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

Lessons LearntMany lessons have been learnt from all the initiatives. The points below highlight some of the keyprinciples that need to be considered for effective implementation and outcomes.•••••••Before engagement in major health reform initiatives, overt state government commitmentshould be demonstrated and evident (e.g. through MOUs).The building of capacity often starts from a low base, thus is a lengthy and sustained process.Ongoing monitoring, supervision and support are essential if quality standards are to be achievedand sustained in resource poor environments.It is important to acknowledge all the challenges (technical, institutional, political) to effectiveservice delivery, and analyse which of these can be won, and which cannot. In the latter case, itmay still be possible to adopt a management strategy that allows for some gains.Political interests are enormously influential and need to be taken into account when planningprogrammes of work.Bringing donors together in a cohesive and collaborative forum can be highly beneficial and costeffective.The interest of, and engagement from, most stakeholders has a strong pecuniary influence.Concluding CommentsDespite the many challenges faced by the PATHS programme there is little doubt by those whohave come into contact with it, both clients and stakeholders, that it is held in high regard and has areputation for achievement.However none of this could have happened without the very considerable commitment and inputfrom an enormous number of people including government employees, private sectors employees,NGOs, CBOs and communities.Eternal thanks go to them all for making the programme in Enugu what it is today, a well known,popular and highly respected programme.“Togetherness in Health” the Enugu Experience in Health Sector Reform, 2002-2008 73