04.12.2015 Review Team - WordPress.com · 2018-04-22 · Régis Hitimane Health Systems Specialist Pillar 3: Human Resources Pillar 5: Medical Products & Technologies Pillar 6: Health

04.12.2015 Review Team

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Content of the presentation y Rationale and Objectives y Methodology, limitations and team members; y All six Pillars with for each pillar (i) its achievements,

(ii) challenges and gaps and (iii) some strategic recommendations;

y Management and implementation arrangements y Overall conclusions and recommendations y Next Steps

12/4/2015 Sierra Leone NHSSP Review - December 2015 2

Rationale of the Review y MOHS is implementing a health sector recovery

plan focusing on prioritised interventions. It would also like to learn what has worked and what has not in the implementation of NHSSP 2010-2015. There is a need to document: y Reasons for not fully realizing the health

outcomes; what worked and what did not work? y Challenges for building a resilient health systems y Identify the strategic HSS gaps and interventions

to supplement the recovery plan


Objectives The overall objective of the review is to support the MoHS in documenting successes and challenges of NHSSP implementation. The review will document: y Achievements and best practices in its

implementation; y Reasons for inadequate implementation, gaps and

causes of system vulnerabilities; y Propose strategic recommendations to

complement the recovery plan and/or other implementations plans, including new NHSSP.


Methodology Based on the TOR, the Review Team undertook the following activities:

1. Key Informant Interviews (KII) with many responsible managers a. Within MOHS: CMO, DHSPPI, DRCH, DPHC, HSS Hub, IHPAU, HIV and

Malaria Programs, HCF Unit, M&E focal point, Donor Coordination Unit and DDMS),

b. Close allies of the Ministries: COMAHS, CCM c. Other Ministries: MEST, MOFED, MLG/ Decentralisation Secretariat. d. Development Partners: WHO / WR, UN Agencies, bilateral partners and the

World Bank, USAID and CDC, DFID, JICA, Irish Aid, McKinzey and TB-AGI; e. NGO and CSO: CHAI and Health Poverty Action.

2. Visit to two districts Port Loko and Kambia: DMO & DHMT, Hospital, MCH A Training Schools, Pharmacy, District Council and PHU (CHC, CHP and MCHP)

3. Desk review to consult a good number of relevant background documents

4. The presentation below follows closely the specific objectives of the Pillars as mentioned in the NHSSP 2010-2015.


Limitations of the review y Two weeks is quite limited to conduct such a broad sector

review with all six pillars and systems; y Two days of field visits is limited to have a good overview

of what happened in the last five years; y Some key stakeholders were not interviewed: examples

like IDSR and Ministry of Labour and social Security y There is insufficient evidence on some system

vulnerabilities: y No annual performance reports over the last three years; y Inadequate information from routine information systems

(HMIS, LMIS, HRIS…)


Team members of the review NAME

CONSULTANTS AREAS OF EXPERTISE

SPECIFIC RESPONSIBILITY NATIONAL Colleagues

Jarl Chabot Public Health Specialist

Pillar 2 Service Delivery Lamin Bangura

Abebe Alebachew

Health Economist / Finance Specialist

Pillar 1 Leadership & Governance Pillar 4: Health care Financing

Régis Hitimane Health Systems Specialist

Pillar 3: Human Resources Pillar 5: Medical Products & Technologies Pillar 6: Health Information System

Melvin Conteh


Acknowledgements y The review team would like to acknowledge the time and support

provided by the senior management of the MOHS, the various directors and staff members that we interviewed and the district health authorities (DHMT) in the hospitals, the PHUs, the training schools and the District Council.

y In addition to the MOHS, we also want to express our gratitude for their time and insights of the Ministry of Finance and Economic Development (MOFED), the Ministry of Education, Science and Technology (MEST) and the Ministry of Local Government (MLG).

y Finally, many thanks are due to the WHO that made this review of the NHSSP possible and the various Development & Implementing Partners and the international NGO, that together gave us valuable insights and ideas to better understand the dire situation in which the Health Sector of Sierra Leone finds itself.


