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Assessment of the current state of District Health System Decentralization - P4H Network

Assessment of the current state of District Health System Decentralization

This report presents the findings of an assessment on the decentralized district health system which was carried out by the Ministry of Health and Population (MOHP) between 21st and 31st May 2018. The assessment was designed mainly to measure progress made by District Councils in addressing the health system related problems and gaps identified by the consultants in 2015 while paying attention to the principles of devolution advocated in the National Decentralization Policy (1998) and the Local Government Act (1998) which include the devolution of powers, functions, responsibilities, HR and budgets to the districts; and the promotion of people participation and democratic governance  in health service delivery. Specifically, the assessment was designed to measure the extent to which District Councils are able to manage the fully devolved health service delivery functions and also identify areas requiring further support.
As a contribution towards redefining the roadmap for devolution, MOHP intends to use the findings in this report to develop operational guidelines for the management of full decentralization of the district health system for use by councils and stakeholders. It is envisaged that these operational guidelines will put to shape the process of decentralizing the health system as well as attract the necessary attention and support from concerned stakeholder at all levels.
 
Recommendations
Based on the findings of this assessment there following recommendations are proposed for smooth implementation of a fully decentralized district health system.

MOHP should develop operational guidelines on management of devolved functions to guide council management, staff and all stakeholders and lobby for the required support from the central level

MoLG&RD and OPC should jointly set up a national level decentralization committee to fast-track decentralization issues preferably to chaired by OPC and its secretariat to be based at MOLGRD. The committee should be given the mandate to drive, coordinate and monitor and evaluate devolution as did the Decentralization Secretariat in the past.

MoLG&RD should come up with a well defined IEC/Communication strategy on devolution as there are people out there who do not know much about devolution. Perhaps this could be another mandate of the task force/committee in 2 above.

MoLG&RD and OPC should set up a decentralization specific M&E system to track devolution, provide timely information and organize periodic appraisals, reviews, and feedback to all ministries and concerned stakeholders otherwise many people are in the dark as what is happening on devolution. Perhaps this could be another mandate of the task force/committee in 2 above.

OPC under the Public Sector Reform Programme should provide the necessary and visible drive to guide and facilitate a well defined and phased approach to full decentralization taking into account prevailing problems and gaps in district and urban councils. This is also critical.

MoLG&RD with assistance of other ministries should resume training/building capacity of key council staff on management of devolved functions since some of the are not sure about this aspect.

MoLG&RD, LASCOM, DHRMD should jointly facilitate the filling of key posts on the Council’s establishment e.g., the post of Director of Health and Social Services which has remained vacant over 10 years.

MoLG&RD, LASCOM, DHRMD and related bodies should make a deliberate move realign and harmonize all sector staff and their grades in all district councils in order to create an enabling hierarchy and environment for making and passing of decisions, information flow, reporting, feedback and accountability as well as meaningful public service productivity.

MoLG&RD, LASCOM, DHRMD should fast track the appointment of Director of Health and Social Services in all district and city councils.