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sector, but few incentives and poor information to drive this. There is an option to combine
the MOH’s policy role in quality with a policy role in productivity, given the close relationship
of these policy areas and the need to make tradeoffs.
These comments indicate that the Department of Strategic Management is lacking some core
functions, including policy and planning facilitation and coordination. Ideally the parts of the MOH
and its agencies that are knowledgeable about core services such as primary health, public health,
secondary and tertiary health, mental health, pharmaceuticals and health information, would lead
policy development in their areas and provide inputs into the policy making, planning and budgeting
processes. These processes could be facilitated by the Department of Strategic Management, but at
the moment the Department lacks resources assigned to do this.
Similarly, a coordinated approach to the monitoring and review functions is missing from the MOH.
There are two inspectorates reporting to the Minister and one inspectorate reporting to the PS (soon
to move to the Office of the Prime Minister). We have not reviewed the option to combine the
inspection functions as these are complex areas that would require in depth analysis, including fully
understanding the reasons for the recent changes. There are obviously issues they are being used
to address that make the routine application of good practice ideas in this area too superficial.
Distinct from an inspection function is a routine monitoring function. There is no routine monitoring of
providers’ services in terms of output quantities, quality and efficiency measures. There is also no
systematic or targeted pre-planned review of providers’ performance, apart from the work of the
small Health Inspectorate. There is apparently a lack of open sharing of monitoring information within
the MOH making monitoring difficult.
There are options for improving the monitoring arrangements including developing a whole-ofministry
routine monitoring function in the Department of Strategic Management that focuses on the
MOH’s high level reporting and monitoring. This is not an inspection role, rather it would involve the
routine review of periodic performance reports from providers, fed through to this department. The
detailed monitoring could be carried out in the service departments (discussed later) and key
information provided to the Department of Strategic Management to compile and process into
various management reports for the PS and others.
Taking into account the missing functions, the overly segmented structure of the department
particularly given its low staff numbers and vacancies, and the comments from MOH staff on the
issues related to the functions of this department, an option for reorganising the department has
been set out below. This is just one of many options, but it captures some of the key ideas as a
basis for discussion with the MOH.
Policy
planning,
monitoring
and review
unit
Health
information
services
unit
Department of Strategic
Management
HR
development
and regulation
unit
Policy, planning, monitoring and review would include coordinating the strategic and annual
planning processes and coordinating this with the budget work; facilitating major policy making
processes that involve cross ministry and agency inputs; working with staff in MOH and agencies to
18
Productivity
and quality
improvement
services unit
Purchasing
/funding
services
HCCA