Columnists Features

Decentralisation in the health sector – Part I

Decentralisation with COREEN CHOOYE-MVULA
ZAMBIA is among the many developing countries which have embarked on decentralisation reforms of their administration systems in order to improve efficiency in public service and to strengthen local decision-making processes.
Decentralisation of functions to councils is one key reform programme that is currently being implemented by the government, with the ultimate goal of creating efficiency in service delivery.
By now, everyone is familiar with the decentralisation programme and these articles are meant to strengthen information sharing and stakeholder awareness raising in line with the Decentralisation Implementation Plan (DIP).
Reading the previous articles on decentralisation, one may have noticed that these were more general pieces of literature on decentralisation. However, with devolution having commenced by Circular No. 10 of 2014, the Decentralisation Secretariat will henceforth focus on specific sector reforms taking place in each sector within the context of devolution.
In this article, I wish to highlight salient issues in the health sector devolution process in order for the general public to appreciate the implications on assets, human and financial resources as we devolve functions in the sector. The Health Sector Devolution Plan is one of the 10 that were approved in May 2016.
A little background here to the health sector reforms will suffice and serve as a key to link the decentralisation reforms. As we already know, in November 1993, the Government of the Republic of Zambia approved the Public Service Reform Programme with the focus to improve public service delivery.
One of the ways to achieve this was through implementation of decentralisation and strengthening of local government. The Ministry of Health responded to the reform programme and formulated its policy to reform the health sector and officially launched it in 1994. The policy introduced a decentralised system leading to the establishment of four types of health boards, namely the Central Board of Health, District Health Board, Hospital Health Board and Area Health Board in 1995, supported by the National Health Services Act of 1995.
Although the health boards have since been abolished following the repeal of the Act, the management of the health sector has remained decentralised, with the health management teams still in control.
As such, the MoH is among the key ministries including the Ministry of General Education and Ministry of Agriculture that have taken the lead to decentralise functions to councils. The decentralisation undertaken then was by deconcentration. The health sector is now ready for decentralisation by devolution as provided for in the republican Constitution.
To further strengthen service delivery, the government in 2002 formulated the National Decentralisation Policy and launched it in 2004 as one of the ways to implement the Public Service Reform Programme. In order to implement this policy, an implementation plan was also formulated.
The plan, known as the Decentralisation Implementation Plan or popularly known as the “DIP”, comprises 10 components, of which Sector Devolution is one of them. Both the policy and the DIP have since been revised to be in tune with the aspirations of the Patriotic Front (PF) government, which is in a hurry to see that the plan is implemented according to the policy.
The Health Sector Devolution Plan for Primary Health Care (PHC) that was developed by the Ministry of Health and approved by Cabinet Office in May 2016, exemplifies the seriousness with which the government through the ministry attaches to the implementation of the policy, both of which focus on the principle of devolution.
Devolution entails the transfer of authority, specific functions, human and financial resources from central government ministries, departments and agencies to councils – through legal provisions.
In line with the National Decentralisation Policy and the DIP and, as required by the Sector Devolution Guidelines issued by the Decentralisation Secretariat, the Ministry of Health has identified the functions which should and have been transferred to the councils.
It has also assessed the implications or changes that the process of devolution is likely to have on both the Ministry of Health and the councils in relation to policy and legislation, staffing, funding and assets, and organisational structure of both institutions.
It is a fact that the health of individuals and communities, to a large extent, is determined by the environment and circumstances in which they live and operate. These factors include the social and economic environment, the physical environment and the person’s individual characteristics, behaviour and circumstances.
The above factors are commonly referred to as ‘determinants of health’ or conditions that make people healthy or not. These include factors such as the state of the environment, standard of shelter, levels of household income and economic well-being, access to safe water, sanitation and other basic needs, access to essential food and nutrition, levels of literacy and education, social, cultural and religious beliefs and practices.
Decentralisation is meant to further improve the delivery of public health services to eliminate most communicable diseases and to meet the minimum requirements of a healthy human being.
The desperate health situation in Zambia provides an understandable justification to the decentralisation of the primary health care function to councils. The importance of community participation in decision-making in the health sector cannot be overemphasised.
The author is assistant director (communications)Decentralisation Secretariat Cabinet Office
Tel: 0211-226787

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