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Develop effective HIS (though not dealt with in detail in this study)
Interestingly many of the priorities in the Health Sector Strategy are not well resourced.
With regard to reducing mobility and mortality, the analysis work to do this is not well resourced.
There are issues with the quality of the health status data and no one in the MOH has the role of
analysing the key health status issues. The NIPH has health status data and undertakes policy
work in some areas, but does not have the role of doing the full range of public health policy
development.
With regard to the priority about the HIS, there is little funding for the HIS apart from a pilot project
in one municipality that is funded by donors. There is one staff member in the MOH assigned to
the HIS and he is acting in another management role.
Regarding the priority about improving the management and quality of services, there is one staff
person in the MOH working on quality assurance and the work is still in the early stages of
implementation in providers. There is no work on improving overall productivity of the health sector
by considering the policy settings and other key factors, and no one in the MOH with this as a
specific role.
Regarding the priority about reorganising the infrastructure, the Master Plan is in a draft stage.
The capital planned for hospitals in the medium term budget is falling from 9,543,000 Euros in
2009 to 9,190,330 in 2010. In 2011 the figure is 10,405,847 which is an increase in nominal terms
over 2009, but may not be in real terms once inflation is taken into account.
The MOH costed some activities to support the priorities which were not funded in the 2009 budget. There
do not appear to be any significant changes in the resources in the medium term budget to support these
priorities, although it is difficult to assess this properly as the budget is at an aggregated level.
Budget
Budget figures for the medium term were provided by the Deputy Minister who headed the Budget
Commission in 2009. This shows a 3.69% increase between 2009 to 2010 excluding THV and a 2.16%
decrease if THV is included in 2009 base; and a 6.15% increase between 2010 and 2011. In real terms, the
2009 to 2011 change may be a decrease after taking account of inflation for two years. This indicates that
the MOH has a challenge in providing services on a declining budget.
Table 1 Ministry of Health’s internal medium term budget document
Budget 2009
Total of
Operative
Expenditur
es 2009
53,785,032
Capital
Expenditur
es
9,543,150
Total
2009
63,328,1
82
Plan of
THV
2009
3,753,4
46
Boundaries 2010 Boundaries 2011
Operative
Expenditur
es
56,474,284
15
Capital
Expenditur
es
9,190,330
Operative
Expenditur
es
59,297,998
Total incl
THV 67,081,628 65,664,614 69,703,845
Capital
Expenditur
es
10,405,847
In contrast to the MOH‟s budget figures above, the MTEF figures are higher, but they relate to the entire
health sector so include the grants to municipalities. The MTEF figures indicate an increase in the health
sector funding from 2008 to 2009 of 29%; from 2009 to 2010 of 1.5%; from 2010 to 2011 of 5%. In real