Pillar 2: Overall Service Delivery IMPACT INDICATORS Baseline (DHS 2008) 2015 Target NHSSP Achievement DHS,

June-Sept 2013.

Infant mortality rate (per 1,000 live births)

89 /1,000 50 / 1,000 92/1000

Under-five mortality rate (per 1,000 live births)

140 /1,000 90 / 1,000 156 / 1000

Maternal mortality ratio (per 100,000 live births)

857 /100.000 600 / 100,000 1,165 /100,000

Prevalence of HIV (% of pop. aged 15–49)

1.50% 1.20% 1.5%

Total Fertility Rate (TFR) 5.1 4 4.9


Pillar 2: Service Delivery Main Achievements (i) 1. Utilisation: Between 2008-2013, use of services increased and outputs improved: ANC 4x up

from 50% to 76%; Births by SBA up from 42 to 54% thanks FHCI; and EPI went up from 40 to 58%; HIV, TB and Malaria programs are fully operational and reached their targets;

Most services kept going during the EVD; Triage systems and IPC widely implemented; Much rehabilitation at all PHU levels undertaken by DPs + NGOs; In general access improved;;


MNCH INDICATORS Baseline (DHS 2008) 2015 Target NHSSP Achievement DHS, June-Sept 2013.

% Births attended by skilled staff (Public and Private)

42% 90% 54% MCHA 14%, Nurse 44%

% Births attended by TBA / CHW 45 NA 35% % Pregnant Women making 4 ANC visits

50 90 76

Contraceptive prevalence rate (CPR: % of women aged 15–49)

14% 30% 16%

Unmet need among married women for FP

28% NA 25%

% Children < 1 yr fully vaccinated 40 90 58

Service Delivery: Main Achievements (ii) 2. Quality: A revised and more comprehensive BPEHS is available; Many guidelines

produced; Most ED are available in PHU and DH; All DH can do Caesarian sections (CEmOC); Much on the job training on IPC and treatment guidelines; HW appear well protected;

3. Management: Most managers and staff are dedicated with good technical capacity; 4. Emergency Services: Emergency Information Systems (mHERO) now address

EVD with guidance from DERC and NERC (transport, housing, treatment centres); Rapidly expanded at all levels;; Ambulances and transport widely available;

5. Community services : Geo-mapping of CHW finalised; Policy being drafted; Cordial relations MCHA with CHW and TBA; Meetings with Committees take place; PHU provides almost all services of BPEHS; Referrals on individual basis and often ad hoc


Pillar 2: Service Delivery Reasons for inadequate implementation of NHSSP

1. Utilisation: Consultation for OPD low before EVD! (0.5/pp/yr), no recent figures; No focus on poor/vulnerable; Constructions did not follow national guidelines; Few staff quarters in PHUs;

2. Quality: BPEHS not costed! More than the minimum package and may not be affordable to be fully translated into practice; secondary facilities much expanded, but maintenance quite uncertain; Environmental health and waste disposal results are not encouraging and has not come out as a priority in NHSSP and the Recovery plan

3. Management: Little coordination among vertical programs; Coordination among Directorates and TWGs, but little follow-up; disconnect between National – District levels; many professional PHU staff are volunteers already for many years!

4. Emergency: Post Ebola activities consume much time and resources; unclear what will be handed over to MOHS and DHMT and how MOHS will manage it after end of the year; Creating emergency Mgmt structures (DERC, NERC) increased vertical communication channels; it seems to reduce ownership by senior management;

5. Community services: Role and scope of CHW being revised, but still undecided; Supervision between PHU levels often not possible (transport); TBA are still trusted and utilized.

OVERALL: Current available Systems (Planning, Finance, HRH, Coordination, Decentralisation, HMIS, SCM) are not well enough performing to allow Service Delivery to improve!


