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Aggregation of corporate functions In line with the discussion above a possible option for the corporate services is set out below. Administration and personnel services unit Finance and budget services unit Options for the arrangements below this level need to be worked out in detail. This would include improving work processes and practices as well as developing the structure and getting the right people into the jobs. SECTION V: Strategic management Current situation and issues Corporate services Procurement services unit The formal structure for this department has four divisions, five offices, two centres and a position covering special programs, as set out in Appendix F. Like many other departments there are unfilled positions and some changes from the official structure. The director’s position is vacant and is being filled on an acting basis by the Head of the Division of Health Information. There are eight staff and four vacant positions including: capital investments (being recruited) and positions not being recruited in the Division of Human Resources, including the position related to the central server. This department provides a range of services including: HR for the sector focused on workforce planning and development for primary, secondary and tertiary levels (not to be confused with the MOH personnel function); this is delivered via the Division of Human Resources (head of this Division is vacant) which has the Office of Specialist Education (vacant position) and the Office for Continuing Professional Development (3 positions). Quality standards for health facilities and strategy to implement these (1 Head of Office and no staff). Licensing of health professionals (Office for Registration and Licensing with two staff supporting a large number of boards). HMIS services covering management of the health information system, standards, and policies, including the patient management systems in hospitals, drug management system, HR management system, and finance system. These services are at a developmental stage (1 staff, central server position vacant as there is no central server). Donor coordination and capital investments (one staff; plus capital investment position which is vacant and is being recruited). Issues raised during interviews in relation to the functions and organisation of this department have been set out below with some comments: 16 Communications services unit Legal services unit
Lack of planning and policy functions Planning, strategic management and policy making could be strengthened in the MOH. There is no health policy and planning coordination or facilitation capacity in this department. This appears to be a core role that is missing. Working groups tend to take on the functions of planning and policy making due in part to the immediate need to cover the gaps in the capability of the MOH. The draft Health Sector Strategy is proposing a Strategy Forum for the sector; a strategic planning working group for the MOH; and a new unit to support these groups reporting to the PS called the “Strategic Development and Monitoring Unit.” In the absence of these functions operating fully, the Minister has been using working groups. It would be good to develop capability in the MOH and use working groups for advisory roles rather than carrying out core functions. There are large strategic management challenges in the health sector including: improving the financing models; developing information systems; policy work and planning related to the building blocks for health insurance; and improving the cycle of planning, budgeting, management and reporting in the MOH and wider health sector (see appendix D). The department is not resourced to deal with these challenges as well as the planning requirements in the Health Law 2004 (section 56 see Appendix C). Planning and management of health reforms could be improved. For example, primary care performance based payments were introduced before the necessary preparatory work was done. Preparation for health insurance and the policy work underpinning changes to the Health Law are not yet well advanced. Some decision-making is undertaken at the political level on routine and technical matters. This could be partially addressed by strengthening the role of the Department of Strategic Management to improve the processes underpinning the decision-making. Need stronger link of strategic planning and budgeting. The Budget Commission is constituted each year and could be better supported by a more strategic planning department that can provide information that links planning and budgeting. Lack of high level monitoring The stewardship role is not functioning well in terms of accountability for different levels and in terms of implementing what is planned. No one is systematically assessing the strategies and implementation. There are no monitoring or review functions in this department and there is difficulty in accessing monitoring information. The draft Health Sector Strategy proposes that the Strategic Development and Monitoring Unit carry out monitoring and evaluation functions. This could be a core role of the Department of Strategic Management. Under-development health information system Under-developed HIS with a lack of resources to improve this situation and some lack of role clarity with the NIPH. Activity data exists for hospitals and other providers but is not up to date and readily accessible from a central point. Hospitals do not use DRGs and this is a core element of pricing services if there is a movement to health insurance. Many providers do not have PCs, internet links or software. Health status data has many problems as noted in the World Bank report on financing. Work is underway on the HIS strategy which may result in suggestions about roles and functions for various entities, so suggestions have not been made about this area. Poor flows of information within MOH including monitoring information from the inspectorates. A problem was noted with a culture of some entities reporting to PS not cooperating with other parts of the MOH and treating information as confidential to them. Issues were noted with a lack of clarity on roles and responsibilities including job descriptions not being clear enough, with no requirements to share information and cooperate with other parts of the Ministry. This may be a MOH wide issue that needs addressing. The lack of recent census data makes it very difficult to design some health sector policies like capitation payments for primary care. Quality control needs strengthening There is one person in MOH with quality control and assurance responsibilities at the policy level. One hospital commented that there is a lack of feedback from this function in the MOH. There are considerable opportunities to improve quality and productivity in the health 17
Page 1 and 2: Functional Review and Institutional
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Improving the health status analysi
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50.2 Section 1.2 of the Law on Pubi
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[check if section 13 is OK or are t
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all of the directors as soon as pra
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Template for examining decision rig
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Name of agency Invest Give loans bu
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Name of agency Modify a license Can
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The issues raised at the start of t
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Figure 2: Integrated management cyc
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fees. The proposal could exclude th
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