Decentralization of health services in emrovia for improved performance of health systems
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Decentralization of health services in Emrovia for improved performance of health systems GROUP 1 Background Middle income country with 30m people 10 health regions each with a regional health directorate (RHD) supervising 3-5 provinces

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Background l.jpg
Background performance of health systems

  • Middle income country with 30m people

  • 10 health regions each with a regional health directorate (RHD) supervising 3-5 provinces

  • Provincial health directorate (PHD) supervises: PG hospital, health centres & private sector

  • Three-tier HS: central, provincial & peripheral

  • MoH took policy decision to decentralize health services to better achieve HS goals

  • Issue: How best to decentralize to improve efficiency, equity & sustainability

  • In-depth system review undertaken by MoH & a team of experts


Q1 most appropriate form of decentralization rationale l.jpg
Q1: Most appropriate form of decentralization & rationale performance of health systems

  • De-concentration (of power to PHDs)/delegation

  • Why?

    • 3-tier health system already exists

    • MoH has a clear policy on decentralization

    • MoH has power for deconcentration & delegation but not devolution (which would require legislative action)

    • PHDs have financial, personnel, planning, monitoring, & IT capacities to efficiently manage services

    • PHDs have operational policies & procedures


Slide4 l.jpg

Q2a: PROPOSED EXTENT OF DECENTRALIZATION OF VARIOUS FUNCTIONS

Finance

Central

Provincial

Peripheral

Rationale

Revenue generation

+++

+

+

To ensure equity in financial allocations

Allocation of resources to programmes

++

++

_

More financial authority to PHDs

Power of expenditure

+

++

++

Financial responsibility & accountability to service providers

Line item flexibility

-

-

-

Only MoF has authority to change

Income from fee & contracts

-

-

-


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Q2b: PROPOSED EXTENT OF DECENTRALIZATION OF VARIOUS FUNCTIONS

Information & Planning

Central

Provincial

Peripheral

Rationale

Prepare annual plans

++

++

++

All levels need POAs

Processing & analysis

+

+

+

Each level should collect, analysis & use its information


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Q2c: PROPOSED EXTENT OF DECENTRALIZATION OF VARIOUS FUNCTIONS

Service organization

Central

Provincial

Peripheral

Rationale

Hospital autonomy

-

-

-

MoH does not have powers for giving autonomy

Insurance plans

-

-

-

Does not exist in Emrovia

Payment mechanisms

+

+

+

- No change

- No info on payment mechanisms

Contracts with private producers

++

++

++

All levels to facilitate management of contracts closer to where services are provided

Local programs/norms

+

+

+

Shared responsibility


Slide7 l.jpg

Q2d: PROPOSED EXTENT OF DECENTRALIZATION OF VARIOUS FUNCTIONS

Human Resources

Central

Provincial

Peripheral

Rationale

Recruit staff

+

+

+

Needed at all levels

Dismiss staff

+

+

+

Empower PHD & peripheral managers

Reward staff

+

+

+

Non-monetary rewards

Determine salaries

-

-

-

Set nationally

Relocate staff

+

+

-

Authority to PHD

Performance evaluation

+

+++

+

Best placed to evaluate them

Continuing education

+++

++

+

Concerns all levels


Slide8 l.jpg

Q2e: PROPOSED EXTENT OF DECENTRALIZATION OF VARIOUS FUNCTIONS

Procurement And Logistics

Central

Provincial

Peripheral

Rationale

New equipment

++

++

+

Easier to identify needs at PHD & periphery

Drugs

++

++

+

Incentives for efficient prescribing practise at periphery

Repair & maintenance

+

++

++

Ease of identifying needs & contract management


Q3 essential steps needed in preparation for decentralization l.jpg
Q3: Essential steps needed in preparation for decentralization

  • Step 1: Health services mapping

  • Step 2: Binding ministerial decree establishing authority for decentralization to PHD

  • Step 3: Establishment of a policy and planning Committee

    • Review & disseminate operating policies & procedures

    • Develop & disseminate guidelines for roles and responsibilities (+ToRs)

    • Develop & disseminate an advocacy/communication plan targeting the management, HRH, and public


Q3 essential steps needed in preparation for decentralization10 l.jpg
Q3: Essential steps needed in preparation for decentralization

  • Undertake capacities strengthening needs assessment & develop & implement a capacity building plan

  • Identify potential threats & mitigation strategies

  • Generate & disseminate pertinent research

  • Step 4: Establish a rigorous M & E system.


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    THANK YOU decentralization


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