Pillar 2. Service Delivery Strategic recommendations

1. Utilisation: develop strategjes to reduce demand side barriers (financial, cultural, distance), reinforce community mobilization and outreach; Recapture HIV and TB patient;

2. improve the Quality of service delivery : y Develop a costed roadmap for BPEHS implementation with fiscal space analysis, if it is over-ambitious, make it realistic to fit in

MOHS budget ceilings from MOFED; y Prioritize and implement environmental health and waste disposal interventions as one of the core MOHS missions

y 3. Management:; y Harmonise Service Delivery interventions with key priorities of the Recovery Plan (10-24 months plan) with

focus on MNCH, FP and EPI; y Consider bringing all (Vertical Programs under one department; y Link the new plan with BPEHS and with the GoSL Agenda 4 Prosperity (A4P);

4. Emergency: initiate C-IDSR (CEBS) once IDSR is performing well; Bring emergency services back under DHMT responsibility; ensure structures created for ebola response are integrated into routine emergency (district) systems

5. Community services: Develop a new community health costed roadmap with fiscal space analysis, GoSL funding commitment, service packages, incentive modalities, career structures, supervision....

OVERALL: Review and invest on Governance, Leadership and Health Financing systems to address service delivery!


Pillar 3: Human Resources for Health Achievements

y Policy and Institutional capacity for HR policy y HRH policy and strategic plan (2011-2015) has been developed y More health staff have been deployed in HF and rural/urban disparities have reduced y HRH technical working group exists and is functional

y Competencies and performance for workers y PBF system and remote incentives have been established, since the free health care (FHCI) y Salaries have been increased, there are in-service training sessions going on y There are capable staff in non-clinical positions (DHMTs, Central level)

y Capacity for training of health workers y Training centers for MCH Aides have been established with standard curriculum y Community health program: training of CHW takes place at CHP levels y There are plans to empower training schools as part of the Recovery phase;

y Evidence-based information y An electronic staff attendance and Human Resource Information System has been initiated y With the Early recovery plan there are interventions to collect evidence on current status (payroll

assessment, mapping of CHWs…)

All districts fall far short of minimum thresholds on health workforce density

15 Note: Includes all service-delivery cadres except MCH Aides

13,9

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tern

Are

a

Urb

an

17,7

WH

O m

imim

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22,8

Bont

he

4,3

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9,5

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o

3,1

6,8

Kai

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n

3,3 To

nkol

ili

4,2

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o

3,8

Ken

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Koi

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Moy

amba

3,5

Puje

hun

3,3

Kam

bia

3,4

Bom

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6,0

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tern

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a

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l Ratio of health care workers per 10,000 population

WHO Recommended minimum threshold = 22.8 per 10,000 population

Northern

Southern

Western

Eastern

Approximately 14,000 health workers (4,000 doctors and 10,000 nurses) to meet WHO minimum with current population size

Distribution

Pillar 3: Human Resources for Health Reasons for inadequate implementation of NHSSP (i)

y Policy and Institutional capacity for HR y From NHSSP to Recovery, there is no costed HR Development with exception of MCH

Aides (in NHSSP), and specialist and clinical officer (Recovery): structures in MoHS not focused on HRD

y Health facilities are understaffed and rural urban disparities are still high: just 1-2 Doctors in District hosp.

y Staff that finish in schools and worked for a long time fin PHUs are not paid in line with the government minimum staffing patterns:, many MCHA wait for years in HFs as volunteers.

y Capacity for training of health workers y Training institutions including COMHAS have not adequate capacity (financial,

Lecturers, infrastructure …) to increase production. Support from MEST has reduced y Training of CHW not coordinated: guidelines not always followed, different partners train

their own CHWs on specific topics.

Pillar 3: Human Resources for Health Reasons for inadequate implementation of NHSSP (ii)

Competencies and performance for workers y Staffing in HFs is not in conformity with BPEHS staffing norms y There is no career progression mechanism for most of the cadres y PBF is not regular; criteria for its distribution among staff is not in favor of motivating lower

level cadres; y Remote allowance mechanism was not successfully implemented: no clear guidelines, weak

enforcement mechanism and no GoSL ownership and investment; y Staff management (recruitment/appointment, payroll…) is still centralized Î delays in

recruitment, ghost staff, no District ownership, possible entry of unqualified staff in service y A large number of staff is not on payroll: demotivated, difficult to hold accountable!

