PATHS Final programme report: "Togetherness in Health" the Enugu ...

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PATHS provided much of the infrastructurerequired to support the establishment of theHMIS. This included: setting up and equippingthe PDPD and SHB computer rooms; provisionof computers and software at District level;maintenance of the machines/software; andsending key HMIS personnel on both nationaland international training in order to enhancetheir skills. In early 2008, PATHS provided supportHMIS TrainingThis focused on computer use, datacollection, data collation, data querying,quality assurance, software use and handling,data generation and data analysisso that the state could migrate to the National Health Management Information System (NHMIS) 1 . Thiseffort focused initially on the training of community volunteers, TBAs and facility staff, some 1200 intotal to date.By early 2008 health data was increasingly being used to inform management decision-making,budgeting and policy and strategy development processes. However, whilst the quantity of datacollected had improved considerably, quality remained an issue. Further support will be needed inthis area. In particular, this will need to focus on the private sector where data collection remains veryweak.Publc Expenditure ManagementAs the business planning process was refined, so were the financial management system and publicexpenditure management processes. PATHS invested very heavily in supporting the improvementof both these systems within the Ministry of Health. The process started in February 2004 with aninitial review of the feasibility of implementing a financial management system within the StateHospital Management Board and six district hospitals. However, with the advent of the DHS the focusshifted to the financing of, and the financial systems associated with, the DHS. It also considered theestablishment of the proposed State Health Fund and the need for adequate systems of accountability.Extensive TA was provided by PATHS to support the process of strengthening public expendituremanagement throughout the programme lifetime, and some very substantial progress had beenmade by early 2008:•••••••Design and implementation of a financial management system throughout the DHSProvision of FMS training for Finance Officers and facility staffRevision of the Chart of Accounts to reflect the District Health SystemProduction of a more refined MoH 2007 budget informed by District calculations of their overheadrequirementsDevelopment of an Excel spreadsheet activity-based budget templateRefinement of the budget for 2008 down to facility level using the budget template linked to theChart of Accounts, enabling for the first time realistic activity-based budgeting. 2Use of HMIS data to inform the budget1 For more detail see PATHS Technical Brief on HMIS.2 This was based on core functions and core activities in order to achieve a minimum baseline service package in allfacilities.34 PATHS Final Programme Report
PATHS budget team Enugu••••Establishment of a SMoH budget group which was able to progress the work without externalassistanceTraining the budget group in use of the activity-based budget templateAchieving a release of funds for the constituent bodies (albeit only for a limited period)Establishment of regular FMS monitoring to encourage transparency in financial accountingAll the above resulted in the production of computerised activity-based and costed budgetarysubmissions which were considerably more advanced that those produced by any other ministry inEnugu. This provided a model for other ministries – and indeed other states – to follow.Despite these very positive advances, an on-going and very significant challenge was the decisionto channel substantial funds into the upgrading of the Park Lane Hospital so that it could become atertiary facility. This severely reduced the operational funding available to the rest of the health sector.It also meant that progress with setting up the much needed State Health Fund was curtailed.Human Resource Management and DevelopmentHuman resource management aims to achieve: the right people, in the right place, at the right time,with the right skills.The SMOH recognised that a considerable amount of work needed to be undertaken in an effortto improve human resource management and development. Nevertheless, this area proved verychallenging and early work stalled due to the paucity of data on staff numbers and their actualplace of employment. Local Government data, in particular, proved virtually impossible to access.This was compounded by the high level of staff absenteeism. However, the period 2006-2008 sawa considerable improvement in staffing data with the Local Health Authorities in particular havingbetter access to data that would enable them to determine their staffing base. Data was much easier“Togetherness in Health” the Enugu Experience in Health Sector Reform, 2002-2008 35
Page 3 and 4: "Togetherness in Health"the Enugu E
Page 5 and 6: FORWARDI am very pleased on behalf
Page 8 and 9: 6 PATHS Final Programme Report
Page 11 and 12: Section 1:Setting the Enugu Context
Page 13 and 14: KEY FACTSHealth Indices: Comparison
Page 15 and 16: PHC centres and cottage hospitals i
Page 17 and 18: Section 2:Overview of the PATHSProg
Page 19: Stakeholder initiatives supported b
Page 22 and 23: PATHS ApproachEngagement Process wi
Page 24 and 25: Pro-poor FocusPATHS pro-poor focus
Page 26 and 27: “PATHS has indeed impacted very p
Page 28 and 29: the 56 Executive Secretaries of Loc
Page 30 and 31: Health Board and the Districts. The
Page 32 and 33: it was agreed that the original ide
Page 34 and 35: •••Working to an agreed timef
Page 38 and 39: to access for the Ministry of Healt
Page 40 and 41: and the core DRF models used in oth
Page 42 and 43: Enabling Service DeliveryDeveloping
Page 44 and 45: Procurement of Drugs and EquipmentT
Page 46 and 47: equired in order to ensure that mor
Page 48 and 49: Training in the laboratory of Annun
Page 50 and 51: The services to be delivered were a
Page 52 and 53: Where care is givenEnugu’s health
Page 54 and 55: Enugu State Total Deliveries in Pub
Page 56 and 57: The selection process resulted in t
Page 58 and 59: Reduced maternal andinfant mortalit
Page 60 and 61: By the conclusion of the second ser
Page 62 and 63: With the advent of the DHS it was a
Page 64 and 65: Inter-Personal Communication and Co
Page 68 and 69: Intermediate Outputs1) The DHS stru
Page 70 and 71: 5) A culture of business planning a
Page 74 and 75: 4) The tendency for politicians to
Page 76 and 77: Abbreviations and AcronymsANCBCCBEO
Page 78 and 79: AcknowledgementsThe PATHS programme
Page 80 and 81: Master trainersSMoH/faith based sec
Page 82: 80 PATHS Final Programme Report

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