understood as the process of steering and coordinating activities and actors in a sector – plays an important role in shaping policy performance and outcomes. There is however lack of clarity on what specific instruments are used to steer and coordinate a sector, as well as the mechanisms through which these impact policy outcomes. This is not helped by debates in public policy and its cognate disciplines that conflate key issues and concepts. For instance, at one extreme debates are focussed on expanding autonomy, voice, and participation for local actors, often packaged and presented as an integral part of decentralized and democratic governance (WHO Erurope, 2008). On the other extreme, key works in the field call for coordination, coherence, integration, and so on in government policies (Peters, 2015). This bifurcated line of thinking has stymied efforts to understand the instruments used to steer the sector, as well as in developing generalisable propositions on how these shape outcomes. The principal aim of this workshop is to speak to this gap in the literature and understand the instruments of governance  in the health sector – one of the most complex and contentious policy sectors -- and the mechanisms through which they affect outcomes. 

Health Governance as Steering

Recognition that health care is a local matter is as old as health policy, evident in the fact that local governments everywhere, in both federal and non-federal systems, bear the primary responsibility for delivering health services. While some local governments may have the necessary resources to deliver the health services, many do not and must rely on financial and other support from central authorities. The central authorities, for their part, cannot simply serve as cash registers transferring funds to local governments and providers, because they have their own priorities and responsibilities as well as fiduciary and other obligations. This leads them to impose conditions which take local needs and preferences into account but allows them to establish common national standards. They also need to ensure that the national policy goals are adhered to by local authorities, necessitating machinery for setting policy directions as well ensuring their implementation. In other words, the national governments and their provincial counterparts must set direction and steer the country towards it. In health policy and other literatures, this is referred to as stewardship (Roberts et al 2003).

Reduced to its essence, stewardship refers to setting of a common goal and organizing collective efforts to achieve it. In health care, this manifests in stating a vision and ensuring that the priorities and actions of all levels of government are aligned and geared towards achieving it. As Barbazza and Tello (2014) elaborate:

“The task of [health] system stewardship can then be said to include defining an overarching vision for the health system and establishing the boundaries in which the system’s actors operate. Characterizing stewardship according to its unique quality of direction, the governance function then distinctly describes the specific efforts and processes that are applied to steer the system toward this given priority.”

Identifying relevant policy tools, assessing their appropriateness, and adapting to local needs – otherwise known as policy design – is the responsibility of the policy steward. The tools include mechanisms for implementing the policy in question but also engaging with the society and collaborating with key stakeholders. As WHO (2014:10) put it, stewardship is about “… ensuring that a strategic policy framework exists and is combined with effective oversight, coalition building, regulation, attention to system‐design and accountability”. In a similar vein, Alvarez‐Rosete et al (2013) note: “The concept of health stewardship … implies a broader over-arching responsibility over the functioning of the health system as a whole and, ultimately, over the health of the population.” This interpretation of stewardship is separate from and narrower than the large literature that conflates it with the concept of governance, especially “good governance” (for example, see WHO Europe 2008).

The reassertion of the role of the government in health and other policy areas – variously described as recentring, rebalancing, de-privatization, re-regulation, etc (see Peters 2004, Capano, 2011; Ramesh and Araral 2010) – is not an effort to revert to centralized government of the past. It rather represents an intention to find practical ways to move forward towards developing practical solutions that strike a balance between centralization and decentralization, autonomy and control, government and society (Mor and Yip, 2015; Wu and Ramesh, 2014; Ramesh, 2008). The idea is to stem centrifugal tendencies without stifling local voice and discretion, best described by the phrase “centralized decentralization” (Chua et al 2019). Under this conception of stewardship, it is the national government that is ultimately responsible for ensuring that all residents within its territory have access to necessary health care. It is also its responsibility to ensure that critical functions are appropriately allocated so that the right level of government is responsible for the functions for which it is most suited, and there exist mechanisms for holding them accountable.

