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Restructuring MoH
The new Minister of Health on Friday announced sweeping changes to the ministry and statutory bodies under its charge. One of the changes was the reduction of directorates from 17 to 7. #Thread.
The new Minister of Health on Friday announced sweeping changes to the ministry and statutory bodies under its charge. One of the changes was the reduction of directorates from 17 to 7. #Thread.
The configuration of the health system has undergone several changes since the early 1990s when the MMD embarked on health reforms.
The IMF and World Bank-inspired reforms included introduction of user fees and the creation of district and hospital management boards, which were contracted and supervised by the Central Board of Health (CBoH), later created in 1995 as an autonomous body.
Western donors agreed among themselves - and sold the idea to the new MMD government - that the health sector would be more efficiently run by separating policy and operations. In a hurry to stamp its reformist credentials, the MMD quickly signed up.
So, CBoH took over operations of hospitals, while MoH focused on policy and infrastructure. But with time, CBoH became more powerful than MoH; it controlled a huge budget as donor funding to the health sector entered through CBoH.
MoH watched as more and more doctors left the wards to do administrative work at the highly lucrative CBoH whose perks the mainstream civil service could only admire.
MoH bosses pinched themselves for buying into the World Bank narrative which created an autonomous body backed by law, whose functions and decisions they could not interfere with without attracting the wrath of donors who were bankrolling the sector.
In July 2004, Mwanawasa announced plans to abolish CBoH and the process was completed in 2006. The case presented to donors was that CBoH was superfluous, and that MoH could manage the sector without an additional layer of monster proportions.
Charmed by Mwanawasa's anti-corruption crusade, donors didn't resist having their highly prized concept abolished and even agreed to fund the dissolution of CBoH.
With CBoH gone, MoH was back in the central role, controlling policy, funding, procurement, recruitments, etc. Districts and provinces now reported to MoH via the already existing civil service chain. The powers were back.
Donors, except the US who don't do direct budget support, now sent their aid via MoH. There was an extravaganza as the sharks circled. By 2009, a major financial scandal blew up resulting in donors who provided 55% of the country's health budget withdrawing funding.
Going by Friday's changes, the new Minister seems to be deploying some gravitas to restore confidence. He has no choice given the scandals he has inherited.
But Honeybee may not be the last scandal to come from the ministry even under the new Minister. Some of the scandals that came to light at MoH under RB actually happened under Mwanawasa except they remained undetected. So, as the Minister tries to clean house, it's possible that
more dirt may well still be under the carpet and in different corners of the house.
MoH is a scandalous entity, going by the record. What the new Minister is dealing with is not new. Even with his bold moves, it will take time to restore public confidence. Good luck to him.
