Leaders in health are responsible for developing and implementing national health strategies, setting health goals and targets for improving health, delivering quality health care services, and monitoring the population’s health. The health sector is also responsible for ensuring that the policies of other sectors promote and positively impact health.

Governance and leadership is one of the six building blocks of the health system, essential for guiding the health sector towards achieving its strategic vision. However, governance is generally poorly defined and may be difficult to operationalise. The WHO definition of governance and leadership includes “ensuring strategic policy frameworks exist and are combined with effective oversight, coalitionbuilding, regulation, attention to system-design, and accountability”⁴⁶.

Good governance is transparent, inclusive and based on a robust system of mutual accountability. MoH needs solid formal governance structures and processes to lead and engage all health providers and the community in a shared purpose and  vision.

SD1 Outstanding Issues

Governance structure
Since the 2013 reform of the MoH⁴⁷, functions of the MoH have been assigned to several semiautonomous statutory entities with their own governing boards, while the MoH Secretariat, headed by the Minister, is responsible for political leadership, sector stewardship, accountability and performance monitoring.

The situation analysis for the development of the current NHSP noted that there had been no review of the objectives of the 2013 reforms and inadequate clarity around roles, responsibilities and boundaries of various leadership posts and bodies.

Communication, coordination and collaboration
There are weaknesses with the flow of information within and across entities within MoH and communication from MoH to other sectors and the private health sector. There is a need for mechanisms to allow clear and timely communication within MoH and with other sectors and the community.

Accountability
One of the reasons for not achieving desired health outcomes is the lack of accountability in the health sector. Accountability refers to the act of holding public officials/service providers answerable for processes and outcomes and imposing appropriate measures if specified outputs and outcomes are not delivered to the minimum expected standards.

Technical leads develop and submit regular progress reports but do not receive feedback from leadership. Roles and responsibilities of professional councils and entity leadership about disciplinary actions are blurred.

To improve health system performance and achieve desired outcomes, there is a need for all in MoH to be accountable. Formal mechanisms are required to make workers at all levels answerable for professional conduct and performance, focusing on utilisation of resources, outputs, and results.

Accountability also applies to the private health sector, monitored by the PHA.

Leadership should shape organizational culture.

Policy and Planning
MoH has developed many policies over the years; however, less effort has been made to plan policy implementation, review progress and its impact. For the next five years, MoH will assess and understand policy gaps and develop urgently needed policies such as policies on donation and quality of care.

Additionally, mechanisms will be developed to periodically review policy implementation to understand and report on policy failures and successes. MoH will seek buy-in for an inter-sectoral policy platform, to advance the HiAP approach.

Partnership
Health is complex, and efforts to promote better health requires using a whole-of-government and whole-of-society approach by engaging all partners, including the community, private health providers and other line ministries. The MoH will initiate inter-sectoral interventions to advance the health agenda, act as a health advocate while engaging the community in health policy formulation, research and sector monitoring.

MoH’s efforts to promote and protect health can only achieve results when the community is empowered and actively engaged. Despite some efforts, there are still untapped opportunities to involve the community and support citizen and patient empowerment to improve health outcomes, health system performance, and satisfaction with health care.

MoH also works with important global partners, particularly the WHO. MoH, with support from global partners, will work to advance the national health agenda and also to achieve regional and global commitments.

Results-Based Management (RBM)
The government has approved the rollout of RBM consisting of four pillars: Strategic planning, Programme Performance Based Budgeting (PPBB), Performance Monitoring and Evaluation (PM&E) and Performance Management System (PMS).

MoH, like other sectors, needs to establish a performance-driven work culture where accountability for results is continually strengthened. Lead portfolio institutions have been tasked to establish a portfoliolevel RBM Committee to oversee the implementation of all RBM pillars and ensure harmonization of the strategic plan with all other pillars of RBM.

The MoH Secretariat will continue to conduct sector monitoring by tracking and reporting on a set of core indicators annually through the annual health sector performance report; however, sector and entity M&E frameworks were not developed for the previous NHSP.

SD1 Priority Areas

1. Clarify and strengthen MoH governance structures and processes.
2. Improve communication, coordination and collaboration within and beyond MoH.
3. Ensure accountability at all levels of the health sector (public, private and non-health actors).
4. Develop needed synergistic health policies.
5. Engage the community and build meaningful partnerships.
6. Implement the RBM strategy.
7. Drive the quality in health agenda and mobilise high-level engagement for HiAP.

SD1 General Objective

Ensure that MoH governance and leadership has the appropriate structures and processes necessary to
successfully steer the health sector to:

• Provide strategic vision and guidance
• Ensure accountability, effectiveness and efficiency
• Develop and monitor implementation of synergistic policies
• Foster community engagement and build meaningful partnerships
• Ensure cooperation and policy synergy across public and private sectors and civil society
• Monitor performance and achievement of desired outcomes and goals.

SD1 Specific Objectives

View the Strengthen Leadership, Governance and Administration: Specific Objectives

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