Planning for district health services: a review of structures; processes and tools

ABSTRACT

Following the enactment of the National Health Policy (NHP) in 1999 and the Health Sector Strategic Plan (HSSP) in 2000; the district's role health service provision has fundamentally changed. In pursuit of these re-defined roles; the structures and processes that enable the districts balance the often competing top-down demands of the central government with the demands from the communities are usually lacking. The situation is made more complex by inadequate co-ordination of donor assistance and actions of vertical programs and projects. This paper seeks to highlight the different issues emerging in the health planning system at the district level; particularly focusing on structures and processes of planning for the district health services. It is based on the findings of a study focussed on highlighting districts 1. Capacity to ensure equitable provision of services that are relevant to the needs of the intended population. 2. Capacity to ensure efficient use of the limited resources available; 3. Effectiveness of health plans at guiding implementation of planned services. The paper aims at investigating the health planning structures and processes of Uganda with the purpose of identifying and recommending viable actions for improvement. The above criteria were implied rather than strengthening and/or establishing of appropriate structures and institutions for the district health planning. Masindi district was used as the case study district. The study reviewed the district health planning system focusing on structures and processes; using the criteria of equity; relevance; efficiency and effectiveness. The methodology was to review local district and national documents related to district health planning as well as published international literature on related subjects. The paper focuses on key issues affecting the district health planning system ranging from national level policies and strategies to those locally inherent within the district health system and local governments. the issues discussed are the planning; budgeting and information system; personnel and financing of district health services