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organisational structures (departments, divisions, centres, agencies, offices, etc) and
administrative instructions from Office of the Prime Minister that require certain structures.
3. Undertake critical policy work that affects the structure and functions of the MOH. A
policy direction with large potential to change the MOH is health insurance. The policy work
could be rapidly strengthened so a realistic transition path is developed to move from where
the health sector is now to a feasible model. An important building block is changing the
MOH from an integrated policy maker and provider of services to a planning, policy, funding,
monitoring and regulation role for the MOH with more autonomy for providers linked to
robust accountability frameworks for those providers (hospitals and other agencies) as
suggested in Appendix G. Other building blocks include: better health status analysis and
demand analysis; improved health information on provider activity/services; specification of
services; costing of services; defining the basic package that government can fund and
aligning entitlements to this; complex contracting including designing contracts to manage
the risks of cost shifting, cream skimming and other risks; monitoring many aspects of
performance; improvements in configuration, efficiency and effectiveness of government
owned providers; improvements in governance and accountability arrangements for
government service providers; market development; and institutional development work for
the health insurance model including investment risks (if this model proceeds). All these
developments require leadership from the MOH, including policy analysis, planning and
driving the implementation of many changes. The MOH could strengthen its capability in
these areas and the restructuring of the ministry needs to address this. Further advice on
this is set out in Appendix G.
4. Use the opportunity to revise the Health Law to put policy changes into the legal
framework including the improved governance and accountability arrangements for
hospitals. The transition arrangements for the Ministry of Health to develop the
purchasing/funding function could also be set out in the Health Law.
Implementation of the Institutional Development Plan from 3 to 12 months- following
completion of the work listed above for the first 3 months
Ministry of Health internal changes (subject to the Institutional Development Plan):
5. Reduce the number of reports to PS; consider creating a senior management level
with more services represented on it in the form of directors of departments for: Public
Health; Primary Health; Secondary and Tertiary Services; Pharmaceuticals; and Mental
Health, as well as departments for Corporate Services (Administration and Finance); and
Strategic Management. The best arrangement should be selected based on a thorough
analysis.
6. For each of the service departments listed above establish units for 1. policy and
planning; 2. monitoring. Where these departments provide services, a third unit could be
established for service provision. Variations on this are possible where there is a
purchasing/funding function which could be undertaken by the Health Care Commissioning
Agency or other options. An option covered in Appendix G is to locate the Health Care
Commissioning Agency within a much strengthened Department of Strategic Management
so the full resources of that department could be used to support the purchasing/funding
function. All units should have staff members who are skilled in various areas and who are
able to take on a range of work. The units should not have tightly segmented jobs focused
on narrow areas of work.
7. Reduce the number of corporate services type of reports by creating a Department of
Corporate Services that includes finance and budget; administration and personnel; legal
services; communications; and procurement.
8. Strengthen the Department of Strategic Management so it has a unit for: 1. facilitating
ministry-wide policy, ministry-wide planning, ministry-level reporting and ministry-level
monitoring functions, as well as units for 2. HIMS; 3. Sector HR development and regulation;
and 4. Productivity and quality improvement. There is an option to locate the Health Care
Commissioning function in this department as a 5 th unit as discussed in Appendix G.
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