Institutional Analysis of the Ministry
of Public Health at Central and
Provincial Levels
First Global Symposium on Health ...
Overview
• Background
• Objectives
• Methodology
• Stewardship functions
• Strengths and challenges by stewardship functio...
Background
• Dilapidated health system and extremely poor health status
• MOPH assumed a stewardship role in the health se...
Objectives
• To identify the strengths and weaknesses of MOPH at central
and provincial levels
• To help the Ministry to e...
Methodology
• Semi-structured Interviews with Ministry’s officials at the
central and provincial levels
• Field visits to ...
Stewardship Functions
– Setting strategies and objectives
– Development of technical guidelines
– Coordination
– Regulatio...
Setting Strategies and Objectives
Strengths Challenges
1. Clear and known
mechanisms for developing
strategies
2. Many gui...
Technical Guidelines and Supervision
Strengths Challenges
1. Relevant technical
guidelines developed for
several component...
Coordination
Strengths Challenges
1. Several coordination
mechanisms exist at the
central and provincial levels
2. Results...
Private Sector
Strengths Challenges
1. Central and provincial
officials have a positive
view about the private
sector
2. P...
Budgeting & Resource Mobilization
Strengths Challenges
1. Many central and provincial
officials involved in
mobilizing ext...
Accountability & Public Relation
Strengths Challenges
1. Extensive presence of
leadership in media
2. Availability of rela...
Monitoring & Evaluation
Strengths Challenges
1. Existence of national
M&E mechanism
2. Unified HMIS across
the country
3. ...
Human Resources
Strengths Challenges
1. Draft national human resource
policy and strategy available
2. Provincial and seve...
IEC/BCC
Strengths Challenges
1. Draft policy and strategy
available
2. IEC/BCC an integral part of
the BPHS
3. External re...
Emergency
Strengths Challenges
1. National plans available for
Avian Influenza
2. DEWS established
1. Lack of national doc...
Conclusions
– Good progress in strengthening the stewardship functions
required for rapid expansion of services
– Many key...
Recommendations
Setting Strategies and Objectives
– Establish a formal mechanism for the distribution and
explanation of guiding documents...
Technical Guidelines and Supervision
– Develop guidelines for mental health, disability, and IEC
parts of the BPHS and tre...
Coordination
– Make available the national and provincial profiles on
regular basis and make sure they are always part of
...
Private Sector
– Establish a technical and coordination mechanism among
the departments dealing with private sector
– Deve...
Budgeting & Resource Mobilization
– Build on program budgeting initiative
– Decentralize budgeting and financial authority...
Accountability & Public Relation
– Finalize and publish the draft public relation strategy and
guidelines
– Publish the we...
Monitoring & Evaluation
– Finalize, prepare, and disseminate summary national and
provincial profiles on regular basis
– C...
Human Resources
– Evaluate the feasibility of introducing differential staffing
and market rate salaries depending on size...
IEC/BCC
– Hire a short-term consultant to finalize the documents
– Reform the department
– Integrate the IEC with health c...
Emergency
– Bring the function under one reformed umbrella
– Develop general guidelines and instructions
– Conduct regular...
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Institutional Analysis of the Ministry of Public Health at Central and Provincial Levels

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This presentation on Afghanistan was given at the Global Symposium on Health Systems Research.

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Institutional Analysis of the Ministry of Public Health at Central and Provincial Levels

