Provider Purchasing and Contracting for Health Services_The Case

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management and planning Decentralization of health system Legislation Policy development Procurement of drugs, medical supplies, equipment Financing • Resource mobilization • Funding aspects addressing placement, distribution, payments (payroll management) Management of the DHBs, HMBs, and others Operational aspects Overall responsibility shifted to CBoH Monitoring, evaluation, and reporting of financial HRH Management of the CBoH Formulation and legislative responsibilities MoH operational roles, and MoH maintained the policy aspects. Decision space was therefore given to the boards on operational aspects of HRH. However, the “delinkage” issue or separation of HRH from the public sector to employment within the boards was delayed and never addressed due to funding constraints. This was identified as a “failure” or a major weakness as “dual” employment of the seconded staff from the public sector was deemed to create difficulties of accountability and control. Basis for purchaserprovider framework and in line with the later National Policy on Decentralization (2003), which seeks to devolve powers to the local government structures with responsibility for health among other areas at the local government level Key aspects of policy assigned to the Permanent Secretary and the Ministers Resource mobilization externally and domestically 12
statements and operational issues in health care financing Policy formulation Operational Overall Mandate Systems development, performance audit, quality assurance, monitoring, and evaluation Commissioning CBoH CBoH as agent Negotiated contracts and commissioned services MoH over CBoH MoH as principal 13 CBoH routinely executed monitoring and evaluation and commenced on functions of accreditation and quality assurance. There were no such assessments and decisionmaking mechanisms adopted or used by the MoH. CBoH assumed responsibility for contracting, fund-holding, and payments, including the final act of disbursement of funds based on contract agreements, to the DHBs, second and third HMBs as well as the other statutory boards. CBoH = Central Board of Health; DHBs = District Health Boards; HMBs = Hospital Management Boards; HRH = human resources for health; MoH = Ministry of Health. In 2004, the public sector health service delivery system was organized into the following levels: • Central Board of Health, operating as the national coordinator of health service delivery • District Health Boards, charged with the supervision of the District Health Management Teams. These managed first-level or district hospitals and a network of health centers. Below the health centers are health posts (which may not have permanent structures), each with a single professional staff member. Health centers have Facility Committees and Neighborhood Committees to encourage community participation. • Hospital Management Boards, the second-level referral hospitals and third-level or tertiary hospitals. These were envisaged to operate as autonomous entities. Although the 1985 medical services provided for the establishment of an independent hospital board at the University Teaching Hospital, the 1995 act extended it to other hospitals. The new organization of the health sector formed the basis for decentralization. Decentralization within the context of health reforms in Zambia has been characterized by delegation of functions, planning, budgeting, management of health services, financial management, resource mobilization, and allocation and control of human resources
Page 1 and 2: The Rockefeller Foundation-Sponsore
Page 3 and 4: Contents 1. Introduction...........
Page 5 and 6: Executive Summary Objective and rat
Page 7 and 8: 1. Introduction Reforms in the heal
Page 9 and 10: principles laid down in the Nationa
Page 11 and 12: In the first phase, the study mainl
Page 13 and 14: where funders of care tend to aband
Page 15 and 16: Following independence in 1964, the
Page 17: • Budgetary reform whereby Distri
Page 21 and 22: Year Key Events/Reforms • Nationa
Page 23 and 24: Ministry of Health is in a stronger
Page 25 and 26: Unlike the pre-reform structure, th
Page 27 and 28: Figure 2: Distribution of health fa
Page 29 and 30: Table 5: Summary of health institut
Page 31 and 32: Table 7: Distribution of beds by pr
Page 33 and 34: ecause there is no direct platform
Page 35 and 36: Figure 3: Distribution of mission h
Page 37 and 38: The memorandum of understanding giv
Page 39 and 40: ased organization; HMBs = Hospital
Page 41 and 42: The Ministry of Health contracted w
Page 43 and 44: Paying the providers Health care pr
Page 45 and 46: clearly specified the obligations o
Page 47 and 48: are drawn. MSL is supposed to suppl
Page 49 and 50: eimbursement process does not diffe
Page 51 and 52: services. Often, private facilities
Page 53 and 54: intermediary for the District Healt
Page 55 and 56: Table 10: Expenditure performance o
Page 57 and 58: Table 11: Contracting revenue for m
Page 59 and 60: managers observed that most of the
Page 61 and 62: ecommended drug, artemether-lumefan
Page 63 and 64: Favorable tax incentives are being
Page 65 and 66: Zambia’s health delivery system t
Page 67 and 68: References Ashton, T. 1998. Contrac
Page 69 and 70:
Walsh K., 1995 Public Services and
Page 71 and 72:
General Hospital - Second-level ref
Page 73 and 74:
Appendix 3: Hospitals by Type, Owne
Page 75:
Southern Province Western Province
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