y Evidence-based information y HRIS captures only around 30% of staff; it doesn’t serve its purpose and the current approach

to complete it with survey is not enough to keep track of HRH

Pillar 3. Human Resources for Health Strategic recommendations

y Policy and institutional capacity y Develop, clear long-term HRH development plan with budget for all critical cadres with clear

Government commitment to fund it. y Government to lead efforts to strengthen institutions for implementation of the plan (MoHS / HRD

department, academic,…) as well as HRH absorption plan y Devolve human resources management, use budget and other control mechanisms to ensure

equitable distribution and/or develop an equitable human resource deployment criteria with transparent accountability mechanism.

y Competencies and performance for workers y Restructure remote allowance and PBF systems, taking into account staff needs, available

budget… Make it a government policy with direct investment. y Put in place, communicate and implement a coordinated continuous professional training and

career progression system. y Evidence-based information

y More use of technologies in HR management and integration of systems is recommended (HRIS, Payroll, attendance, performance management)

Pillar 5: Medical products & technologies Achievements

y Policies and guidelines y Legal and policy framework in place: Pharmacy and drug act and related

guidelines, Drug policy…

y Access to good quality, medical supplies and technologies y Availability of drugs has improved (for Free Health Care Initiative) y Electronic management information system has been initiated

y Medicines regulation and quality assurance

y Institutions have been established: NPPU, Pharmaceutical board with quality control lab, DHMT have pharmacy staff

Pillar 5: Medical products & technologies Reasons for inadequate implementation of NHSSP

y Policies and guidelines y Existing legal and policy framework are not well enforced: Supply chain is vertical and not coordinated,

NPPU has not yet started to play its intended role Î entry of counterfeit, entry drugs without registration, or quality control, frequent use of drugs out of essential drug list (EDL), non useful donations…

y Access to good quality, medical supplies and technologies y Push system still in place: Central level procures and distribute. Supply some times doesn’t match with

demand Î a lot of waste and heavy donor dependency without Government plan to takeover y Cost recovery system doesn’t function well to support revolving fund for medical products y LMIS is not fully functional and not used for keep track of stock levels, make orders. No DHMT

involvement and insufficient computers; y Storage infrastructure is not adequate: space, guidelines, standards…

y Rational use of medicines y Inadequate prescription behavior; drug therapeutic committees are not functional Î volume of expired

drugs increased y Technologies

y No coordinated maintenance and replacement plan (with budget) and capacity for medical equipment

Pillar 5: Medical products & technologies Strategic recommendations y Policies and guidelines

y Government leadership to enforce legal and policy framework is key! y Access to good quality, medical supplies and technologies

y Pull all capacities (staff, money, equipment) related to logistics from vertical programs to NPPU and make one procurement plan and one supply system. Invest in strengthening NPPU

y Set up a revolving fund for drugs and consumable at central and DHMT and facility levels with a clear management and accountability system, and sustain it with a functional cost recovery plan

y Fully implement e-LMIS with GoSL ownership, use it as a tool for tracking stock levels, basis for quantification and procurement planning by DHMT, ordering, with DHMT involvement and use.

y Shift from push to pull to match demand with supply y Rational use of medicines

y Develop and disseminate and enforce guidelines on rational drug use y Revive drug therapeutic committees and include their functioning in the performance appraisal

system for PBF

Pillar 6: Health Information System and M&E Achievements y Policy and institutional framework

y Results and accountability framework developed y DHMTs have data managers and M&E staff

y Routine data collection, management, dissemination and use y DHIS2 has been established in PHUs (paper based) DHMTs and central level (electronic) y Birth and death registration takes place y DHMTs are equipped with staff and tools for data management y Efforts to improve data quality for programs like Malaria, EPI, HIV…

y Monitoring and evaluation, research and knowledge y Use of data for planning and review is fairly good at District level

y Strengthen IDSR and integrate it into national HIS y With Ebola, IDSR has been improved; there are plans to improve it further in the recovery

plan

Pillar 6: Health Information System and M&E Reasons for inadequate implementation of NHSSP

y Routine data collection, management, dissemination and use y Currently there is no reliable source of routine information, HRIS is incomplete, District hospitals and