  1. 1. Institutional Analysis of the Ministry of Public Health at Central and Provincial Levels First Global Symposium on Health System Research November 18, 2010
  2. 2. Overview • Background • Objectives • Methodology • Stewardship functions • Strengths and challenges by stewardship functions • Recommendations
  3. 3. Background • Dilapidated health system and extremely poor health status • MOPH assumed a stewardship role in the health sector and left direct service provision to NGOs • The division contributed to important gains in health for the Afghan population • At the central level, the Grants and Contracts Management Unit (GCMU) provided a strong role in overseeing contracts and coordinating donor inputs
  4. 4. Objectives • To identify the strengths and weaknesses of MOPH at central and provincial levels • To help the Ministry to effectively carry out its stewardship functions
  5. 5. Methodology • Semi-structured Interviews with Ministry’s officials at the central and provincial levels • Field visits to Parwan, Baghlan, Samangan and Balkh provinces • Review of Ministry’s key documents
  6. 6. Stewardship Functions – Setting strategies and objectives – Development of technical guidelines – Coordination – Regulation and promotion of the private sector – Budgeting and resource mobilization – Accountability and public relations – Monitoring and evaluation – Human resource development – IEC/BCC – Emergency response
  7. 7. Setting Strategies and Objectives Strengths Challenges 1. Clear and known mechanisms for developing strategies 2. Many guiding documents developed by the MOPH 3. Senior MOPH officials heavily involved 4. Documents widely shared with development partners 1. Lack of an effective mechanism for dissemination and explanation of key documents to central and provincial staff 2. Lack of involvement of provincial officials
  8. 8. Technical Guidelines and Supervision Strengths Challenges 1. Relevant technical guidelines developed for several components of the Basic Package of Health Services 2. Guidelines made available to the NGOs 3. Staff of the health facilities trained on how to use the technical guidelines 1. Lack of technical guidelines for mental health, disability, and IEC components of the BPHS and treatment guidelines for the EPHS 2. Inconsistencies in the training of provincial staff
  9. 9. Coordination Strengths Challenges 1. Several coordination mechanisms exist at the central and provincial levels 2. Results presented to and discussed in certain coordination mechanisms 1. Variations among coordination meetings at the central and provincial levels in terms of discussing the results, decision making and follow up 2. Some NGOs not sharing their reports with provincial officials
  10. 10. Private Sector Strengths Challenges 1. Central and provincial officials have a positive view about the private sector 2. Private sector rapidly growing in the cities 3. Signs of its expansion in rural areas 1. Lack of updated policies, strategies, quality assurance guidelines, monitoring checklists, etc 2. Low capacity of departments dealing with the private sector
  11. 11. Budgeting & Resource Mobilization Strengths Challenges 1. Many central and provincial officials involved in mobilizing external resources 2. Managers have adequate knowledge about their development budgets 3. Budget expenditure relatively high compared to other ministries 1. Lack of specific operational budget for departments 2. Limited involvement in operation budget preparation 3. Complicated administrative and procurement procedures 4. Centralized financial authority 5. Delay in the reform of the General Directorate of Administration
  12. 12. Accountability & Public Relation Strengths Challenges 1. Extensive presence of leadership in media 2. Availability of relatively extensive information on MOPH website 3. Regular meetings with community representatives at the national and provincial levels 1. Lack of formal policies and guidelines about accountability and public relations 2. Unavailability of MOPH website in local languages 3. No disclosure of MOPH datasets and financial figures on the website
  13. 13. Monitoring & Evaluation Strengths Challenges 1. Existence of national M&E mechanism 2. Unified HMIS across the country 3. Extensive use of data at certain departments of the MOPH 1. Variations in data use at the central and provincial levels 2. No regular feedback to provincial officials 3. Concerns about the BSC: (i) known timing; (ii) prolonged gap between data collection and report; (iii) potential conflicts of interest; (iv) still not understood and used by many officials
  14. 14. Human Resources Strengths Challenges 1. Draft national human resource policy and strategy available 2. Provincial and several central departments reformed 3. Many officials paid salaries close to market rates 4. Community midwifery training program implemented in many provinces 1. Same level of provincial staffing and salaries regardless of population size, number of health facilities, and remoteness 2. Too long recruitment process 3. Lack of a strategic plan for addressing human resource issues 4. Issues with the gender, location and knowledge of health workers
  15. 15. IEC/BCC Strengths Challenges 1. Draft policy and strategy available 2. IEC/BCC an integral part of the BPHS 3. External resources available for IEC/BCC 1. Shortage of technical expertise 2. Delay in finalization of strategies and guideline
  16. 16. Emergency Strengths Challenges 1. National plans available for Avian Influenza 2. DEWS established 1. Lack of national documents for other emergencies 2. No preparation for certain emergencies 3. The function divided among several directorates 4. Emergency subcommittees not present in some provinces
  17. 17. Conclusions – Good progress in strengthening the stewardship functions required for rapid expansion of services – Many key areas still need to be reformed for sustaining the momentum • Budget and financial management • Capacity building for peripheral levels • … – Need for a systematic approach to strengthening the stewardship functions
  18. 18. Recommendations
  19. 19. Setting Strategies and Objectives – Establish a formal mechanism for the distribution and explanation of guiding documents to staff – Consider reinitiating the provincial health quarterly workshop – Involve the provinces in the development and revision of documents – Finalize and publish the draft list of health indicators and summary sheets
  20. 20. Technical Guidelines and Supervision – Develop guidelines for mental health, disability, and IEC parts of the BPHS and treatment guidelines for EPHS – Conduct training need assessment and training on technical guidelines at the provincial level
  21. 21. Coordination – Make available the national and provincial profiles on regular basis and make sure they are always part of agenda – Make sure NGOs are submitting their activity and financial reports to provincial offices – Hire provincial consultants
  22. 22. Private Sector – Establish a technical and coordination mechanism among the departments dealing with private sector – Develop norms and standards – Reform and strengthen the capacity of concerned departments
  23. 23. Budgeting & Resource Mobilization – Build on program budgeting initiative – Decentralize budgeting and financial authority – Reform the General Directorate of Administration – Simplify procedures – Develop resource mobilization strategy and guidelines – Improve the negotiation and proposal writing skills of the officials at the provincial level
  24. 24. Accountability & Public Relation – Finalize and publish the draft public relation strategy and guidelines – Publish the website in local languages (requires more staff, translators, and IT equipment; could be contracted out) – Make the datasets and financial figures publicly available
  25. 25. Monitoring & Evaluation – Finalize, prepare, and disseminate summary national and provincial profiles on regular basis – Conduct training need assessment and provide tailored training on HMIS, BSC, etc – Increase the salary of HMIS officers to levels paid by NGOs – Evaluate the feasibility of: (i) making BSC entirely independent; (ii) using M&E staff only for quality control and double check; (iii) doing continuous on demand data collection and analysis through out the year.
  26. 26. Human Resources – Evaluate the feasibility of introducing differential staffing and market rate salaries depending on size and remoteness of provinces – Introduce incentives, organize informal events, etc to boost morale – Translate the human resource strategy to an action plan with a focus on developing local human resources – Expedite recruitment by strengthening and authorizing the General Directorate of Human Resources
  27. 27. IEC/BCC – Hire a short-term consultant to finalize the documents – Reform the department – Integrate the IEC with health care delivery departments
  28. 28. Emergency – Bring the function under one reformed umbrella – Develop general guidelines and instructions – Conduct regular assessment of potential emergencies and resources – Make sure subcommittees exist in all provinces

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