LHW Management Review - Oxford Policy Management

Strategic and management controls
4 Strategic and management controls
Key question: Do the management controls of the Programme support the
implementation of the Strategic Plan and PC-1?
4.1 Introduction
The Programme provides an important health service to the poor communities of Pakistan.
Over the past 15 years, the Programme has improved health indicators and increased its
coverage.
To continue to fulfil its purpose, it needs to have the necessary strategic and management
control over its future direction, its policies, and its performance and quality standards. For
the period under review, these controls are outlined in the Strategic Plan (2003–11) and the
PC-1 (2003–08).
A judgement of governance failure to drive key strategic initiatives, and management failure
to implement Phase 2 of the PC-1 was given in Chapter 3. Examples were provided from
evaluation findings of non-compliance with some key policies, and non-implementation of
initiatives that were designed to implement the agreed strategic directions.
This chapter describes the core control mechanisms, the operation of which should have
supported full implementation of the Strategic Plan and PC-1.
4.2 Description of controls
The functions and committees described in the next sub-section are to provide the
Programme with the level of strategic and management control necessary to provide
direction, ensure compliance, mitigate the risk of corruption, manage service delivery, and
strengthen the Programme’s capability for ongoing development.
The Programme is monitored by: the Secretary of Health (and, through him, the Director
General, Health Services and the Deputy Director General of Health and Planning and
Development), the Planning Commission and the Ministry of Finance. 19 The Programme is
also subject to external audit by the Auditor General, and there is provision for an audit
officer to be posted at the FPIU from the Auditor General’s office in order to provide
continuous internal audit.
The PC-1 also specified that there be progress reports that would be prepared by expert
agencies and reviewed by the provincial and federal Health Management Committees.
These reports would aim to review progress against targets, and evaluate the effectiveness
of the strategy. They would be in addition to the two external evaluations planned for 2005
and 2008.
In addition, the Programme has two high-level cross-sectoral committees, the Programme
Review Committee and the Inter-Provincial Committee on Decentralisation. 20
19
The day-to-day interface of the Programme with the Ministry of Health is with the Director General of Health Services.
20
There are a number of oversight and coordinating committees specified in the PC-1. The establishment of such committees
is very typical of how the Public Service operates in Pakistan. Committees can provide a way to facilitate decision-making and
action within the framework of the bureaucracy. Their role is to:
improve collaboration between the Ministry of Health and the federal level of government, and the Departments of Health and
provincial level of government; to improve decision-making and policy development; and
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