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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
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