In parallel with the rise of vertical stewardship has been a shift towards greater emphasis on horizontal coordination of policies, arising from disappointment with earlier efforts to promote functional specialisation in governments (Peters, 2015). Inspired by New Public Management ideas, governments around the world had promoted specialization among agencies with individual managers held responsible for the performance of their organization. A by-product of these reforms was fragmentation of governance and public services, highlighting the need for counter measures. The increasing recognition of inter-connectedness among problems, especially “wicked” problems, also pointed to the need for increased integration (Verhoest, Van Thiel, Bouckaert and Lægreid, 2012; Hood and Dickson 2015). As Peters (2015: 5) put it, specialization artificially segmented problems when what was needed was a more integrated approach. The underlying idea behind policy coordination – often used synonymously with policy integration, policy coherence, holistic government, joined up government, and whole of government – is to promote greater coherence in policies through concerted efforts. The objective of the coordination efforts is to develop coherence across programs such that they not only reduce contradictions but are, in a positive sense, complementary and mutually reinforcing (Peters 2018). While policy coordination can be achieved through both top-down and bottom-up measures, what matters is that the national steward owns responsibility for it.

There are various instruments for achieving policy coordination, including network governance, collaboration and co-production, and hierarchy (Peters 2018b). While much discussion a decade ago centred on network and collaborative governance, it is increasingly realized that they complement rather substituted hierarchical coordination due to the unavoidable centrality of the state in government (Capano, Howlett, Ramesh 2015; Anka, Howlett, Ramesh 2018; Peters 2018). As Peters (2018) summarizes, “The centre of government actually has a very large repertoire of instruments to use when confronting coordination problems. Some of these instruments have been in place for decades, while others are relatively recent innovations.” One particularly widely-used method for promoting horizontal coordination is the establishment of central agencies and super-ministries with the explicit mandate and authority to promote coordination among related policy functions.

This workshop seeks to bring conceptual clarity on instruments and mechanisms used to steer and coordinate policy activity in the health sector.

 The importance of governance – defined as the process of steering and coordinating– in determining policy performance and outcomes is now broadly accepted. Yet, the details of what constitutes steering, its different forms and scope, the instruments, and mechanisms by which it affects outcomes remain unclear. The objective of this workshop is to invite papers on steering in healthcare -- one of the most complex and contentious policy sectors with deeply divergent interests -- from a variety of perspectives including public admin, health policy & management, and public policy. We are interested three overarching questions. 

1) What are the key activities that form steering?
2) What are the instruments of health governance?
2a)What instruments and mechanisms used to coordinate policy activity in the health sector? 
2b) What instruments and mechanisms used for steering the sector (setting objectives, goals, allocating resources)
3)How are instruments of health governance deployed/implemented?
3a) What factors condition their effectiveness?
 

We welcome papers that engage with these questions.   The proposals may be of theoretical or empirical nature, including case studies.

 The importance of governance – defined as the process of steering and coordinating– in determining policy performance and outcomes is now broadly accepted. Yet, the details of what constitutes steering, its different forms and scope, the instruments, and mechanisms by which it affects outcomes remain unclear. The objective of this workshop is to invite papers on steering in healthcare -- one of the most complex and contentious policy sectors with deeply divergent interests -- from a variety of perspectives including public admin, health policy & management, and public policy. We are interested three overarching questions. 

1) What are the key activities that form steering?
2) What are the instruments of health governance?
2a)What instruments and mechanisms used to coordinate policy activity in the health sector? 
2b) What instruments and mechanisms used for steering the sector (setting objectives, goals, allocating resources)
3)How are instruments of health governance deployed/implemented?
3a) What factors condition their effectiveness?
 

We welcome papers that engage with these questions.   The proposals may be of theoretical or empirical nature, including case studies.

M Ramesh is UNESCO Chair on Social Policy Design in Asia at the National University of Singapore. Previously, he was the Founding Head of the Department of Asian and Policy Studies at the Hong Kong Institute of Education and Chair of the Department of Government and International Relations at the University of Sydney. Specialising in public policy and governance in Asia with a particular focus on social policy, Ramesh has authored and edited many books. His widely used textbook Studying Public Policy has been translated into several languages. He is the Editor of the journals Policy and Society and Policy Design and Practice.

Azad S. Bali in Senior Lecturer in Public Policy and holds a joint appointment with the School of Politics & International Relations and the Crawford School of Public Policy at the Australian National University (ANU). His research interests straddle comparative public policy and health policy in Asia. Some of this research research has been published in leading journals including Policy Sciences, Policy & Society, Public Policy and Administration, Social Policy & Administration among others. His most recent book (with M Ramesh) is Health Policy in Asia: A Policy Design Approach. Bali is Editor of the Australian Journal of Public Administration and part of the editorial collective of Policy Design & Practice, and the Review of Public Personnel Administration.