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Continuous Professional Development in the Department of Strategic Management). The Centre for
Telemedicine supports the hospitals (15 staff).
Issues identified by staff in the MOH, hospitals and other agencies in relation to secondary and
tertiary services include the following.
Allocation of roles and responsibilities- lack of delegated power
Decision making on technical and routine matters sometimes occurs at the political level that
sidelines the technical level.
There are frequent interactions some staff members with the PS on operational matters.
Overload on PS with hospitals and NIPH reporting directly to the PS while the Office of
Hospital Institutions is vacant and has no active role. This also causes an overload on the
Director of Health Services as this Director analyses the performance reports. Consideration
could be given to clarifying the nature of the reporting to the PS or Minister for health sector
agencies, being in the nature of very high level matters such as signing off accountability
documents (see Appendix G). Regular and ad hoc performance reporting could be provided
to the Office of Hospital Institutions and it could take on the relationship management role
and related tasks.
There may be opportunities to improve the allocation of roles and responsibilities for the
education functions in the Department of Strategic Management and the education functions
in the Department of Health Services. We were advised that a third centre for professional
education may be set up soon which seems unusual given the current number of centres
and the fragmentation of these between two departments.
Health services are not represented well at senior management level
Lack of profile at senior levels for the health services and overload on the Director of Health
Services. As noted earlier, there are many corporate service functions with direct reports to
the PS. There is an opportunity to consider raising the position of the various health
services and providing integrated policy, planning and service monitoring functions for
service areas including secondary and tertiary services. There is no function for
systematically monitoring and reporting on the performance in secondary and tertiary health
care (Division of Health Care head vacant and Office for Hospital Institutions vacant). Policy
making is also very limited.
Process problems
Many staff mentioned issues with delays and wasted effort in getting routine things
processed and approved. The major services and outputs of the MOH could be specified
and then the processes underpinning the production of these services and outputs could be
examined to find ways to streamline them and make them more efficient. This can involve
many changes like removing unnecessary steps, using IT solutions to reduce the need to go
from office to office to get things done, making information more readily available on the
intranet, etc.
Cultural practices affecting performance
Departments and agencies reporting to the PS and minister do not always cooperate well
and freely exchange information, despite weekly meetings for directors and meetings for
wider groups. Examples were given of staff members not being willing to share draft strategy
documents within the MOH and performance reports from agencies not being made
available to the departments that have monitoring roles. There are many ways to address
this problem including requiring cooperation in job descriptions and assessing performance
in relation to this; making information available on the intranet; and treating non cooperation
as a serious performance issue for the director or manager causing problems.
There is a large use of working groups to do core roles like producing strategies and
monitoring these, which may be necessary in the short term, but capability should be
developed in the MOH. Sometimes tasks are given to working groups that they are unlikely
to be able to do given their incentives, such as working on the organisational structure of the
ministry. This involves many personal interests and requires leadership from the top, rather
than placing this task with a group of directors that will include winners and losers from the
changes. Working groups can be advisory, but should not be doing core MOH technical
functions.
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