HomeOpinionAccountability imperative in the administration of the health fund

Accountability imperative in the administration of the health fund

The introduction of a national health fund is a welcome development to the people of Zimbabwe who have for long cried for a sound health delivery system.

Muchesa Chatsama

Health is a fundamental human right which must always be prioritised.

It is also, at least on paper, a clear demonstration by the government of its willingness to provide basic and essential services to the citizenry.

To me, this was a long overdue move. One hopes, this time around, there are evidently laid plans for the utilisation of this fund so that it achieves its intended goals. Health is a fundamental human right which must always be prioritised. Health is one of the fundamental pillars of development. Indeed, a country needs health people who can think and work properly.

With a healthy populace the country is truly rich. Once again, a big thumbs-up to the government for this noble innovation.

The old adage, “failure to plan is planning to fail” holds true in many situations.

Lack of serious plans often leads to failure to achieve the good results for which the programmes or policies have been originated. Failure to plan always leads to reactivity on critical national issues. It is always like chasing the wind since no tangible results can really be achieved. What is required is a proactive approach to national developmental programmes.

We need to think through the kind of conditions that we desire for our people, our national institutions and, indeed, our country and then come up with deliberate plans which set forth the desired accomplishments. With this we can then carefully direct and/or lead our efforts towards what we really want to achieve. We will have work cut out for ourselves.

We will know where, when and how we are going wrong within the context of the stipulated plans. We would have defined our path and any detours will be guided by the bigger mission and should happen as a matter of intent rather than by accident.

There are a number of issues that need to be addressed to avoid counting the chicks before the eggs are hatched: What plans directed the establishment of this fund? How was the size of this fund determined? What are the priority areas for this fund and how is it going to be administered? If the plans are there, how do they resonate with ZimAsset, the country’s economic blueprint? Health is under the social services and poverty alleviation cluster which has specified outputs, outcomes and strategies. Surely this initiative cannot run parallel to the country’s principal policy, ZimAsset.

All the above are pertinent issues which must be attended to if we want the health fund to have the intended. With clearly laid down plans, monitoring and evaluation initiatives can be crafted, enabling those tasked with the responsibility to utilise this fund to be assessed on the attainment of the fund’s objectives. It is therefore critical to have a clear vision, mission and objectives for this fund particularly within the context of ZimAsset.

The health sector has a lot of demands as it has been under-funded for a very long time. Drugs, machines, infrastructure, ambulances and even improved working conditions for the health personnel are all demands requiring financing. It is important to note that all these demands cannot be solved at once and in a short time. The first and fundamental principle of economics is derived from two extremes of a continuum, “scarce resources versus infinite wants/need’. This points to the need to set priorities in a way that is most gratifying, in economic terms, “to achieve optimality”.

Where I am leading my discussion is that there should be clear plans for the deployment of the health fund with well-defined milestones over given epochs. With these in place, monitoring and evaluation become easy, enabling constant adjustment of plans to ensure the best possible results are achieved.

Planning, monitoring and evaluation should be ingrained aspects of governance in this country, for both the private and public sectors. There should never be room for the haphazard way of doing things. Without properly defined plans that stipulate sets of deliverables, we would have created fertile grounds for corruption through lack of accountability. Success of any programme or policy is measured against set targets. These targets, in turn, are a result of careful planning, having taken into consideration specific circumstances obtaining.

Any expenditure from this fund must not be arbitrary but rather should follow the dictates of the established plans. There must be clear procedures for the release of these funds. Now we hear Natpharm saying all drug purchases should be done through them and then they will be distributed to health institutions. Is this what has been planned, and is this the most accountable and effective way to do it?

In my last contribution to this column (28 July 2017) I briefly mentioned the need to seriously implement the Integrated Results-Based Management (IRMB). This is basically a performance-focussed management philosophy and approach that identifies the appropriate and timely achievement of results in an integrated and holistic manner. The integrated approach ensures full vertical and horizontal integration of various critical success factors in development planning and implementation. I will continue to applaud the government for opting for this management tool though I have my reservations over its application. It is one tool that, if well executed, can bring forth immense results on national projects and policies. The health fund initiative can reap the desired results if effected through this management tool. My anxiety over the utilisation of the health fund was also expressed by the Health and Child Care Parliamentary Portfolio Committee chairperson, Ruth Labode, who remarked upon the pronouncement of the health fund that, “the only challenge is that the 5% must not disappear and I hope Chinamasa will come up with proper management of that fund so that it is administered like the Aids Levy which went to the National Aids Council. The Health minister David Parirenyatwa needs to consult stakeholders to discuss how that levy can be managed efficiently”. She added that strict monitoring measures must be adopted for the fund.

Community Working Group on Health executive director, Itai Rusike said “What is important now is to ensure the fund is ring-fenced so that it is used for health purposes. The challenge is implementation because government has a culture of indiscipline with funds. We do not want a situation whereby the fund is then used for civil servants’ salaries”. These wise comments must be regarded seriously in all efforts to achieve real results from this proposed fund.

It is my humble suggestion that existing health administrative structures be adopted for this fund. Geographical clusters must be created around major district health institutions which must be tasked with coming up with plans that take into consideration requirements of the feeder centres (clinics and polyclinics) within specified boundaries.

Plans drawn from district centres must then be submitted to the main provincial centre. Finally, the provincial centres will have to submit their plans to the National Coordinating Committee (NCC) for the health sector (which must be created for the purpose). The health NCC must then compile comprehensive fund utilisation plans which must then guide allocations from time to time. Monitoring and evaluation plans must be imperative at all planning levels.

This model, I believe, will bring the much-needed results since accountability will be enhanced. It is also a participative approach wherein all provinces and districts are proactively involved in the health development of their communities.

They will contribute to accountability with regards the fund’s utilisation. As it stands, I do not believe we have put in place strong plans and/or administrative infrastructure to ensure the health fund achieves its noble intentions.

We also require that the fund be audited periodically (half yearly) if possible to ensure possible pilferages are detected early and corrections also done in time.

The time has come for results-based governance. Anyone tasked with managing public funds must do so with integrity. Every penny taken from the public must be clearly and accurately accounted for.

Muchesa Chatsama is the leading organisational development and training and leadership development consultant with ProSource Global Consultants. He is an expert in strategy and policy design. These New Perspectives column are coordinated by Lovemore Kadenge, president of the Zimbabwe Economics Society (ZES) Cell +263 772 382 852 and cell +263 772 382 852.

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