Capacity Development Workshop on Health Systems Development for Regional and Country Office Staff

1. Capacity Development Workshop on Health Systems Development for Regional and Country Office Staff Group II Presentation on Governance May 21, 2007

2. Group Members • Dr. Fatih Abu Mogli – Chair • Ms. Rachida Souissi • Dr. Bothaina Attal • Dr. Besrat Hagos – Rapporteur • Dr. Wim Van Lerberghe • Dr. Amal Bassili • Dr. Werner Buehler • Dr. Joses Kirigia • Dr. Abdul Hannan Choudhury • Dr, Kassem Sara • Dr. Ishtawi Abu Zayed • Dr. Hossein Salehi • Dr. Riham Asady

3. Strengths Economic reform packages implemented - increased public expenditure for health Health policies and strategies in place Forums exist for stakeholder involvement Legislative assembly created Policy focuses on PHC Strategy, Pro-poor Availability of human resources for health Constitution gives authority to the state and local authorities Policy favours access to information Social protection schemes address financial barriers for the poor health Insurance, poverty reduction project Number of qualified public health personnel at federal MOH increasing Financial audit carried out annually Weaknesses Poor implementation of policies and strategies, no clear mechanisms for implementation Inadequate consultation and ineffective coordination of other stakeholders in health services Inadequate technical and sectoral representation in legislative assembly Inequitable human and financial resource allocation, biased towards secondary and tertiary Health Care at Central level Lack of transparency on recruitment, discrepancy in budget allocation and disbursement De-motivated civil service, low salaries, attrition of mid-level Health workers, questionable quality of health personnel training (e.g. in health management) Lack of accountability, no system for monitoring of assets and life styles of civil servants, political interference in day to day activities Poor monitoring and evaluation systems, weak health information system, poor quality of data, data not used for decision making No consumer protection laws , Strengths and Weaknesses of the Health System

4. Problems Poor implementation of Policies and Strategies Inequitable human and financial resource allocation Ineffective Coordination of Stakeholders Lack of transparency and accountability Weak Monitoring and Evaluation System Strategies In-depth health sector analysis Development of a national policy implementation plan Effective implementation of decentralization Formulation of resource allocation models (formulas) Clear guidelines for recruitment, posting, transfers and promotions Establishment of transparent performance evaluation system Establish a sector coordination committee with clear TOR, membership to include other ministries, community, civil society, private sector Empower civil society, consumer protection organizations, the media to act as a watchdog for accountability Establish an effective audit system for financial and technical accountability, including recruitment, transfers etc. Establish an effective M&E and Health Information System with the involvement of all stakeholders Priority Problems and Potential Strategies to Address Them

5. Potential Risks to tackling Governance related problems • Political interference • Resistance to change • Responsibility without commensurate authority

6. Thank You