NEW YEAR KICK STARTING INSIGHTS FOR DISTRICT HEALTH PLANNERS

It is the 9th day of the 365 days in the year 2019. A new calendar year, where many people in different organizations are folding their sleeves to kick start business on a new slate. A lot of organizations are plotting on conducting final evaluations of how they fared in the year 2018 on all fronts, all this in a bid to bring in ideas that would help avert the paths that led to unsuccessful results. On the positive outlook, many organizations are garnering up all the stories of success to help set out another year of positive outcomes as they seek continued organizational accomplishments.

Personal experiences in the Ministry of Health, having been at the helm of Policy, Planning and Health Systems Strengthening undertakings at different levels of the system have given me a lot of insights on how to drive towards and achieve a lot of successes in each calendar year. Ultimately, at the centre of coordinating this success especially at the key level of service provision which is the District, is a Planner. The planning unit has a lot of responsibilities, most important is the bridging of health systems at all levels and over different departments namely Clinical, Information, Public Health, Human Resource, Procurement, Pharmacy, Finance, Maternal Child Health, and Community. These are the key operational departments in a district set up which see to it that services are provided as close to the people as possible. At the helm of the district is the District Health Director, who in principal expects to have full support from The Planner, to ensure all systems, services and departments are functional in accordance to the many policy guidelines accorded by the Ministry of Health. Key to this is a cordial working relationship between the two as in instances where this fails, a lot of system failures are experienced eventually leading to murky performances of other departments.

As the year begins, a lot is at stake in the districts than a layman in health systems cannot see. What is usually interesting is the uninterrupted service provision in Health Posts, Health Centres, Hospital Affiliated Health Centres and First Level Hospitals. In instances where this is mistaken for business as usual even in the Planner’s Office, then the whole year gets messy, unproductive, and wasted. I mean, who does not want new thinking or new ways of doing things to be applied at work at the beginning of the year? It is an undeniable fact that in 2018, DHOs experienced a lot of impediments in the delivery of services, and these need to be avoided in 2019 by all means if we are to improve on service provision. For example, we experienced Maternal Deaths, while screaming in many meetings that ‘no woman should die whilst giving birth’. Of course it is very easy to apportion this problem to the Maternal Child Health Coordinator and Clinical Care Officer, since they are the program officers. However, I would still argue that this is a problem for all and most importantly the planning unit has to coordinate the process that will generate efforts to avert such occurrences in 2019. This is just but an example of how versatile a Planner should be in institutions.

In 2019, periodic guidance/tips/feedback/engagements will be shared to all District Health Planners with a bias to Central Province whose landscape I know properly. Other Planners from other regions can use these and relate to their areas as nationally accepted practices will be the focus in order to fully engage each other as we strive to offer the much needed support in our districts.

In this first issue, focus is on the key areas a District Planner should have on the desk as we start working on health systems and service delivery. In week

1.   Ensure the District, Hospitals Health Centres and Health Posts have well printed, aligned and bound 2019 – 2021 Mid Term Expenditure Framework Action Plans. These should be distributed and with a signing in register to ensure accountability for all the collections of this important document. Ensure you search for other key documents needed as the year begins from all program officers such as registers, cards (bin cards, stock control cards, under 5 clinic cards). In the first or second weekly management meeting, share the need to have these distributed in order to systematically design adopt a process to be used. This will give facility staff full support and guidance importance of these key documents.

2.   Ensure that all departments at the District Health Office extract their activities from the main plan that they will be able to follow in order for implementation to be done as shown in the cost framework and activity gantt chart of action plan.

3.   Design and share a comprehensive schedule for institutional meetings. This could be for the 1st quarter or the whole year. Ensure to adopt the guidance from the Performance Assessment checklist on the key meetings and their occurrence intervals. Then include other key meetings but not appearing in the performance assessment checklist. As you schedule the dates for the meetings, the respective program officers should be consulted and in agreement to avoid imposing timelines on them. This will also help them prepare in advance for these dates which they will suggest. Remember to print and share this schedule to all health facilities and program officers. For all meetings that are attended by external members such as the Maternal Death Surveillance Reviews, share the schedule with involved members. As you disseminated these, remember to have a distribution register. As a Planner, you will have the overall responsibility of ensuring these meetings are adequately prepared for, and are convened not for academic purposes but to deliver their mandates. Key to this schedule is the Finance Committee Meeting is scheduled for a definite week in each month. This will ensure you hold the meeting monthly which is key. For example, you can schedule it on every Tuesday of the final week of the month so that you go straight on to implementation once the funds are received from central government. The composition for each meeting should include Atleast 3 health facility staff who will be attending the meeting on a rotational basis amongst all health facility staff.

