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information to undertake further work on aligning the staffing arrangements to the budget and
assessing the costs of the proposed changes. The work on the Institutional Development Plan
should involve breaking the budget down to smaller cost centres to make it clearer what costs are
related to various functions and what the fiscal costs to the budget are for the proposed changes.
Positions reporting to the Permanent Secretary
The PS has around 28-30 direct reporting positions with many of these being corporate services and
providers of health services to the public. This suggests that the PS is at risk of being overwhelmed
by provider issues and corporate issues, with little space to focus on the core functions of the
ministry in terms of planning, policy, regulation, monitoring and review. The MOH needs to be
providing strategic leadership in the sector, but this may be compromised by the reporting
arrangements in relation to the PS. A more common range is around eight to ten including the
support staff. The options for reducing this number of reports are discussed in this report.
The corporate functions reporting to the PS are identified below, with options suggested for changing
these. In contrast to the high profile that many corporate service functions have, key health policy,
planning, monitoring and review functions lack a high profile in the structure of the MOH. The policy,
planning, and review functions for public health, primary health, mental health, and secondary and
tertiary services are all located under one director, along with the role of monitoring the hospitals.
This causes many problems related to a lack of adequate representation for these functions at a high
level in the ministry. 4 It also overloads the Director of the Health Services Department according to
comments from staff. It potentially overloads the vacant position of the head of the Division of Health
Services as this position has the Office for Hospital Institutions (vacant) and the Office for Primary
Health Care.
The Permanent Secretary has 13 agencies (institutions) reporting to this position, covering most
hospital services. The reporting involves more than just exercising the role of appointment and
management of the executive director of the agencies. In some cases it extends to receiving the
performance reports of these agencies and dealing in some detail with their issues. There is an
Office for Hospital Institutions under the Department of Health Services that is vacant and is not
being filled. This situation of many direct reports by agencies to the PS and a lack of an oversight
function elsewhere in the ministry, coupled with weaknesses in the accountability framework for the
agencies are discussed in section VI.
The options for reorganising the corporate functions, lifting the profile of core MOH services, and
improving the arrangement for the agencies is discussed in the sections that follow.
SECTION IV: Corporate functions
The corporate functions located at the level of reporting to the PS are discussed below.
Legal Department: An administrative instruction from the Office of the Prime Minister requires this
office to be designated as a department. This department has five staff including the Director of the
Department, with other positions required by the PMO administrative instruction, but which the MOH
is not filling due to other priorities (as at April 2009). The Department focuses on legal aspects of
administrative instructions and draft laws. It does not provide advice on legal matters relating to
contracting, procurement, or personnel, nor does it represent the MOH in legal proceedings as this is
a Ministry of Justice role. Consideration should be given to revoking the PMO instruction as it
presumes all ministries will be well served by having a predetermined level of legal resources and
that they should be delivered through specified jobs. This is proving not to be the case in the MOH,
where under a budget constraint, the MOH has identified other priorities. To maximise the use of the
legal resources, consideration could be given to changing the structure and roles. For example the
Department could be a unit under a Corporate Services Department where it could be located with
4 Hospitals report to the PS. This is discussed later in this report, including an option to have this reporting relate to high
level matters only with other areas of the MOH dealing with the function of monitoring hospitals.
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