community health program have been excluded in DHIS2 implementation y Existing information systems are not integrated: programs have their own reporting tools, software and staff. y Little Government investment in information system, inadequate staff and infrastructures: few computers,

servers, no reliable internet…in HFs and DHMTs and at central level in M&E desk y Capacity of reporting staff in PHUs is not good, A lot of indicators, few staff for data entry Î high

possibilities of errors, Data quality initiatives are vertical and hospitals are left out y Vital statistics are not complete Birth registration (70%,DHS2103) and death registration: about 20%1 cause

of death not well captured y Monitoring and evaluation, research and knowledge

y Poor data use and feedback from central level Î poor data quality y Inadequate training of M&E staff mainly in District hospitals (electricians, engineers..)

y Integrate IDSR into national HIS y IDSR, though it has been strengthened, is not yet integrated with other systems;.

Pillar 6: Health Information System and M&E Strategic recommendations y Policy and institutional framework

y Strengthen DHSSPI to be able to do regular data analysis, use dissemination and data quality checks in coordination with other departments.

y Routine data collection, management, dissemination and use y Set up one-stop center for health information from health facilities using DHIS2 platform. Pull all resources from

programs to strengthen that system. y Put in place accountability mechanisms for data quality at all levels, use PBF and other mechanisms. y Initiate electronic reporting in CHCs, and empower them to be a layer for data synthesis and supervision for

lower PHUs y Improve data management capacities at central level (staff, servers, computers…) and District level (staff,

computers, internet…) y Lobby to GoSL to expand electricity and internet services in remote areas, y Instruct all programs and projects (FHCI for example) to commit a % allocated to HIS and M&E

y Monitoring and evaluation, research and knowledge y Institute data dissemination & use (bulletins, review meetings, performance reports) Î data quality will go up

y Strengthen IDSR and integrate it into national HIS y Put in place infrastructures and capacity for IDSR at all levels and integrate it in DHIS2

25

ARE WE STILL TOGETHER ?

Sierra Leone NHSSP Review First Debriefing 12/4/2015

Pillar 4: Health Care Financing Achievements y According to NHA 2013, the share of Health from total government spending

increased from 8.5% to 11.2% and its share from total health Expenditure show also marginal increase from 15 to 17%.

y The Free Health Care Initiative supported by the PBF has: y Increased uptake of services for the U5, pregnant and lactating mothers y Motivated health workers y contribute to the availability of medicines and medical suppliers. y BEMOC and CEmOC facilities have been established and are functioning y More of the resources of DPs are going to finance under-five services; 33% of the

total spending on health went to reproductive health and family planning. y there is also evidence that the OOPs financing of under-five is about 18 percent of

the total cost.

Pillar 4: Health Care Financing Reasons for inadequate implementation of NHSSP (i) y Underfinancing of the health sector is leading to catastrophic high OOPs; y There is high dependence on external resources y Many PHC activities are run by volunteers.

GoSL 2013

DPs (2013)

Total public spending

International recommended level

Per capita spending on health

$ 6.5 $23.2 29.7 CMH 2012 prices = $71 HLTF for innovative Fin = $86 WHO for UHC-government 5% of GDP

Financing trends

1.7% 1.8%

1.2% 0.8%

0.3%

5% 5% 5% 5% 5%

2010 2011 2012 2013 2014

Health Expenditure as a % of GDP

% of GDP (estimated requirement for UHC)

9% 10%

8%

6%

2%

13%

11%

9%

6%

3%

15% 15% 15% 15% 15%

2010 2011 2012 2013 2014

Health Expenditure as a % of Total Domestic Revenue

Health Expenditure as a % of Total Domestic Revenue

% Health expenditure (Abuja commitment)

