Lusaka — THERE is a need to fully restructure the Ministry of Health and its substructures, health permanent secretary Dr Simon Mitti has said.
But Central Board of Health (CBoH) director Dr Ben Chirwa said restructuring the Ministry of Health, if not done well, could lead to massive brain drain.
Appearing before a parliamentary committee for health chaired by Chiengi member of parliament Katele Kalumba, Dr Mitti said the health reforms introduced by the MMD government in 1992 had brought about numerous challenges.
Dr Mitti said successful de-linking of health workers from the civil service to health boards had failed as unions had demanded terminal benefits amounting to K400 billion which the government had failed to raise.
"Despite Ministry of Health having recorded some successes during implementation of health reforms, a number of challenges have emerged which call for strategic refocusing of the core mission of the ministry. Some service delivery indicators are still worrying and thus the need to repeal the National Health Service Act. Before restructuring we need to repeal the act which has brought about problems," Dr Mitti said.
"Failure to de-link workers has led to dual employees who are enjoying conditions of service as they are getting full civil service salary and a top-up as they are working for CBoH. Currently Ministry of Health has no control of operations of health management boards. Central Board of Health has disregarded Ministry of Health because of its being in control of financial resource."
Dr Mitti said apart from a duplication of functions in the health ministry and CBoH, expenditure at CBoH was high compared to what was at times spent in the country's 72 districts.
He said reabsorbing CBoH would enable the Ministry of Health to reduce expenditure at the centre and reallocate savings to the periphery.
"Functions of CBoH will be reincorporated into a directorate of health services with very specific functions within Ministry of Health, and provincial health offices will remain under the ministry's supervision. Redeployment of current board employees into civil service will ensure uniform conditions of service and Ministry of Health will assume all responsibilities of the board of CBoH. The ministry will assume its role as purchaser and health boards as providers through provincial health offices," he said.
Mitti also said the assets and liabilities of CBoH would be adequately addressed in the transitional period.
However, Kalumba wondered whether the proposed restructuring of the Ministry of Health was a failure of health reforms or a failure to reform.
Dr Chirwa said the National Health Services (repeal) bill did not state what would happen to staff and other board related activities.
Dr Chirwa said institutional and financial arrangements in the transitional period were also not clear.
"All board employees serve on three years fixed term contract of employment which does not provide for retirement. It is our assumption that such an employee will be entitled to full salary and gratuity up to the end of contract, leave days, housing allowance and repatriation. Positions in the restructured Ministry of Health will be competitive and thus not all may be retained," Dr Chirwa said.
"It is our fear that this may result in loss of valuable human resource critical to the health sector especially if the issues of salary and retention of conditions are not addressed. This could lead to disruption of health service delivery."