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There is a National Institute of Public Health (NIPH) with a staff of 297 that covers many areas of
public health including: a school of public health, services related to communicable diseases, non
communicable diseases, public health observation, food control, water quality, laboratory
diagnostics, health education, health promotion, HIS, research, and environmental health services.
The NIPH is planning to set up seven centres to deliver services. This reorganisation is not
expected to result in any staff changes, but is expected to improve the efficiency of services.
The NIPH is not actively involved in public health policy unless invited to contribute by the MOH. It
does not routinely monitor health status, although it does keep databases on aspects of health.
The public health functions managed by the NIPH are decentralised at a regional level and they
report activities to the Director of Finance. The Director of the NIPH is not involved in detail on
regional activities, but considers that the reporting is adequate for this country at this stage.
Issues raised by staff include:
Options
Policy development based on good health status analysis for public health could be
strengthened. There is a lack of resources allocated to this in the MOH and no formal
arrangements with the NIPH to provide inputs to the MOH’s role in doing this. No one is
doing health status analysis in a planned and systematic way. There are possibilities of
using the capacities of the NIPH more effectively to contribute to health status analysis,
public health policy making and planning.
The services of the NIPH and Division of Public Health could be better coordinated to take
advantage of the capacity of the NIPH. A lack of clarity in roles and poor access by the MOH
Division of Public Health to health status information in the NIPH were noted as problems.
The World Bank report on financing noted problems with the quality of health status and
patient activity data. Planning for improvements in data and analysis could be part of the
policy and planning work of the MOH at a high level and undertaken in cooperation with the
NIPH. Work underway on the Health Information Strategy will be considering this.
Duplication with a department of Health Information Systems in the NIPH that collects and
analyses field data. There is also an HIS division in the MOH. Roles are not entirely clear.
Little progress has been made on improving information, however the WHO is supporting
consulting work to improve the Health Information Strategy, beginning in March 2009.
The program for mother and child in MOH is a possible duplication with the NIPH work in this
area. NIPH does monitoring of the referral policy and other matters while MOH does policy,
but sometimes they mix functions. Also reproductive health policy in MOH affects services
provided by University hospital, NIHP and others. There are coordination issues. MOH’s
role in implementation is not clear. This is normally a role for NIPH.
Better clarity on roles and responsibilities is critical to improving performance in public health
services, whatever option for restructuring is chosen. There are several options that could be
considered. One option is to raise the profile of public health services and make it a department
reporting to the PS. The NIPH could be more closely involved in the policy, information, planning
and monitoring work of the MOH. For high level matters it could report to the PS. It could deliver
services to the Director of the Department of Public Health Services, including contributing to the
policy and planning work of that Department.
If the option of having a Department of Public Health Services was to be considered further, the
internal arrangements could be researched to develop the best structure for these. A simple example
has been set out below. It would require clarity on the roles of the MOH and the NIPH. In addition to
its usual services, there is an option to fund the NIPH to provide specified services to the MOH and
an agreement used to clarify the expectations. The public health services in the diagram below are
MOH level services, but they could also cover responsibility for the service agreements with the
NIPH for various public health services.
The monitoring by the MOH envisaged in the diagram below is not the detailed health status
surveillance and other monitoring that NIPH does, rather it would involve routine monitoring of the
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