District Management of Health Services

In close partnership with national and local health authorities, the Swiss TPH assists the strengthening of planning, management and decision-making processes and competencies at district level in low and middle income countries. This entails the building-up of functions in district management teams and their roles with regard to managing local health service delivery.

Building Capacities

To improve performance of health systems at local level and access of people to healthcare services, Swiss TPH works to strengthen processes and functions such as increased responsibilities in planning, budgeting, monitoring, performance appraisal, human resources and facility maintenance. Thereby we give practical meaning to the decentralization processes under way such as demonstrated in several of our long-term projects in Tanzania, Burundi, Chad, Albania, Kosovo and Tajikistan.

Health Information

The collection and use of health information at local and regional level is essential to enhance coordination, decision-making and accountability to the population including vulnerable groups. We strengthen the role and functions of the health information system especially of IT-supported platforms, emphasizing better reporting of key health indicators, processes and information flow, information usage for policy-making and feedback to healthcare institutions and the population.

Enhancing Management

Working plans (or business plans) can be an essential instrument to promote accountability and the autonomy of districts and their primary healthcare services. To improve management functions, we develop and apply tools for budget administration and execution, health information, priority planning and human resource management. Our experiences in Tajikistan, Chad and elsewhere indicate that better management also translates into improved access healthcare services.

Management of Health Services at District Level in Chad

Since 2015, the project aims at improving health system performance and governance as well as access of populations to quality preventive and curative services in two districts of Chad.

Covering a population of more than 100’000 people, the project increases the quality of the offer in respect to mother and child health and nutrition services. In parallel, demand for healthcare in the population is spurred and management and planning are strengthened at district at regional levels.

Intermediate results show that the population used health services more frequently which we anticipate to translate into lower mortality rates of children and women in the midterm. The project is implemented in collaboration with the Centre de Support en Santé Internationale (CSSI) and funded by the Swiss Agency for Development and Cooperation (SDC).

Link to Project

Strengthening Local Government Units in Albania

Due to local government reforms and decentralisation, a number of functions are shifted to local governments across Albania including increased responsibilities in budgeting, monitoring, performance appraisal, human resource oversight, and facility maintenance.

To support this process and strengthen management practices, Swiss TPH assisted the Department of Public Health of the University of Tirana in developing and offering a modular health management course. From 2016 onwards around 20 health managers are enrolled into the course.

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Decentralised Management to Improve Health Workforce Performance

The PERFORM project strengthened district health management teams in all three countries regarding problem analysis, activity development and implementation. Based on research conducted in the nine project districts, workforce performance was addressed through empowerment, increased initiative-taking, team work and collaboration, and application of lessons learnt to other areas.

In Ghana, for example, more regular supportive supervision improved record keeping of community health officers contributing to increased vaccination coverage and reduced drop-out rates. PERFORM was a multi-disciplinary and multi-partner project including Swiss TPH implemented from 2011 to 2015 with the financial support from the European Commission FP7.