NHSSP and JPWF financing

59%

51% 51% 47%

34%

48%

0%

10%

20%

30%

40%

50%

60%

70%

2010 2011 2012 2013 2014 total

% of NHSSP cost funded

0%

50%

100%

150%

200%

250%

300%

350%

2012 2013 2014

153% 132%

105%

311%

338%

251%

% of JPWF cost funded

% external Resources available from JPWF projections

Pillar 4: Health Care Financing Reasons for inadequate implementation of NHSSP (ii)

y Inadequate focus on health financing as a HSS pillar: y No financing policy and strategy y The HCF unit understaffed and fully funded by DPs; senior position remain vacant y HCF unit not fully involved in costing of strategies; only engaged in NHA that is not

disseminated well and used for policy making y No visible efforts to diversify domestic resources or enhance VFM

y Complete neglect of the cost recovery scheme (transparency, centralization, no new mode of generating funding)

y Risk pooling mechanisms are yet to be piloted and implemented y No visible effort to track resources and enhance efficiency

y Inadequate capacity to advocate for and use resources y Late release of funds and many bottlenecks to access funds y Weak linkage between planning and budgeting, thus making planning ineffective y Inability to justify request for and to account for disbursed government resource

y Issues around sustainability of free health care initiative: y Relies on DP funding and the continuity of PBF after 2017 is uncertain y Inadequate communication and confusion by the community on free health care.

Pillar 4. Health Care Financing Strategic recommendations y Develop a health care financing strategy and implementation plan

y Strategy that sets policies on free services, cost recovery, risk pooling strategies, resource mobilization, enhancing efficiency of resource use

y An implementation plan that translates the strategy into action y Restructure and strengthen the HCF unit:

y Make it the driver for implementation of the HCF strategy and its implementation plan y Engage them more on resource mobilization, costing and financing works in the MOHS y Government recruits and funds the staff, with initiation TA

y Work on risk pooling mechanisms, specifically CBHI as a means to move towards UHC and reduce OOPs (large scale, government led and financed; risk equalization schemes etc)

y Rethink and strengthen the cost recovery system y Guidelines, transparency of resource use, and private wards y Strategy for long-term facility financing through cost recovery mechanism with devolved

and clear management arrangements

Pillar 1: Leadership, Governance and Planning Achievements

y Increasing political will to prioritize on the health sector, especially after EVD outbreak y Presidential flagship programs, the recovery plan but not necessarily reflected as increased

investment y The leadership by the State house; Recovery plan (6-9 months and 10-24 months); MOHS

flagship programmes; the establishment of NERC and DERC; HSS hub; the establishment of IHPAU

y SLA is a good initiative to streamline the IPs interventions at district and national levels y Top management meetings take place: there are weekly and monthly meeting at the MOHS with

directors; Monthly and quarterly review processes takes place at district levels y A costed and mapped recovery plan with clear sources and gaps of funding for interventions

y Coordination structures exist y at national and district levels: HSCC, HSSG and the TWGs; y monthly meetings with IPs, DHMTs and councils y Facility community management committees exist

y Good working arrangement and relationships between the DHMTs and councils within the framework of partial devolution.

Pillar 1: Leadership, Governance and Planning Reasons for inadequate implementation of NHSSP (i) y Inadequate ownership and commitment by GoSL to the NHSSP implementation:

y Top management and technical leadership not having common position y Not enough consultations, dialogue and consensus within MOHS and with partners; y vertical program priorities are not aligned and integrated with NHSSP and JPWF y Weak communication and coordination within national (MoHS) and between MOHS and DHMTs

y The NHSSP and JPWF were not accompanied by: y A sound fiscal space analysis and projections of resources based on commitments y The comprehensive annual plans are not based on a resource mapping and resource constrained processes,

as is the case in the Recovery plan; y Weak policy dialogue and mutual accountability b/n government and DPs

y Compact (Dec 2011) not implemented y The policy dialogue weak: HSCC not met for the last five months; HSCC not guided the recovery plan and

overtaken by new arrangements (NERC and DERC); not able to enforce NHSSP implementation y DPs rely more on projects to deliver quick results but undermine systems strengthening since they do not

work within the system y Weak collaboration and working arrangement between MOFED and MOHS in DP coordination y Poor coordination between DHMT and partners: working systems and arrangements

