Table 2 Mozambique PHIT Partnership: Successes, Challenges, Adaptations

Successes

Collaboration and ownership by provincial and district Ministry of Health authorities

Embedded technical and financial support has built ownership of the PHIT activities by health system leadership, which has led to refinements in PHIT tools to be contextually appropriate in design, accelerate the pace of implementation in the province, and provides an avenue for further scale-up.

Scale of implementation

Working across an entire province has directed support to resolve upstream and downstream health system bottlenecks, and reach a large scale of beneficiaries.

Development of sustainable applied research capacity

Project support for the MOH Beira Operations Research Center to meet implementation research and evaluation objectives has built sustainable capacity and led to new funding opportunities.

Challenges

Management and Leadership training

Training curricula focused on capacity building for both management and leadership that are readily available, contextually appropriate and feasible to implement with limited time and resources are in short supply.

Complementary funding

Unpredictable changes in complementary funding have resulted in adaptations to the design and size of PHIT technical support personnel.

Slow, uneven decentralization process

The pace and process of public sector decentralization is unpredictable, challenging project assumptions on how to most define the role of district managers and strengthen their management capacity.

Turnover of key managers

Frequent turnover of district and provincial managers requires ongoing stakeholder engagement and flexibility in programming.

Adaptations

Focus on practical management skills building approach

After initial trainings for district managers, management capacity support has focused on ongoing mentoring to put into action data driven decision making and system improvement capabilities.

Adaptations to the design and size of PHIT technical support personnel

The reconfigured design supports district capacity through teams based the provincial health directorate, rather than five sub-provincial teams that directly supported district managers across the 13 districts.