Columnists Features

Decentralisation in the health sector – Part II

Decentralisation with COREEN CHOOYE-MVULA
THE Ministry of Health will devolve primary healthcare to councils, from the district medical office and health centre to the lowest level of health service delivery, the health post.
The specific functional activities or elements of the primary healthcare function to be devolved to the councils are:
1. Control of communicable diseases such as diarrhoea, cholera, dysentery, sexually transmitted diseases (condom distribution), HIV/AIDS, voluntary counselling and testing services;
2. Control of malaria through Indoor residual spray (IRS) and distribution of insecticide treated nets (ITNs);
3. Child health programme (immunisation);
4. All vaccinations including yellow fever;
5. Environmental sanitation;
6. Maternal health (antenatal and post-natal services);
7. Family planning, counselling and dispensing of family planning commodities);
8. Nutrition (demonstrations and food supplements distribution;
9. Health education;
10. Curative services (treatment of common illnesses);
11. Rehabilitation services (physiotherapy, occupational therapy)
Devolution does not necessarily mean that all functions will be moved to councils and as such, the ministry will retain the following responsibilities:
1. General and legislative policy formulation for the health sector;
2. Monitoring and evaluation;
3. Provision of advice to councils on delivery of infrastructure development functions;
4. Quality assurance and setting national performance standards;
5. Maintenance of a strong working relationship with the health services department in the councils.
In the light of the foregoing, devolution will have a number of organisational structure implications on the ministry. At the ministerial headquarters, there will be few or no structural implications when devolution begins because the ministry’s current structure has its own decentralisation policy of implementing activities through provinces and districts.
At provincial level, there will be few or no structural implications for the provincial medical office headquarters now that devolution has commenced.
However, there will be enormous structural implications at district level as all the primary healthcare functions being performed by the district medical offices, health centres and health posts will be devolved to the councils.
The Ministry of Health will have to develop a new structure to accommodate the statutory functions that will remain as its responsibility at district level. Based on the foregoing situation, devolution will have some human resource implications on the ministry.
Implications of devolution on human resource in the health sector will have far -reaching implications on the councils. This is because the majority of the councils, especially the district councils and some of the municipal councils do not have public health services departments and health staff.
Therefore, the implementation of the proposed organisational structure will entail movement of staff (whether by transfer, secondment or separation) from the Ministry of Health to the councils as provided for in the National Decentralisation Policy (NDP).
Appropriate staff will have to be identified and moved to councils in accordance with their devolved functions. This means that the ministry will be left with fewer staff to perform the functions that will remain as ministerial responsibility.
This will in turn result in several other actions, such as modifying or creating new structures in the councils to accommodate new functions. To a greater extent, this has already been done with new organisation structures for councils already developed and approved. In the new council organisation structures, all district medical officers have been devolved to councils, serving now as director of health services within the councils. This was with effect from January 1, 2015.
Another implication is that staff identified for movement to councils will require to be sensitised to prepare them for the movement, whether by transfer, secondment or separation. The Ministry of Health is already on the ground undertaking this awareness raising in order to prepare the officers affected.
The further implication is that councils will have to prepare for the receipt of staff transferred from the Ministry of Health to councils both financially and materially.
Councils will have to recruit new personnel for some posts that are not currently filled or new creations in the council structure that are relevant to the councils.
In terms of financial implication, devolution will create minimal financial implications on the Ministry of Health in the sense that resource requirements in the ministry budgeted to provide primary healthcare are already decentralised and districts receive direct funding from the Ministry of Finance.
Salaries and conditions of service will not have an implication on the Ministry of Health since the remaining functions will be retained by the ministry for purposes of policy direction and coordination, monitoring and evaluation, and provision of technical support and officers will continue to serve within existing prescribed government terms and conditions of service.
Currently, the assets of the Ministry of Health used in units with functions to be devolved include both movable and immovable assets and these will be decentralised as well.
The ministry has an inventory of movable assets consisting of motor vehicles, motor cycles, plant, medical equipment and other equipment, office machines, equipment and furniture of various types in all district health offices, district hospitals and health centres in the country.
The Ministry of Health assets in the districts will be transferred to the councils through a legal instrument or in accordance with the Public Finance Act (Store Regulations Part IX).
Consequently, council assets will increase and with this increase, there will be need to improve the council’s management capacity. There is a likely conflict of pieces of legislation regarding assets management in councils and these will need harmonisation.
It is important to mention therefore that capacity building for councils is a must to enhance the effectiveness and efficiency of operations and should be ongoing from the time the functions are handed over.
The Ministry of Health is mindful of all these requirements and is working to ensure smooth devolution of the PHC functions outlined above.
The author is assistant director (communications)
Decentralisation Secretariat
Cabinet Office Tel: 0211-226787

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