Pillar 1: Leadership, Governance and Planning Reasons for inadequate implementation of NHSSP (ii)

y Existence of many overlapping and competing plans and priorities y Districts develop two plans (one for MOFED/Council based on provided ceiling another

comprehensive plan for MOHS, no ceilings) y Programs have also their own plans that is not necessarily aligned y Two presidential flagship programs (zero tolerance and maternal and child health) y the Recovery Plan (the 6-9 ms and the 10-24 ms plans) is not comprehensive enough to guide as

the sector y Inadequate effort to strengthen MOHS systems:

y Most of the initiatives aimed at strengthening systems are driven as projects rather than integrating and implementing them through the existing health systems

y Most programs are financed by DPs and their efforts are more geared towards meeting the interests of financiers than implementing the core priorities of the NHSSP, the JPWF or the Recovery Plan;

y Weak review and monitoring mechanism for translating NHSSP and JPWF into action

Overarching Public Sector Management: Two Challenges

y The implementation of devolved functions are heavily affected by the centralization of the expenditure assignments (resource allocation, payroll and personnel management). y The councils have NO control over the human resources y Have no discretion to allocate resources for priority areas, as the money is provided as

earmarked grants-Do not have resources to respond to Ebola outbreak y The development grants were discontinued with the completion of the WB project.

y There is an issue of credibility of the budgeting process: y Ceilings are provided for budgeting, but often change during the planning process y The approved budget is not released on time, due to fiscal constraints at the national level

and poor accounting for expenditures by MOHS and districts- only received 50% or less of the 2015 budget and often very late;

y The medium term forecasts are weak and poorly linked to policy or plans. y There are no costed sector strategies linked to MTEF resource ceilings and investment.

Pillar 1. Leadership, Governance and Planning Strategic recommendations

y Lobby Government, MOFED and Ministry of Local Government to: y Improve the budgeting and disbursement process (conservative budget

ceiling ) y Complement the functional devolution with expenditure decentralization

(accountability at district levels) y Improve ownership and feasibility of plans

y Base plans on commitments (DPs and IPs and mapped resources); At least work with DP to be on-plan

y Enhance top and senior management ownership: on priorities, strategies, resource allocation criteria

y Develop measurable performance milestones for short term capacity to transfer skills to MOHS to ensure sustainability

y Develop a compressive new strategic plan that integrates the recovery plan within it

Pillar 1. Leadership, Governance and Planning Strategic recommendations

y Develop and implement a HSS capacity Development Plan (structures, human resources; skills, and processes and systems) to create confidence for partners to be come ‘on-plan’ first, then ‘on-budget’ and finally ‘on-account’ over the long term;

y Strengthen the leadership, planning and management of DP/IP coordination y Have a common position with MOFED y Ensure all activities are on-plan!! y Undertake resource mapping and include it in the plan at all levels y Bring the various planning exercises under ONE comprehensive plan for Central and District

levels y Support SLA with resource mapping by making it part of the annual routine planning and M&E

process y Enhance coordination

y Communication within MOHS and with DHMTs y Enhance accountability for delivering planned targets (rewards and sanctions )


Overall Recommendation y Develop BPEHS implementation plan affordable to government y Develop and implement a feasible and affordable community health

strategy and its packages y Development a long-term approach to strengthen systems capacity

(structures, human resource, skills and process) y Develop strategies and enforce e integration of systems into the

mainstream y Develop long term health financing strategy and invest on its

implementation y Strengthen commitment, leadership, coordination and management at

all levels to translate plans into action y Develop a medium terms health sector strategic plan that takes into

account the recovery plan


NHSSP Review Next steps NHSSP Review y Incorporate comments from Stakeholders meeting

today (04.12) in power point presentation y Team to continue writing the draft report y Submit draft report within two weeks (18.12) to MOHS

and DPs y Team to receive consolidated comments on draft

report from MOHS and DPs / NGOs on Friday 08 January 2016

y Finalise the NHSSP Review and submit final report to MOHS on Friday 22 January 2016.

12/4/2015 40

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04.12.2015 Review Team - WordPress.com · 2018-04-22 · Régis Hitimane Health Systems Specialist Pillar 3: Human Resources Pillar 5: Medical Products & Technologies Pillar 6: Health