Health planning and services development

Joint MOH/Westinghouse Health Systems PES covers the period 9/80-4/82; no methodology is noted. Results so far have been mixed. The HPU has been established but has not shown a capability for problem-solving or policymaking and seems vaguely positioned within the MOH and largely unrelated to PHC activities. Due to a lack of coordination in the health sector, it is doubtful whether the HPU in its present form will have a comprehensive planning function. Initial forms for managing a health information system have been developed but are yet to be field tested. Health sector evaluations have not yet been conducted; presumably, this output awaits the training of the planning staff. Progress in PHC worker retraining includes two training of trainer courses; development of a PHC manual and a guidebook for physicians in charge of PHC centers and clinics; the beginning of a revision pf PHC training curricula; and the retraining of 65% of nurse assistants at MOH clinics. All PHC personnel should be retrained by the project"s end. An initial survey was conducted for the proposed national health manpower information system, but the MOH has not used or updated the information and the proposed system will not be established. Implementation has been impeded by the project design"s lack of a clear understanding of the linkages between health planning and the different health systems, the MOH directorates, public and private health care providers, and PHC training. Although the project has generated a clearer understanding of what PHC involves, its 3-year life and original input levels were inadequate; at least 5 years is needed in projects such as this. The retraining of PHC workers unexpectedly revealed the inadequacy of logistical, supervisory, and record-keeping support systems, a situation which the MOH made efforts to remedy. Included are six recommendations.