Future physical investment will be focused on underserved locations, with increased attention to optimal location for serving the catchment area and poor and excluded, which may require re-consideration of the policy of only building on donated land. The main effort will be to continue with the facility upgrading programmes (CEOC in all district hospitals, birthing units in all health and sub-health posts, upgrading district facilities in locations most likely to increase access by the poor and excluded).
“Problems in financial management include slow disbursement, lower than desirable efficiency and effectiveness in budget implementation, and a generally weak control environment. The Ministry has been addressing the problems by implementing a financial management improvement plan from March 2008, incorporated in the governance and accountability action plan. There has been progress in some areas, for example the rate of budget execution has improved.
During NHSP-2, the Ministry will focus on timely distribution of grants to health facilities; alternative assurance arrangements such as social and performance audits; implementation of transparency and disclosure measures; capacity development supported by technical assistance; and general systems development and integration at central, district and facility levels.
The timeliness and value for money Ministry procurement activities will be improved by:
- Mandatory submission of procurement plans with proposed budgets, not after budget approval.
- Standardization of specifications.
- Building capacity in procurement, with a specialist procurement cadre at all levels to provide a career path. Training on the 2007 procurement act and procurement procedures offered to bidders too.
- Improved transparency, complaints handling, e-bidding.
- Improved budget estimates to reduce the risk of cancelled tenders, combining orders into larger packages, increased use of multi-year contracts.
- Central bidding and local purchasing for essential drugs, to address disparities in price, equality of medicines districts procure.
- Improvements to storage, vehicles, transport budget to ease distribution problems in the districts.
- Improved quality control of drug procurement, with improved capacity of DDA and LMD to test quality on site, and PPP with private sector laboratories for testing of health commodities and drugs.
Governance and Accountability
Measures to make services more client-centered and accountable to those they serve, with a particular focus on the poor and excluded, will include:
- Participatory planning, social and public audit, mandatory public hearings to strengthen accountability at local level.
- Capacity building of local health management committees, with clearer financial management procedures.
- Implementing a 3-5 district pilot on Strengthening Local Health Governance, to develop a more integrated and locally management, with a view to expanding to more districts.
- Building on existing policy forms at national level (e.g. Health Sector decentralization Policy Forum and others) and involve civil society organizations in policy discussions, in order to strengthen voice, transparency and accountability.
- Continue documenting local innovations, learning and best practices of local health management committees.
- Regular and timely public disclosure activities through the Ministry’s website, radio/TV, newspapers, performance auditing, and annual progress report among other activities.
Cost and Financing
In the middle scenario, the Ministry would spend an additional $2.80 at 2009-10 prices and would be able to expand and scale up cost effective health interventions that are capable of saving an additional 45,000 lives cost-effectively.
Monitoring and Evaluation
HMIS produces detailed service data, disaggregated by age and gender. The accuracy is broadly confirmed by survey-based estimates, HMIS data are supplemented by regular surveys for information not obtainable from facility reporting-health seeking by socioeconomic characteristic, user satisfaction, and human resources in place, detailed budget and expenditure analysis to explore efficiency, effectiveness, and accountability issues.