4.   Begin sketching your 2020 – 2022 MTEF planning outline for all levels of service provision. Indeed January is a very good time to start brainstorming and making a tentative scheduling for the planning process. In planning, working ahead is key as it gives the system a lot of relief and ease when working. Strategize for community planning activities, which you should commence by end of February. Begin mini preparatory meetings with management with focus for the coming year. Remember to fully examine the 2018 plan on successes and failures and use it as a basis to this fore-planning process. Set tentative dates for all activities and lead all program officers to start departmental cross examination of interventions earmarked for the year to come. This will help you have a good planning process and a good document that you will be able to implement than the hasty ones you have had in the past years.

5.   Sketch your performance assessment and technical support work plans for the year 2019. This should include officers to be involved, the schedule with tentative dates, total cost and transport allocations. In instances where you have inadequate transport, it would be important to engage other government departments through writing officially now indicating your need for help in order for them to plan in advance too. Once you determine the cost, you will be able to get the support on reserving a certain amount of funds in each finance committee meeting towards the anticipated health systems strengthening activities. Engage the human resource department on the leave plan to determine the availability of staff at that period so that those areas requiring replacements can be attended to with ample time. As you do so, scan for areas that came out as strongly requiring attention so that possible literature, mentors, and particular attention can be prepared in advance.

6.   Pan out your district Commitment Ledger in Excel. Yes, the year has just began, start counting every penny spent, but of course for planned activities. Remember, as Planner, you are the Commitment Control Officer for your district. Never let any expenditure take place without your commitment or approval on the form. Use the 2019 Approved Yellow Book and Action Plan to isolate these expenditures according to activity areas, program areas and units. Disaggregate the amounts allocated in the following trends: Biannual, Quarterly, and Monthly. Any activities you decide to spend on as a district should be in the plan, if not, then lead the noble process of meeting as management to discuss the need to which should be documented officially. Avoid deciding on expenditures with you District Health Director as it is improper and leads to suspicions of embezzlement or mismanagement of funds. A template on the expenditure ledger will can be shared on request.

7.   Set out the monthly outreach activities’ comprehensive micro plans. This is one activity that is very important and a lot of resources are allocated to ensure it is fully delivered. Coordinate the finalization of the quarterly or monthly plans to determine the cost and set out the dates for each outreach health post visitation. This will also help on spot checks and planning ahead in cases of fuel allocations, motorbike placements and human resource for this activity. This will help you determine the resources put in this activity, and it will inform future activities, and help you relate the performance of the program against the resources allocated during program performance reviews.

8.   Engage Public Health Officers, Environmental Health Officers, TB Focal Point Persons and MCH Coordinators on all the Community Based Volunteer groups they manage. These are Safe Motherhood Action Groups, Community Based Distributors of Family Planning, TB Treatment Supporters, Neighborhood Health Committees, Health Centre Advisory Committees etc. These are key stakeholders in the implementation of health service delivery as the Ministry of Health is currently focusing on primary health care where community health is being used as the main vehicle of service delivery. These should be properly guided on policy matters regarding their work, reporting tools and tenure of office. Be cognizant of the fact that for each monthly grant, 10% or more should be spent on community and family service activities. Therefore, quarterly activities should be extracted from your 2019 – 2021 MTEF Action Plans.

9.   Map all cooperating partners that are operating in your district. Identify their scope of work, target populations and facilities. Formally call for a cooperating partners’ meeting where health facility staff can be in attendance to fully engage these organizations in order to tap into their support. Identify gaps that they can fill up and pledge total support to their work as this will ease your burden. As a Planner, your key role is to manage partnerships therefore ensure this is stressed with partners in order for you to have a grip and total support on them. Local Faith Based Organizations, civic and traditional leaders should be brought on board in the first quarter too as they are key gate keepers in communities where they wield a lot of power and influence which can be taken advantage of for health service marketing issues. Coordinate and manage all projects and programs implemented under partner support by working as the interface between the ministry and the partners.

Having taken these into consideration, any District Planner is set to begin the year on a high stake. These key areas are pace setters to a fully and well-functioning District Health Office from a Planning perspective.

By Sidney Monze

Health Planner

Disclaimer: The views expressed in this article are clearly the author’s, and do not represent the views of the organization I work for, have worked for, and will work for in the future