Political system features
Presidential regime with the same President in office since the 1980’s. Prime Ministers are designated by the President. Traditional chiefdoms.
Leadership in the Ministry of Health
Two Ministers with the same Secretary of State in office. Three permanent secretaries in office and few changes of directors.
Three Ministers, three Director General and changes of high ranking civil servants in health policy and planning units
Tiered health system features
Health system governance arrangements
National ministry of health + inter-sectoral governing bodies for public health programmes. 10 provincial delegations and 143 districts with dialogue structures poorly functional.
National ministry of health + inter-sectoral governing bodies for public health programmes.
National ministry of health + inter-sectoral governing bodies for public health programmes.12 regional directions and 87 districts. Dialogue structures linked to different levels of local governments.
10 regional delegations and 178 districts with municipal leaders holding leadership positions in health district management boards.
Health financial arrangements
User fees under a fee-for-service scheme in government owned facilities. The Government raise some funds from the general tax system and overseas development aid. Civil servants are paid by the central government but also receive bonus based on user fees. Private clinics operate under a poorly regulated fee-for-service scheme.
User fees under a fee-for-service scheme. 98% out of pocket payments. Despite a national strategy to promote community-based health insurance, coverage is below 2%. Rising petty corruption in state owned facilities.
Abolition of the user-for-service scheme in 2001 in government owned facilities. Civil servants are paid by the central government.
Service delivery arrangements
Community health volunteers provide some benevolent primary health care services. Free preventive services in government health facilities. Private clinics operate under a fee-for-service scheme and pharmacies. Faith based and not for profit NGO health facilities operate under a subsidized fee-for-service scheme. Traditional healers and informal health facilities.
Technologies, medicines and vaccines
A national procurement system for essential and generic medicines coexists with dedicated procurement systems for vertical priority health programs (vaccines, ART). Private medicines wholesalers operate under a poorly regulated environment in which drugs prices are free. Private medical equipment firms.
MDGs Indicators (from UNDP, 2011)
MDG 4: under five mortality ratio/1000
MDG5: maternal mortality ratio/100000
MDG 6: HIV prevalence/1000
MDG6: tuberculosis prevalence/100000
MDG6: malaria mortality rate/100000