Swaziland health planning and management project (OPG)

Final PES covers the period 7/83-11/85 and is based on document review, site visits, and interviews with personnel of the MOH and other ministries, government and missionary hospitals, and the implementing agency, International Human Assistance Programs (IHAP). Most of the project"s many objectives have been achieved. A reorientation of policy from curative to primary/preventive health care led to development of a country-wide decentralization plan, under which new Regional Health Management Teams (RHMT"s) have already been established. In addition, the project helped the MOH clarify lines of communications at the central and regional levels, although central-regional communication has not been achieved and roles remain unclear. However, the commitment of key senior MOH personnel to decentralization was uncertain. Lack of involvement of the personnel and finance units in the decentralization process has curtailed development of the necessary management support systems (finance/budgeting) at the regional level. Project TA helped improve the MOH"s management capability by establishing a Personnel Unit, initiating three personnel information systems, establishing procedures for determining needs, and creating 100 new MOH positions for 1985/86 (as opposed to a total of 7 in the two previous years). Inadequate counterpart participation was the main problem experienced by the project. At headquarters level, counterparts either were not brought in soon enough, were away on long-term training, or were unable to work with advisors. In designing institution-building projects and establishing implementation schedules, the target institution"s capacity to absorb TA effectively must be considered; the project"s difficulties may have stemmed not from the disparateness of project objectives, but from the MOH"s lack of personnel. Also, long-term training of counterparts to work with expatriate advisors must be coordinated, especially when the pool of host country individuals suitable as trainees/counterparts is quite small. Recommendations for a follow-on project are provided.